Overview

A sharp exposé of the roots of the cost-exposure consensus in American health care that shows how the next wave of reform can secure real access and efficiency. The toxic battle over how to reshape American health care has overshadowed the underlying bipartisan agreement that health insurance coverage should be incomplete. Both Democrats and Republicans expect patients to bear a substantial portion of health care costs through deductibles, copayments, and coinsurance. In theory this strategy empowers patients to make cost-benefit tradeoffs, encourages thrift and efficiency in a system rife with waste, and defends against the moral hazard that can arise from insurance. But in fact, as Christopher T. Robertson reveals, this cost-exposure consensus keeps people from valuable care, causes widespread anxiety, and drives many patients and their families into bankruptcy and foreclosure. Marshalling a decade of research, Exposed offers an alternative framework that takes us back to the core purpose of insurance: pooling resources to provide individuals access to care that would otherwise be unaffordable. Robertson shows how the cost-exposure consensus has changed the meaning and experience of health care and exchanged one form of moral hazard for another. He also provides avenues of reform. If cost exposure remains a primary strategy, physicians, hospitals, and other providers must be held legally responsible for communicating those costs to patients, and insurance companies should scale cost exposure to individuals' ability to pay. New and more promising models are on the horizon, if only we would let go our misguided embrace of incomplete insurance.

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Reviews

Compassionate, timely, content heavy, and incredibly well written...After reading it, one hopes that Robertson, one of the true expert voices in health law and policy, continues engineering creative ideas for years and years to come.--Isaac D. Buck Journal of Legal Medicine (11/01/2020) A masterful forensic dissection of the self-imposed plague of health care financing, and options for potential cures. A must-read for all health care students, leaders, and elected officials.--Richard Carmona, 17th Surgeon General of the United States An important addition to a debate that is sure to be front and center in the 2020 elections.--Glenn Altschuler Florida Courier (01/28/2020) Read this important and timely book. Then send it to every politician and health policy wonk you know. Your financial solvency and health depend on their learning what this book teaches.--Arthur L. Caplan, NYU Langone Medical Center In this sweeping and superb book, Robertson exposes the dark side of an appealing American narrative: that giving insured patients 'cost-sharing' responsibilities is good for us all. Exposed reveals that doing so creates problems much bigger than the one it aims to solve.--Michelle M. Mello, Stanford Law School A powerful argument against patient cost-sharing. Through extensive data, international experiences, and a deep dive into theory and philosophy, Exposed convincingly demonstrates that charging sick people is not only a blatantly unfair practice, but one that also has little financial benefit and risks further health impairment.--Thomas Rice, UCLA Fielding School of Public Health Exposed forcefully and persuasively demolishes the shibboleth that the so-called 'cost-share' elements of insurance in the U.S. cut costs and improve healthcare decisions and outcomes. A must-read for anyone interested in making sense of the morass of U.S. healthcare.--George Loewenstein, Carnegie Mellon University

Read this important and timely book. Then send it to every politician and health policy wonk you know. Your financial solvency and health depend on their learning what this book teaches.--Arthur L. Caplan, NYU Langone Medical Center A masterful forensic dissection of the self-imposed plague of health care financing, and options for potential cures. A must-read for all health care students, leaders, and elected officials.--Richard Carmona, 17th Surgeon General of the United States An important addition to a debate that is sure to be front and center in the 2020 elections.--Glenn Altschuler Florida Courier (01/28/2020) A powerful argument against patient cost-sharing. Through extensive data, international experiences, and a deep dive into theory and philosophy, Exposed convincingly demonstrates that charging sick people is not only a blatantly unfair practice, but one that also has little financial benefit and risks further health impairment.--Thomas Rice, UCLA Fielding School of Public Health Exposed forcefully and persuasively demolishes the shibboleth that the so-called 'cost-share' elements of insurance in the U.S. cut costs and improve healthcare decisions and outcomes. A must-read for anyone interested in making sense of the morass of U.S. healthcare.--George Loewenstein, Carnegie Mellon University In this sweeping and superb book, Robertson exposes the dark side of an appealing American narrative: that giving insured patients 'cost-sharing' responsibilities is good for us all. Exposed reveals that doing so creates problems much bigger than the one it aims to solve.--Michelle M. Mello, Stanford Law School

Author Information

Christopher T. Robertson is Associate Dean for Research and Innovation and Professor of Law at the University of Arizona. He also teaches at the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School. Robertson’s articles have been published in leading outlets such as the New England Journal of Medicine and featured in the Wall Street Journal and the Washington Post, and on NBC News and NPR.

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