Dalibor Rohac proposes that patients should bear a greater proportion of their medical costs. However, imposing higher cost-sharing on patients will not curb the explosion in health spending. The vast majority of expenditures is concentrated on a small sliver of patients who hit their out-of-pocket limits, causing catastrophic insurance to take effect and costs to rise.
Instead of raising cost-sharing on patients, healthcare providers should bear financial risk for the cost and quality of care they deliver, because they determine resource allocation. Physicians and hospitals should be financially integrated to incentivize the delivery of efficient, coordinated care.
Rohac is right in that it's absurd for the federal government to let states define the "essential health benefits" package — what has to be provided to patients with affordable premiums — when they don't have to pay. But he is wrong that making patients do co-pays every step of the way will lower utilization. Your doctor says you need a certain treatment; are you going to say, "No, it costs too much so we'll skip it"? How about giving doctors incentives to find the best care for the money.