In many parts of the country, it is illegal to open up a new hospital without a government license. Existing hospitals often lobby to prevent competing hospitals from opening up.
It's not a problem, it's a feature.
In free market health care, those who can't afford care, die.
We as a society have agreed that's not acceptable and hence the regulations, EMTALA being one
Why not have a system closer to food stamps but for healthcare? i.e. the government will cover costs for the poor up to some amount.
We have exactly that. It's called Medicare + Medicaid. The govt fixes the price for what doctors/hospitals can charge on these plans and that's why doctors/hospitals absolutely hate Medicare + Medicaid.
For Native Indians, we also have the Indian Health Services.
For veterans, we have the VA.
That said, you nor I would really enjoy being on a Medicare + Medicaid system.
Having the govt. set rates, getting out of the way and leaving who and how that price gets paid provides the ultimate flexibility and value.
It seems we are on the same page.
Let's assume that that problem was solved tomorrow.
Thanks to that, you now know the regular doctor charges $20000 for the ultrasound while the one upstairs would charge you $100000.
What would you do next?
The issue in the U.S. is the $20000, $100000 fees that is normal here - NO ONE ELSE in the WORLD Pays those rates!
It's the same process to get a ultrasound done in Mexico, India, London, Poland, California - yet the prices are out of what when you introduce the US. into the table of prices (I am only talking about imaging, which is a fairly mechanical and routine process - not reading/interpretation).
Transparency seems like it will help, until you really think about it
> it's the lack of price transparency
I have been working as a software consultant for decades now and always have a menu price ready. The reason why I get referrals is because my menu price quote is very similar to what the client ends up paying in the end unless there is intense customization.
Even with this menu pricing, my customers still need my help in figuring out what they need from the menu because they have a very vague idea of what the solution is going to look like.
They kinda understand their problem, even hurt from it, but they don't know how to fix it properly.
If my customers already knew what they needed to solve their problems, I have 0 value to add as a consultant - at that point, they just need to either hire staff/developers to execute on their requirements.
If I broke my hip today, how exactly would a menu of hip related items help me compare costs?
How would I even begin to know which items from the menu apply to my situation without having some idea what is involved in fixing a broken hip?
Do I need a MRI? XRay? Both? Which sections of the hip? We even have not started on diagnosis.
Price transparency is only useful when one knows exactly what is needed.
You pretty much have to be a doctor to shop prices unless you're doing an elective surgery where time is on your side and you can do some research as you wait and shop.
I'm not sure anyone's doing price comparison when their wife's on the delivery table and has just had some complications.
He could do that because now even he can see the prices and that doctor doesn't have too much of an incentive to send you to be fleeced by someone else
There are some details where this would need to be worked upon, but it sounds like the kind of thing the free market would figure out.
Every problem, including death can be solved if enough effort is put into it. The question is which problem is worth solving.
The problem of price transparency is just not worth solving - because the main issue people have with healthcare in the U.S. is the price.
No one complains that they got better after going to the E.R.
People complain that they got their wages garnished by a collection agency after going to the E.R.
Shopping for the cheapest price might feel like a solution, but if you really think about it, it's really not.
> You would a primary doctor (at a known rate) who would say "You need X, Y, and Z now" and then refer you to a reasonably priced location
A few questions:
1. What does the primary physician gain out of telling you that and that too for a known rate which will likely be less than what they can charge for an actual medical consultation? Who pays for it? It's not an office visit - it's a "pricing consultation" and no insurance currently pays for "pricing consultation". They pay for medical necessity visits. Even if you paid for that out of pocket because you have liquidity/cash on hand, which most of the U.S. does not, the primary physician has only so many hours in the day and their time is definitely better served seeing someone unwell/running a fever than helping you haggle pricing.
2. NO primary physician is going to tell you specific procedures of what a specialist is going to do. First, they don't know how. Second, it does not make sense for them to. Maybe they can give a rough idea what you might need. Try asking your primary physician what ointment to put on your rash. Unless they are your childhood buddy, you get a referral to a dermatologist. Even the, they will highly recommend you see a dermatologist (or right now, a lab test because COVD19 can express as benign rashes).
3. We still have not addressed the core issue of why something that costs "EUR x" in most of the EU costs "EUR 500x" in the U.S.
The problem of why something in the U.S. costs 400x of what it does in other countries even after accounting for subsidies, is a problem far worth solving.
Take a look at the stupidity around getting a authorization to test for COVID19, and realize that this is not a aberration.
Obviously it won't work for non-elective surgery.
An example of how bad the current system is:
When my wife was pregnant and needed an ultrasound, her regular doctor was busy one month and recommended we go to the doctor upstairs. Our regular doctor charged us $200 for the ultrasound, the one upstairs sent us a bill for $1000!
This 5x price difference was in the exact same building, just a different floor!
Hospitals benefit from keeping the prices obscure, to the detriment of the rest of the country