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Why Our Health Insurance Is Incomplete and What Can Be Done about It

Christopher T. Robertson

ISBN 9780674972162

Publication date: 12/17/2019

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A sharp exposé of the roots of the cost-exposure consensus in American health care that shows how the next wave of reform can secure real access and efficiency.

The toxic battle over how to reshape American health care has overshadowed the underlying bipartisan agreement that health insurance coverage should be incomplete. Both Democrats and Republicans expect patients to bear a substantial portion of health care costs through deductibles, copayments, and coinsurance. In theory this strategy empowers patients to make cost-benefit tradeoffs, encourages thrift and efficiency in a system rife with waste, and defends against the moral hazard that can arise from insurance. But in fact, as Christopher T. Robertson reveals, this cost-exposure consensus keeps people from valuable care, causes widespread anxiety, and drives many patients and their families into bankruptcy and foreclosure.

Marshalling a decade of research, Exposed offers an alternative framework that takes us back to the core purpose of insurance: pooling resources to provide individuals access to care that would otherwise be unaffordable. Robertson shows how the cost-exposure consensus has changed the meaning and experience of health care and exchanged one form of moral hazard for another. He also provides avenues of reform. If cost exposure remains a primary strategy, physicians, hospitals, and other providers must be held legally responsible for communicating those costs to patients, and insurance companies should scale cost exposure to individuals’ ability to pay.

New and more promising models are on the horizon, if only we would let go our misguided embrace of incomplete insurance.


  • Read this important and timely book. Then send it to every politician and health policy wonk you know. Your financial solvency and health depend on their learning what this book teaches.

    —Arthur L. Caplan, NYU Langone Medical Center


  • Christopher T. Robertson is Associate Dean for Research and Innovation and Professor of Law at the University of Arizona. He also teaches at the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School. Robertson’s articles have been published in leading outlets such as the New England Journal of Medicine and featured in the Wall Street Journal and the Washington Post, and on NBC News and NPR.

Book Details

  • 256 pages
  • 6-1/8 x 9-1/4 inches
  • Harvard University Press