Published Pricing Healthcare

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Now that many of us are paying the first few thousand dollars out of pocket it would be nice to have the right to know what the prices are before we make purchases. Problems in healthcare evolved over time but now we have the rare chance of a do-over. This non-partisan petition would be to require all health related prices be published so they are no longer secrets of your insurance company or provider.

But before we reform US healthcare again let’s review ALL the problems.

1.       Lack of cost transparency to consumers.

2.       Lack of quality transparency -- period.

3.       Scarcity of insurance carriers serving local markets (low selection).

4.       Market skewed to favor being part of an employer group over individuals.

5.       Limited insurance portability when leaving employment.

6.       Cumbersome billing methods and poor error tracking and auditing abilities.

7.       Costs of administration and collection from uninsured and under-insured non-payers.

8.       Cost shifting from Medicare and Medicaid and uninsured to the insured.

9.       Lack of robust provider network for Mcare and Mcaid patients and “Marketplace” policies.

10.   Medical malpractice insurance costs and costs of the practice of defensive medicine.

11.   Medical conditions arising while uninsured or under-insured (pre-existing conditions).

12.   Lack of clear test of what level of careis a universal human right (at public expense), regardless of cost or ability to contribute to payment.

13.   Partisanship over who can take credit for national healthcare (or blame for lack of). One party is invested in the ACA and the other is invested in its repeal. Some may place party politics as the highest priority, preferring a systemic failure to political loss. Perpetual partisanship hurts us all.

Is there a solution to all the problems?

Yes. 

The ACA’s marketplace was a near miss with a good idea. We can utilize the ACA concept of a national web portal marketplace and make it a national publishing register of every provider, insurer and maker’s prices. This is transparency “on steroids.” The effects would be:

1.       To allow any national insurer to enter any local market by eliminating the need for individually negotiated contracts in order to maintain a workable provider network, as is done now.

2.       To make every provider’s network reach nationwide.

3.       Allow ease of access of any health provider, no matter how new or small, facilitating startups and expanding consumer choices.

4.       Allow consumer shopping, utilizing easy price visibility.

5.       Simplify consumer decision making.

6.       Remove the market advantage given to groups of insured over individuals.

Markets not only need price and quality transparency but regulations to create the right incentives and keep everyone honest. The following additional regulations would do that:

1.       Expand Health Savings Accounts to allow payments of premiums with an annual contribution cap according to age. This would allow us to replace employer-chosen/employer paid plans with consumer chosen plans, paid out of personal accounts, funded by both individual and employer.

2.       Continue the ACA’s idea of standardized tiers but consolidate the standards of coverage of each tier while expanding the tiers to include levels of quality as well as levels of deductible. This allows one to choose what level of coverage quality and self insurance to lock in.

3.        The reason I say lock in is because pre-existing conditions would not be covered except to the level already insured for when the condition is realized. Someone with a high deductible or low quality coverage would not be able to upgrade a policy without paying a premium asked for by the insurer. But once upgraded they could never be dropped.

4.       Standardization also allows easy continuation of policies taken over by new insurers from a failed insurer through a regulated resolution auction.

5.       Anyone without insurance, whether they could not afford insurance or could afford self-insuring, would be billed the same rate. Upon non-payment in 90 days the bill would be submitted to the IRS for collection according to pre-set forgiveness criteria. Everyone would pay something even if it came out of other government assistance. This mitigates waste. Medicaid would be repealed. Instead, all providers would follow a floor coverage protocol for the uninsured, giving a truly universal coverage since no enrollment is necessary.

6.       A national quasi-governmental cabinet would set the level of coverage for the uninsured, high enough to meet human rights, low enough to encourage paid coverage. The self-insured could negotiate with advance deposits on procedures, which is already done. High HSA balances could facilitate this.

7.       Use ACA codes to allow patient feedback on every billed procedure with code specific relevant metrics and have it published on Healthcare.gov as an anonymous statistic on every provider and product. The statistics would be valuable to every potential patient, doctor and medical scientist.

8.       Change Healthcare.gov to a privately leased portal provider to continually innovate for fast and relevant production of costs, feedback ratings and other info to be available 24/7, including on phone apps.

9.       Offer retirees a choice in lieu of Medicare to have deposits to HSAs so they could continue their private insurance and established doctor.

10.   Offer long-term care and disability also on the online portal, so they too could benefit from easy cost information and published feedbacks.

Here is a link to Q&A details of a proposed plan that would do all this:

https://drive.google.com/file/d/0B84Ov8Kg0YQUVGljWndJbUxIbmc/view?usp=sharing



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