• Quote: Uwe (Need I say more?)

    [T]he often advanced idea that American patients should have “more skin in the game” through higher cost sharing, inducing them to shop around for cost-effective health care, so far has been about as sensible as blindfolding shoppers entering a department store in the hope that inside they can and will then shop smartly for the merchandise they seek. So far the application of this idea in practice has been as silly as it has been cruel. [...]

    In their almost united opposition to government, US physicians and health care organizations have always paid lip service to the virtue of market, possibly without fully understanding what market actually means outside a safe fortress that keeps prices and quality of services opaque from potential buyers. Reference pricing for health care coupled with full transparency of those prices is one manifestation of raw market forces at work.

    -Uwe Reinhardt, The Journal of the American Medical Association. I thank Karan Chhabra for the prod.

    @afrakt

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    • Yes! Let’s attack the opacity of pricing. Let the hospitals post their prices: X for Medicaid. X+this for Medicare, X plus some more for this insurance, X+ even more for that insurance. 7X for no insurance.

      • Depends upon how much lead time you have to make the decision. If I’ve got many months then maybe transparent pricing works but if I need help today or next week then posted prices are irrelevant. If it’s an immediate need then I’m going to pick a provider a trust and hope for the best. If it’s a truly acute problem then I may not even be in the position of picking a provider.

        Related link:
        http://jaredbernsteinblog.com/attention-health-care-shoppers/

        • ” If I’ve got many months then maybe transparent pricing works….”

          When one thinks about the complexity of transplants, the possible (likely) complications, and the lifetime follow-up care………..

          • > “When one thinks about the complexity of transplants, the possible (likely) complications, and the lifetime follow-up care………..”

            Yes, good point.

    • Another manifestation of a free market would be competition. At the moment, doctors can have people arrested for trying to compete with them without the proper doctor approved credentials.

      It’s easy to extol the virtues of a free market if you’re insulated from a free market.

      • So we should induce competition by removing the barrier to entry that is the license to practice medicine, the one that requires you to actually be a trained, knowledgable doctor before practicing medicine?

        You do know that we used to have that system right? Only about 100 years ago? Back when hospitals were where you went to die, and medicine actually saved very few people?

        There was a reason, a very good reason, that we established that regulatory barrier to entry.

    • Opacity, plus barriers to entry = Margin.

      Efficient Markets Hypothesis 101.

    • I would love to read this article but it is for JAMA members only and behind a pay wall. If anyone could help out it would be great.