Paying the ‘sick tax’

Since insurance spreads the risk of major costs over a large population, it has been said that “Insurance sets the law of averages to work for the common man.” But insurers have found a way to mitigate this benign effect. Many of us, if we are ill, encounter large bills for medication or hospitalization. We assume that these would be covered, after paying premiums promptly for years, but we then encounter a surprise. We are on our own each year until we have paid a “deductible.” This can be $1,000, $3,000 or even $5,000.

Large deductibles do decrease premiums. So an insurance policy can seem to be a very good deal. And it is, so long as you don’t develop a disease, or have an accident. Then you find that you are on our own — until you have paid that deductible. In short, the low premium is a very good deal if you stay healthy.

With the onset of disease, however, your insurance will not help till the deductible has been paid. The deductible is really a “sick tax.” It applies only if you are sick and need care. Therefore patients whose insurance policies include deductibles often avoid preventive care, or do not fill prescriptions. This is hazardous, and adds to the already astronomical cost of health care.

It would be better if insurers did not levy the sick tax. It would not cost us much individually if the deductibles were absorbed by a small increase in the bill we all pay. Then we would indeed set the law of averages to work for the common man.

Steven Wolfson, M.D.

Guilford