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I'm supportive of price transparency, though it's limited by a number of factors: 1) the majority of health spending is on services that aren't shoppable, so this has no impact on them; 2) spending in any given year is concentrated on a relatively small segment of the population, and those folks will hit any reasonable out-of-pocket limit, again rendering this useless for them; and 3) the percentage of the population that doesn't have enough money saved to cover an unexpected $500-$1,000 expense is staggering--it's like two-thirds of the population or something. All of which make price shopping for health services more challenging.
1) the majority of health spending is on services that aren't shoppable
I'm curious how you've come to this conclusion. Please, inform me.
If you think of the larger expense procedures, such as surgery, those things are scheduled inside of a day, unless in an emergency life threatening situation. Aren't the follow up procedures and care, where even greater costs are, more so over the longer course of time?
2) spending in any given year is concentrated on a relatively small segment of the population, and those folks will hit any reasonable out-of-pocket limit, again rendering this useless for them
People stop shopping if they hit the out of pocket limit? Why would they? Because they think that someone else's paying for it? Even if they see the true costs involved?
Well, maybe they do, maybe they don't.
3) the percentage of the population that doesn't have enough money saved to cover an unexpected $500-$1,000 expense is staggering--it's like two-thirds of the population or something. All of which make price shopping for health services more challenging.
I suspect that this is unfortunately the case. But I also think that some of this lies at the feet of people who do make bad life decisions, and I don't think that society should be held, at the point of the government gun, responsible and liable for those bad decisions. Its part and parcel, and the cost of, having the freedom to make those decisions. It comes with responsibility.
And it's logistically difficult to implement under the current system. As you pointed out, prices are the results of contract negotiations between insurers and providers. Which means there is no set price for a service, it will depend on who your insurer is and what price they've negotiated. And that's usually considered proprietary information anyway.
If any sort of pricing competition is going to enter into this marketplace, if the true excessive padded cost are going to be bent downward, open pricing information is going to have to be part of it. Perhaps legislation that prohibits this information for being proprietary? Forcing these pricing deals out into the sunlight to disinfect it?
Expanding public coverage is already a major component of the ACA. That's what the Medicaid expansion is.
There was a proposal back in 2009 (and resurrected in the campaign last year by Hillary Clinton) to also allow older adults under age 65 to buy into Medicare but that was defeated.
Whether you force the public costs of caring for those that can't care for themselves out into the sunlight, or you continue on hiding them in the shadows, isn't the reality that these costs are going to be paid by the greater public one way or another? My vote is to make those costs and that pricing public, out in the open, and in the bright sunlight.