I think insurance should be turned around and should reimburse the patient, not the provider. Specifically, if I go to a hospital, I should get a bill from the hospital that does not depend on my insurance status. My insurance can pay some or all of it pursuant to the terms of the insurance. Whatever they don’t pay is my liability. If the insurer and hospital cooperate, the insurer can pay their share before my bill is due, and that’s all.

On top of this, medical providers must disclose the full cost structure of any non-emergency service up front and get my initials, just like auto mechanics. Emergency services should be strongly regulated.

The goal here is to have price transparency where it matters: with the patient, and to prevent insurance from corrupting the market.

Abusive medical consolidation like we have in the Bay Area won’t happen, since there would be no benefit for providers to merge to improve their insurance contracts.

As evidence that this could work, look at dentistry. Every dental provider I have ever encountered can tell you, in advance, exactly what they will charge. The prices are not insane the way non-dental medical prices are. And there are no surprise bills in dentistry.