Perhaps single payer wouldn’t have been taken off the table by Obama in his deal with the insurance companies & drug manufacturers.

Perhaps “reimportation” of drugs from Canada — resulting in lower prices — would have been supported.

Perhaps allowing Medicare to bargain with drug companies for lower prices would have been allowed.

All sorts of good provisions that never made it in to legislation because there was insufficient knowledge and concern over how bad our medical “system” really is.

IMHO things that should not be for-profit (or “nonprofit” in the case here) – schools, jails, basic medical and dental care. The people who work for those institutions should be well paid. The government should provide those basic services to everyone by way of taxes. Anybody who wants to start a for-profit hospital, jail, school, is welcome to. But those services should be available to all as a part of living in a civilized society.

I am so far from an expert on this and no one should ask me for healthcare policy input, but as far as I can tell, the entire individual fee-for-service model of paying for healthcare is broken. The incentives end up so out of line with reasonable decisions and like, actual patient well-being, and “normal” market pressures that might otherwise discourage the worst abuses don’t come into play because consumers don’t have anywhere near the kind of information they need to make informed decisions, whether it’s about pricing, the actual effectiveness and risks of treatments, what their insurance is going to cover, or…anything. Any part of it.

(Not saying it’s not completely fucked up, just the way the logic works…)

Surveys exist that provide national/state fee information for each and every Tylenol and cotton square. This information is reported as percentile ranges. Good billing practice dictates that an institution wants to be in the higher range of these fees, if not above the 100th percentile. So each year, the chargemaster is adjusted. (Usually upwards, but occasionally downwards, if the Fee Reference indicates a drop in price due to something like a generic release or whatever. No one wants to be flagged for possible fraud.) Since this is standard practice, everyone does it. And so the survey shows higher rates and so the chargemasters go higher and then are surveyed and the survey increases and then the charg…. ad infinitum.

So why is it good billing practice? Because the increasing charges are a way to justify an increase in the rates paid by contracted insurers and the government. Each party involved knows good and well than that cotton square didn’t cost $7. They know it cost a little less than the $.17 that has been previously negotiated for payment. BUT if the hospital can show that nationally, the charge for a cotton square has gone from $7 to $7.50, well, maybe they can negotiate a new rate of $.19. Multiply those tiny increases across the board? Suddenly your overall reimbursement rate is up 4% for the year.

Dumb, stupid, painful…you betcha. But not without (arcane, twisted) reason.

Oh and as always: DO NOT PAY 100% OF ANY AND ALL MEDICAL CHARGES. EVER.