“If you shift costs to the patient who has a chronic illness, you can keep costs lower for everyone else.”

Quoted by the LA Times in an article about increasing costs to patients for generic drugs that have not actually increased in wholesale prices.  Stated by Dan Mendelson of Avalere Health, a consultancy firm that studied generic costs.  He found that the insurance companies have been holding down premium costs for Part D Medicare by moving generic drugs from “Tier One” to “Tier Two”, increasing out-of-pocket costs for drugs that have not actually increased in price from the manufacturer.

Isn’t this a contradiction of the idea of “insurance”– spreading out costs to everyone so they are affordable to everyone?  After all, it’s not necessarily the patient’s fault (nor under the patient’s control) if they have a “chronic illness”– like type 1 diabetes, which is caused by genetic factors, not controllable by the patient, yet accounts for a huge proportion of overall medical costs.  Higher costs to the patient for drugs might lead to less compliance– the patient saves pocket money by reducing the use of the medication, which results in higher complication rates and higher overall costs.  It’s an example of how treating chronic illnesses with maximal preventive/treatment measures saves money in the long run by reducing complications– only in reverse.