There's something that's always bugged me about the idea of injecting market incentives into the health care system as a check on patients' consumption of services. As far as I understand it, the idea goes like this: if patients have to bear more of the cost of their health care, they will decide to purchase the combination of services that is most economically efficient for them. People will go to the doctor when they need to, they will stop getting unnecessary tests and treatment, and the overall costs of health care will go down.
The problem is in the assumption that people should consume health care services the way they consume other goods. Take shoes. Say I have two possible shoe insurance plans. With Plan A, I pay a flat fee (copayment) every time I visit a shoe store, but while I'm there I can pick up almost all the shoes I want. For the really really expensive ones, the Manolos whatnot, I have to convince the shoe shop owner that I really need them. But if I can prove that I need them, I can have them, and it'll only cost me a fraction of the price. With Plan B, instead of paying a flat fee, I have a shoe deductible, so that in one year I have to pay for the first $1000 of shoes I buy. But, if I end up needing lots and lots of shoes, the Plan will cover much of the cost over the first $1000. Having to pay that first $1000 out of pocket is going to be a big deterrent for buying shoes, so I'll almost certainly consume a lot fewer shoes on Plan B than on Plan A, and then only the ones that I need, rather than the ones that are just really pretty. Plan B is therefore minimizing my shoe purchasing costs.
With health care, on the other hand, there's a big difference between the cost of primary preventive care (a check-up, an HIV test) and the cost of catastrophic care (pregnancy, cancer). There's also the link between the two, such that consuming the right amount of primary care can reduce your consumption of catastrophic care: getting a patient to exercise and stop eating butter and shrimp when they come in with high cholesterol is much cheaper than hospitalizing him for a heart attack. High-deductible plans put the cost of primary care on the patient but cover the cost of catastrophies. What kind of incentive does that give to the patient? If I have a cold, and I have to pay for my doctor and my meds out of pocket, I'm more likely to wait until I have pneumonia before getting treatment.
The incentives are backwards! We want people to get primary care. We want everyone to go to the doctor at least once a year, to go to the dentist at least once a year. Some healthy people should do more: women should get annual pap smears, pale people should get annual skin check-ups. This care should be free, or at least very very cheap. And I'm sorry, but $500 a month in health insurance premiums is not cheap.