Editor’s Memo

Skinned in the Health Care Game


Peter Wehrwein

By some accounts, Warren Buffett coined the phrase “skin in the game.” In business, it makes sense. Having your own money on the line might make investors more willing to trust you with some of theirs.

Putting cutaneousness in the contest also has some appeal when it comes to health care coverage and costs. The thinking is that if people have to spend their own money on health care services they will shop around for better deals.

As Richard Mark Kirkner, the contributing editor who writes our Legislation and Regulation department, discusses, HHS Secretary Alex Azar is pushing for price transparency. Now add in some user-friendly quality data and out-of-pocket costs (a health care version of skin in the game). Azar and many others believe that’s the formula for empowering American patients and bringing the value revolution to American health care.

But there’s a problem—actually, many of them.

Senior Editor Timothy Kelley’s cover story examines how high drug prices affect people’s decisions to take them. He spoke with Jalpa A. Doshi, a University of Pennsylvania researcher who has studied medication “abandonment”—when the insurer has approved the prescription but the patient doesn’t pick it up. Not surprisingly, abandonment goes up as out-of-pocket costs increase.

One response to high drug prices has been the proliferation coupons. But they shift the cost burden to payers—putting pressure on premiums and public payer budgets in the process.

Geisinger has started sharing price information with prescribers so they are more aware of the financial impact of their prescriptions on their patients. Doshi has the sensible idea of averaging out medication costs over the year.

These are solid, pragmatic approaches to the problem.

But really, what is the point of health care priced and covered in such a way that Americans don’t—or can’t—use it? Seems like something more fundamental needs to change.

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By Peter Wehrwein