If we want the free market approach to work, we need to make it possible, easy even, to make informed decisions among competitors.
But fixing this is increasingly feeling intractable, and this pushes me further and further towards believing a single-payer (maybe not exactly, but that's the buzzword) system is the better fix.
Likely not going to happen purely out of complexity if nothing else. Look at the list of ICD procedure codes[1] and imagine all of these with a price attached. Comprehensive, sure, but comprehensible? Ehhh.. pushing it.
"Hey, we'll do CPR, but that'll will be $100, please sign here so we can save your life".
The ala cart method seems like it might work until you start thinking about the logistics. If someone goes to a doctor complaining about chest pain, do we really want them to leave because an EKG and blood test are going to cost $200. No matter how much the doctor explains to them "You might be dying" plenty of people will walk out of the hospital once the bill is presented. In some of those situations, that's going to be deadly.
By the time the anesthesiologist came around, I was drifting in and out of consciousness -- no way to ask if they were in-network. (They weren't, by the way.)
This isn't an uncommon scenario, and one where price transparency isn't really going to help.
Also, what am I supposed to do, decline the services of an anesthesiologist and request an in-network one? What if there isn't an in-network one on duty? What if they're busy? if I need a surgery now, what choice do I have?
Sure I can shop around and do a bunch of research for something that I know is coming up, but when the out of network specialist drops into my wife's hospital room as she's having an asthma attack and can't breathe I don't have the temporal luxury of vetting how much that particular specialist is going to cost out of pocket and can I please have one that's in network.
And we didn't even take an ambulance to that ER. When I had my motorcycle accident I was definitely not given a choice of which ER I was being hauled to - they stuck me on a back board and away we went.
The issue isn't just transparency it's also coverage. We can get the menu of prices from the hospital but the specialists do their own billing so won't be covered on that - you're back to an "MP" on the menu.
Even if it's a non-emergency, getting the prices up front will cause a lot of people to chose to either go untreated or to delay treatment until a problem becomes far worse.
Just having prices available does nothing to improve the costs. People with type 1 diabetes know the cost of insulin. Has that prevented it's price from moving to levels that many can't afford?
It doesn't matter if the costs are known up front when drug manufactures end up with patent help that allows them to gouge. When medical devices are often produced by very few manufactures. When hospitals enjoy local monopolies.
The thought that the only thing missing from keeping medical prices down is the price tag is just absurd.
If statistics about refused services were kept, we could see where the various providers are pricing in-demand services out of reach of those who need them. Or conversely, what services were advised above and beyond actual need.
We could see pressure on providers to bring costs in line with the benefits of each code/procedure, and the ripple effects could help reduce the premium->insurer->provider cost overages for everyone.
Mind you, I still believe single payer will be the eventual end game, but this could be a solid step in the right direction.
Why would it? They can literally just raise the price and those that have insurance are going to get it which ultimately covers the loss in those that refuse service due to price. That ultimately is reflected to the customer in the form of higher premiums which they pay regardless of whether on not they get EKGs.
Further, with less people getting services it really is as simple as cutting nursing, doctor, and lab staff because there isn't as much demand.
It may make a difference if the market was completely unregulated and insurance didn't exist at all. In that case, some guy could do EKGs out of his van at a much lower cost.
However, that's not the market we have. Doctors command high salaries and we've regulated that only those with medical licenses can practice medicine.
Medicine is not a free market and it's a bad idea to ever make it one. There are already major issues with unlicensed quacks selling placebos.
I believe the Trump administration is addressing this:
https://www.hhs.gov/about/news/2019/11/15/trump-administrati...
https://www.hhs.gov/about/news/2020/10/29/trump-administrati...
> The rule requires that most health plans and health insurers not only provide easy-to-understand personalized information on enrollee cost-sharing for healthcare services, but must also publicly disclose the rates they actually pay healthcare providers for specific services.
> Through a shopping tool available through their plan or insurance company, consumers will be able to see the negotiated rate between their doctor and their plan or insurer, as well as the most accurate out-of-pocket cost estimate possible based on their health plan for procedures, drugs, durable medical equipment, and any other item or service they may need.
> Consumers will also have access to accurate price and plan information that allows them to shop and compare costs between individual doctors before receiving care, so they can choose a healthcare provider that offers the most value and best suits their medical needs.
But it'll be another couple years before it's all implemented it seems