Session 2: Discussant

Tomas Philipson, PhD, says historical reform efforts in the United States have raised doubts as to whether or not the implementation of the Affordable Care Act will slow health spending growth. “The problem with spending growth,” Dr Philipson says, “is that it's driven by medical innovation. These reforms are not designed to deal with medical innovation. Medical innovation is driven mainly by global innovation incentives.“

Dr Philipson also suggests that concepts of value-based insurance design must be considered differently when managing a chronic condition like diabetes. He reasons this is due to 3 factors. The first is that there is no risk for over overconsumption of diabetes prescriptions—if anything, under-usage is likely. Second, diabetes is a chronic disease, meaning most patients are not newly diagnosed and they therefore are merely continuing existing health treatment plans. Third, and most importantly, Dr Philipson argues that insurance design needs to be coupled with altruism.

“Health economists wrongly believe that low copays lead to moral hazard, which has the implication that Medicaid should raise copays,” Dr Philipson said, “But that's crazy because the reason we have low co-pays in Medicaid is because we basically have altruistic motives that want to stimulate consumption of people.”