This is the year.  Until now, I have put off addressing various physical issues that paid me a short visit and then decided to stay.  So I am in the midst of scheduling an array of visits, tests and procedures for restless legs, varicose veins, a colonoscopy and a minor surgery.  In the spring, I check in with my physician about blood pressure; in the fall, I have my one-year followup with the dermatologist.

That is in addition to my quarterly retinal scans and yearly injections of 2 mg of Eylea™, a drug that costs me $3000 a dose.  This works out to be $42,524,250 an ounce, just a trifle more than the $41,965,424 annual compensation of Leonard S. Schleifer, M.D., founder and CEO of Regeneron, the outfit that makes Eylea.  Schleifer is the highest-paid biopharma executive in the U.S.  He is now a billionaire and I (eye) helped put him there.

I have a hunch that Leonard S. Schleifer, M.D., doesn’t think much about his health insurance deductible when he needs medical care.  But I do.  The way our system is designed (and I use that term loosely), it pays to defer care until there is enough to do in one calendar year to satisfy one’s annual deductible and out-of-pocket maximum.  Many people don’t have the luxury of timing their medical needs — and those people wind up paying more.

I selected a high-deductible, high out-of-pocket ($10,000 maximum) policy, which is still available thanks to President Obama’s famous line: “If you like your health care plan, you can keep it.”  It’s not so much that I like my plan, but it makes the most financial sense.  I did the math: for any given amount of medical care I might need in 2016, I would pay the least in premiums and total out-of-pocket costs with the highest-deductible plan.  It is just the way policies are priced.  The sooner you want an insurance company to start sharing your costs, the more you will pay in monthly premiums — but you are unlikely to make up the difference in terms of overall benefits.

The problem with health insurance in the U.S. is that all plans create perverse incentives, depending on the deductible and out-of-pocket figures.  For example, an insured person has no incentive, once the out-of-pocket maximum is reached, to limit his demand for health care for the rest of the calendar year.  In fact, one who is close to his out-of-pocket limit has an incentive to accelerate care so that its marginal cost is shared by the insurer.  On the other hand, high deductibles force people to decide between seeking care and doing without, which puts the burden on the individual as to how much his or her quality of life is worth.  This is unfair.  One’s health and life expectancy should not be subject to how deeply the notion of frugality has been ingrained into you.

It may be impossible to devise a health care system that cannot be gamed by consumers, physicians, hospitals or drug companies.  But our goal as a nation should be to implement a system that delivers the greatest health benefit in the most efficient way.  To be efficient, we must tackle fraud, abuse and predatory pricing in all corners of the health care system, and end this nation’s simple-minded fixation on throttling consumer demand by way of the insurance industry.

Who, after all, wants to be sick?  Who wants to go to the doctor?  You don’t, and I don’t.  In the long run, insurer-based disincentives to seeking health care (such as deductibles) have a perverse outcome of their own: by making health care seem precious and desirable, they counter our natural reluctance to even enter the health care system — and they all but invite cynicism and gaming behaviors.

I would not be surprised if Medicare Part E (for Everyone) would reduce the demand for health care, once our citizens were assured that good, affordable care would be available to anyone when it is needed.  In the meantime, we play these games.

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Insurance companies are run by smart people.  They know that some of their subscribers will lump medical procedures into the same calendar year so that the insurer pays a larger share of the cost.  What they don’t know is whether I plan to do it.  They’ll soon find out:  this is my year of living deductibly.