Sep 10, 2020 crunchicrant -

Healthcare market – how to fix it

The healthcare market is a mess of protections, government interventions & regulation and market information imbalance and oddities, which conspire to make it dysfunctional. This is, irretrievably, a heavily regulated market and it is, incontrovertibly, not working for the American people – exhibit A:

Crunchicrant is unhesitating in proposing further regulation to try to fix it, (but would be open to any other approach).

Crunchicrant’s course of therapy

Pricing clarity:

– Every health provider must be required to publish a list of prices for each of the services (procedures) and products (including drugs) it offers.
– That price must be the price charged to all buyers (whether insurance companies, or government or individuals, or combinations thereof – eg insurance and individual sharing a cost).
– Providers shall not be permitted to make ‘off list’ price adjustments.
Federal government shall publish a list of prices that it will pay for each procedure that it funds: same price for all federal programs Medicare, Medicaid, VA, military and civilian employee and retiree.
– Providers must collect any excess price over that funded by federal government, from individual patients or supplemental insurance plans subscribed to by the patient – or pay a penalty.
– A service and price information industry should be encouraged to enable patients to obtain information on satisfaction of past patients with a health provider, and to compare prices of health providers, within relevant regions.

(As a point of reference, there are a little over 10,000 CPT (Current Procedural Terminology) codes – each a distinct procedure used in medicine and together a comprehensive listing of all such procedures, used by insurers to determine pricing and reimbursement: most providers, specialists, will offer only a fraction of this number.)

Pharmaceuticals:
Government should be allowed to:
– Negotiate a price that it will cover for patented pharmaceuticals
– Contract directly with generic drug makers to manufacture patent expired drugs (those manufacturers should be encouraged to produce more than needed to fulfill the government contract and to market the surplus to the private market – at the same price charged to government).

Insurance:
– Insurance should be required to be bought and paid by the patient, out of taxed income.
– Insurance companies should be required to market a basic plan which covers, say, 90% of federal government allowed costs (these would be standard between insurance companies allowing easy and meaningful comparison of pricing) – and optional supplementary plans that cover higher service pricing (for those Americans who wish to access premium providers or insure away ‘co-pays’).
– Patients must pay the gap between a provider’s service charge, and insurance covered charge, out of pocket.

Uninsured (“indigent”) patients:
A market system does not handle fair and compassionate treatment of indigent patients well. (Fair to provider/compassionate to the patient).
In a market system, we must, as a society, be willing to step over the metaphorical body in the street, and go about our business: to do otherwise admits moral hazard, makes it easy for an individual to not obtain insurance and rely on rules surrounding care of indigents.
(If we are not willing to do this: we should opt for a universal healthcare system like the rest of the world: it is, evidently, cheaper too.)

Assuming we do not opt for a universal healthcare system, and that we as a society do want some sort of safety net for indigent patients, Crunchicrant supposes that there are a limited number of acute conditions that must be treated no matter the patient’s ability to pay, and that for each, there is a protocol – involving one or more CPT classified procedures – required to treat those conditions so that the indigent patient’s overall condition is stabilized.
In the interests of fairness, Crunchicrant advocates for a system where each healthcare provider does an accounting of the pro bono work for indigent patients that it carries out, and that there is then some mechanism by which some proportion of its foregone revenue (limited to the minimum protocol) is recouped from the healthcare system, either as a levy on insurers, or on healthcare providers (or both).