Throckmorton,
I’m making you a write-in candidate for the next Secretary of Health and Human Services.
Not only do you “get it,” but you explain the issues amazingly well.
We have to sit down for beers some day.

All well and good for pre-existing conditions, but what about the new ones? When I learned that I had ovarian cancer, how long should I have spent researching hospitals before scheduling surgery? I know that cancer isn’t an emergency but mine was very aggressive, so a month’s delay could have meant the difference between stage II and stage III.

I’m not surprised that residents of a small town know who the best orthopedic surgeons and OBs are, but I’m a Bostonian. There are 27 hospitals within 15 miles of my house; comparing them all would take far more time than comparing a handful of orthopods or OBs serving a small town even for me, and I work in health care so I have a lot of resources at my fingertips.

I’m not making excuses why it shouldn’t matter; I’m pointing out that regardless of how much it matters, most people simply can’t get it because they lack the substantial time and/or resources needed to find it.

What do you think would happen if the government did compete with auto insurance? I believe that Medicare and Medicaid should also reimburse the patient, not the provider. Lets allow the patients to see how their Medicare trust fund money is spent.

One thing I found interesting about your post was this:

“It is also important to know how insurance companies work. Most if all the money they take in has to go back out in services. They make money on the intrest they make while holding your money. For an insurance company to make the most, it has to be the middle man for the most money. This is done by having the most people pay the most for their care. ”

Couple thoughts. One, it’s not necessarily interest, but it’s investments with the float (see Warren Buffett’s annual letter to shareholders for a readable explanation, as insurance is Berkshire’s true cash cow). Often insurers actually lose money when you just look at premiums in v. admin costs & paid claims. That’s part of the business model few realize. You could tell how few physicians knew it as one of their bases for tort reform in the last “crisis” was that X insurer paid $1.30 for every $1.00 they took in, and therefore insurance was unaffordable and their rates were jacked. The truth is payouts were steady, but the float income had declined with the recession. That’s what really mattered and caused the “crisis”.

Point is that people paying the most for their care doesn’t necessarily make the health insurer the most money. Investing wisely does, although it helps to have a larger premium pool to scale up the returns. To get that larger pool, insurers will often underprice premiums. Which works until the returns on the float fail, and voila “crisis”! Where do they make it up in a down economy? Jacking premiums. And again, we may be saying the same thing in different ways about insurance.

The one rub, the elephant in the room, with putting your proposal, which I largely agree with, to work, is that the government is in there paying 1/2 of all healthcare costs. GEICO (Berkshire company), Allstate, State Farm don’t really compete with the government for car insurance.

The payor does not have to change, the payee does. With car insurance you can go and get estimates. The insurance company then sends you a check. You then go and have your car fixed, if you are lucky you can find a good deal and not have to spend the whole amount. Sometimes you want better than the insurance will pay, so you pay extra. This is how health insurance should be for nonurgent care. The patient should shop around and be the one who ultimately has to be responsible for the bill. Right now the insurance customer is not the one negotiating the charges. You have to keep the client and the money together.

It is also important to know how insurance companies work. Most if all the money they take in has to go back out in services. They make money on the intrest they make while holding your money. For an insurance company to make the most, it has to be the middle man for the most money. This is done by having the most people pay the most for their care. In this way the insurnace company gets the most money in intrest. It is not in their best intrest therefore for costs to be cheaper. If they are, they have to take in less money and therefore make less in intrest. This fact is not lost on our politicians who have long realized that the private insurance has offset the nonviability of Medicaid and SCHIP.

Long and short, have patients be the ones that pay the bills, have pateints be the ones who directly have to send money to their health insurance company, and have patieints be the ones who try to get reimbursed. By doing this, you will have commercials on every channel like GEICO, ALLSTATE, etc trying to get your business and you will have doctors, hospitals and clinics advertising discount colonoscopies.

I am suprised that you couldn’t find out prices. We quote prices everyday to cash pay patients. In our area you can call to any number or places and get a price for a cash pay chole, lumlam etc. These include facilty fees, anesthesia and surgery. The only resource needed is a phone or an ability to send an email.