In a rational world, deductibles and copayments serve an economic purpose.  Where it is appropriate and desirable for patients to make choices (e.g., primary care, small-dollar services), out-of-pocket cost sharing allows patients to bear some or all of the costs and reap some or all of the benefits of the choices they make.  Where patient choice is not appropriate or desirable (e.g., on a hospital gurney, large-dollar services), we would not expect to see cost sharing.  At least these are the principles that govern other insurance markets.

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