"Most people who defend deductibles and co-payments argue that these devices give patients incentives to make better decisions. But, if that is the goal the means to achieve it are too crude and too weak. In the case of the deductible, the incentive to economize vanishes once the deductible is exceeded. In the case of coinsurance, the incentives are incredibly weak. If I have a 10% copayment, my incentive is to consume care until it's worth 10 cents on the dollar to me. At 20%, my incentive is to consume care until it is worth 20 cents on the dollar. Can't we do better than that?"

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