Why well-insured patients should demand value-based insurance benefits.

VARIATIONS ON THE FAMILIAR REFRAIN “COSTS SHOULD not factor into decisions about health care” permeate contemporary discussions on the state of the US health care system. The US populace seems to strongly agree with this proposition: a 2003 poll indicated that 86% of US citizens do not support the denial of health services for reasons of cost. A significant part of this resistance can be attributed to the general feeling that health care services are a special good, the provision of which should not be “unfairly” influenced by costs. In particular, patients with good health benefits often suspect they personally have nothing to gain—and much to lose—by integrating costs into coverage determinations. These beliefs are short-sighted and mistaken. Health insurance coverage uninformed by cost considerations already poses harms to insured patients and will pose an even greater threat as health care spending soars. All US citizens, even those with excellent health care insurance, should demand value-based insurance, in which health benefits are designed to reflect the underlying ratio of associated costs and benefits for the services covered.