Wow – a whole post based on my one comment! You shouldn’t have! But I enjoyed it – thanks, and now I have some follow-ups.

First of all, I totally agree with you about the pricing system, having recently had a baby in Dallas (with insurance, thankfully). Looking at the bills was almost comical, seeing what the hospital wanted to charge and then seeing the negotiated insurance rate. And had we found ourselves uninsured at that point, I would have made advance preparations for a cash-payment delivery at a local hospital – I would have shopped around.

However, isn’t it true that most health procedures are not planned for? If I have a heart attack, or get injured in a car accident, it’s too late to shop around for the best deal at a hospital. I want to go to the closest ER and get treatment ASAP. See, I disagree that health care works the same as all other commerce in a free market system precisely because people can’t shop around. No one is calling hospitals asking about their prices for stitches in case they ever need stitches. Or an appendectomy. I’m not sure competition would win out because I do not believe health consumers are primarily motivated by price.

Furthermore, if everyone had insurance then no one would get gouged by the ridiculous hospital rates, right? You seem to imply that everyone deserves to pay the negotiated rates, and I agree. I also think everyone should have insurance, all the time.

Now about the PPACA. In my mind, greater access and coverage is in itself an improvement for our health system, seeing as how the U.S. ranks well below other industrial nations for health coverage. If you look at the individual states in our country, Massachusetts is ranked near the top for many health categories. They have near universal coverage, the lowest infant mortality rate and more primary care physicians per capita than any other state. The health reform that got them there looks very similar to the PPACA – in fact, PPACA was based on it.

And how can you say it had little to control costs? PPACA will do more to lower Medicare costs (the primary driver of our long-term deficit problem) than anything has since the Balanced Budget Act of 1997. It has several cost-controlling provisions, like payment-for-care instead of fee-for-services, advisory boards, and some other experimental things that couldn’t be counted financially but could end up saving tons of money.

It is a balancing game where you are trying to control costs and also increase the number of physicians in the pool. One would seem to counteract the other, so I can appreciate the difficulty. And I will be the first the say that PPACA is not perfect- not by any stretch. But it seems a credible first attempt that will actually improve healthcare in America by improving access and beginning to reign in costs. But how could you possible scrap PPACA – which will provide access to millions more Americans – without a credible alternative?

Looking forward to your responses…and thanks for the discussion.

I enjoy reading your blog and your perspective, and as a fellow Texas I understand some of the issues with getting reasonable health insurance for a family that meets basic needs. I’m interested in what you think would bring about “transparency…cost reductions…and plans available to all at reasonable costs”? Do you think Congress had impure motives with this legislation, or are you just skeptical that it will actually improve healthcare in America? If the latter, can you point to a legitimate proposal you like that might be more effective?

Thanks,
Tyson