My wife and I recently had a little girl. Until that moment I had never been exposed to the healthcare and insurance ecosystem. I have been fortunate. I’ve never had an extended stay at the hospital, I’ve never been on prescription medication, and as an adult, I have never been to the doctor outside a checkup. Now I realize that the system is completely convoluted and non-transparent.
From what I can tell there are four major problems with the healthcare and insurance mechanisms.
1. Prices for healthcare services are unavailable, non-existent, or not published.
2. There is no crowd-sourced ratings system for hospitals (think yelp for hospitals).
3. Since everyone is insured no one cares about cost. This has resulted in higher prices.
4. The people have no power to control the quality or cost of the healthcare services.
These four problems ultimately result in a system that is too expensive, low quality, and where the people have no power to do anything about it.
Here are my proposed solutions:
1. Pricing for healthcare services are unavailable, non-existent, or not published.
Require all hospitals post itemized prices for their goods and services. Every procedure should have an itemized “menu” outlining what the procedure may cost. Since any given procedure is highly variable the menu should include “average cost”, “best case”, “most likely”, and “worst case” scenarios.
The menu should also include things like bandages, medication, and anything else a hospital could use to inadvertently pad the bill. Great hospitals should even consider hiring a “budget specialist” who discusses costs and options with each patient.
These menus should be posted online and available before he procedure. This will allow individuals and insurance companies to shop around for a facility that meets the individuals’ need. This will also drive prices down since hospitals will be forced to compete based on price (or provide superior service to justify higher prices).
I would not eat at a restaurant that didn’t post prices so I should not have to receive healthcare services without prices either.
2. There is no crowd-sourced ratings system for hospitals (think yelp.com for hospitals).
There should be a crowd-sourced ratings system for hospitals. In my opinion this would have been a much better investment than healthcare.gov. When hospitals are forced to compete for business based on price and services the consumer benefits. Prices will ultimately fall and service will rise.
For example, in Atlanta there are several major hospitals in the metro area. For most procedures I have no idea what a service cost or who the best service provider may be. I usually just go to the closest major hospital. I imagine most people do the same thing.
A rating system would enable a consumer to quickly and easily search for a service provider based on thousands of consumer ratings. Ultimately a sick person cannot choose if they want to go to the hospital, but they can choose which hospital they visit. The power of consumer choice based on good information will ultimately force hospitals to compete.
3. Since everyone is insured no one cares about prices. This has resulted in higher prices.
The third major problem I see with the healthcare system are insurance companies.
Healthcare prices are so complex and expensive (for reason listed above) that no one can or wants to deal with it. We defer all responsibility to our insurers. Now, with the implementation of the Affordable Care Act (Obamacare) we have no choice anyways. Ultimately this leads to a system where no one cares about prices because they will be paying the same insurance premium regardless. But this is a false premise.
Because no one cares about prices and live under the illusion that their costs are the same there is no incentive to seek more cost effective solutions. People rarely look at their hospital bill and pay whatever the insurer requires. This ultimately leads to higher healthcare costs and higher healthcare insurance premiums.
Healthcare insurers should provide incentives (lower insurance premiums) to individuals who shop around for better prices and value. This would ultimately lower insurance prices and force hospitals to compete again.
4. The people have no power to control the quality or cost of the healthcare services they receive.
The biggest problem with our healthcare system is that the people receiving the services have no power to control prices or the quality of service they receive. The appropriate infrastructure is not in place. All of the power resides with the insurance companies and healthcare providers.
Insurance companies operate as powerful unions who dictate what they will pay a hospital for a given good or service. Insurance companies have large staff who perform complex pricing studies so they understand what people are paying and how much a product SHOULD cost regardless what a hospital charges.
This results in hospitals charging several times market value for a given good or service because they fully expect the insurance company to pay only a small fraction of that amount. Meanwhile: the consumer is screwed, hospitals charge too much, and insurance companies reek most of the profits.
Obamacare has only served to strengthen this broken system by further empowering insurance companies and disenfranchising the individual. Since EVERYONE is now forced to have healthcare insurance this eliminates any opportunity for individuals to negotiate or bargain for themselves.
Ultimately, we live in a system where the insurance companies dictate how much they will pay hospitals and how much they will charge consumers. Meanwhile, there has been no progress toward a system that promotes competition, dives prices down, or leads to better services.