• Shocked, shocked, he is!

    Looks like Uwe Reinhardt had a reaction to the Steven Brill piece that was similar to mine. Go read it.


    • What I’m finding hard to understand is your reaction and some other health economists’ reactions to the Brill article. Instead of saying “There’s a great new article with a fresh take on a persistent problem,” you (and Reinhardt) say “Oh, that’s old news! We’ve been telling you about that for years! Why have you never listened to us?” It sounds like you’re jealous that Brill is getting all of the attention and hanging out with the cool kids.

      We should all be happy that a general-interest journalist (and great writer – let’s face it: it is not easy to keep a reader interested for 26,000 words) and a mainstream news magazine picked up a story that has been largely ignored by the general public and was largely absent in the health care reform debate. I’m glad that people outside of health econ circles are finally talking about this problem.

      • Maybe it’s an expression of cynicism/frustration at the fact that nothing ever changes. I do think something will change on the price gouging front, because there are more people with very high deductible insurance plans who will be at least trying to demand more price accountability.

    • SAO

      You are correct…HSAs coupled to high-deductible health plans represent one of the fastest growing vehicles in the industry—up from just a million beneficiaries in 2005 to >11 million in 2010, and still climbing. Interestingly, large employers are now the largest sponsor of HSAs/HDHPs, in contrast to 2006 when they only accounted for a tiny portion. The trajectory approximates that of 401(k)’s in the late 70’s. A key question is where HSAs/HDHPs will exert their buying power first. The presumption is outpatient services, where rapidly expanding venues such as retail clinics, workplace clinics, concierge practices and cash-only practices could serve as early adopters.

      But let’s keep this to ourselves! We don’t want to upset all those central planners who are doing such a fine job of creating robust sector economies. Or challenge their belief that the Federal government can cobble together a high-performance bureaucracy to oversee the creation of a high-performance health care system. After all, the Federal government is doing such a fine job of it elsewhere.

    • People who adopt HSA’s are a self-selected group of relatively careful shoppers. So they will have some ability to avoid price gouging on outpatient care.

      But quite a few people with high deductible policies have no HSA savings account whatsoever. They forced into high deductibles because they are older or just broke.

      They have no interest in and no experience in shopping for health care. In the 1970’s they would have been in union health care plans with no deductible whatsoever.

      Plus, one can find numerous articles about relatively sophisticated patients still getting battered by hospital billing departments after emergencies.

      So all in all, I have no faith that the rise of HSA’s will cure the problem of price gouging.

      We need a Consumer Protection Bill that is national in scope. About 6 states do have some level of protection right now, but it is pathetic that this only happens in CA, NJ, IL, MN, CT, etc.

      Such a bill would have a maximum price for one day surgery, one day in the ER, etc.

      Obama would have to come out and really shame some hospital CEO’s. He would even have to put one or two CEO’s in jail when they violated the bill, as some of them will.

      Bob Hertz, The Health Care Crusade