I agree with everything you said up until the very simple solution, David.

Requiring billing transparency is obvious. While simple transparency wont do much about highly complex bills nor emergency procedures, that’s not where we spend most of our money, it’s in the simple day to day prescriptions, medical tests, office visits and non-emergency procedures. People absolutely can compare prescription prices between pharmacies, blood test offices, imaging centers, etc, and they can also discuss the cost/benefit ratios for one drug regimen over another. As for the bill for my knee replacement, I didn’t get one, at all. I would certainly have been willing to analyze the choice of one piece of hardware over another, or one medical center over another, but after choosing my doctor, the process was entirely opaque, so opaque that I delayed the procedure for years to make sure I could comfortably afford the expected deductible that in the end never materialized.

While I agree our private system makes it difficult for businesses of any size to compete internationally against companies who don’t have to directly shoulder insurance costs, I have no desire to grant power over my health to any government no matter how benign. Just read the UK or Canadian papers for almost daily horror stories about government managed health care. BTW, I have Canadian relatives, and have seen repeated clear evidence of care rationing in their treatment. Not to mention that Canadian doctors aren’t even allowed to practice privately. Billing transparency combined with tort reform would go a long way toward lowering the cot of medical care in the US.

You talk about delay, obfuscation, and outright obstruction. Studies show that in fact, medicare/medicaid and the VA all have far higher rates of claims rejections than any major private insurer, routinely delay care, and make access to care a deliberate maze only the most diligent can overcome. I have five children adopted from foster care and run into those issues routinely even though I also carry private insurance.

My viewpoint on the Pharma industry is different, but also biased since I have a relative who manages clinical trial. I will say that the incredibly high costs of bringing lifesaving medication to market are primarily driven by FDA regulations, not profit padding by pharma companies. When you develop fifty promising compounds, run trials for 8 or 10 and successfully bring to market two, those two have to cover not only their own costs, but the R&D costs for the 48 that never made it. Worse, the patent clock starts before you begin the trials, not when the drug reaches the market, severely compressing the timeline to recover costs that are in the hundreds of millions of dollars. Honestly much of the cost of our health care system is the cost of protecting themselves from suit by requiring additional tests or more aggressive treatment, FDA regs that unnecessarily raise the cost of drug trials, and the short patent window. The overhead for those three components alone is astounding, and we get to pay all of it. Lastly, why are so many willing to, in essence, make medical professionals slaves to the state? Seriously. If governments control payments, they are dictating revenue/income to doctors. In Canada, the UK, and other places, doctors are strictly government employees. In the UK, junior doctors are earning less than a US RN. Under Obamacare, doctors are prohibited from owning texting facilities and even hospitals, meaning the professionals with the greatest knowledge of a market aren’t allowed to address market needs. Numerous hospital projects were cancelled soon after the law was enacted, to little fanfare, but over time, it’s going to greatly lessen choice in care for all of us. There’s also a drive to force doctors to become practice/hospital employees, driving family doctors out of business and reducing the incentives for anyone to attend medical school.

I’ll close with this. A kid who becomes a plumber’s helper at 18, works his way up to a master plumber and opens a little business will have a higher lifetime income than someone who devotes more than a decade to medical school and becomes a family doctor. What have we wrought?

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