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Mish Health Care Proposals

Published fees: Providers should be prohibited from charging different amounts for their services to insured patients versus non-insured payment. Fees for routine services, medicine, rooms, and operations need to be published, not set by government mandate.

Shopping Around: People should be encouraged to shop around for the lowest cost provider. Under my proposal, insurance providers can allow certain amounts for specified services, and give that allowance to the insured. The insured can then shop around for the best provider. Insurers may even consider rebating the insured a portion of any savings on their next insurance payment.

Foreign Services: Low cost plans should be allowed to require foreign operations for hugely expensive operations for those able to travel.

For example, Bloomberg reported Heart Surgery in India for $1,583 Costs $106,385 in U.S. Demand treatment in the US? Fine. You should have to pay for it. Obviously, this provision does not apply to emergency services like an accident, or to a heart attack.

Insurers should cover travel expenses for the insured and spouse for stays longer than 10 days.

Drug Pricing: There should be a price schedule for drugs. Pharmaceutical companies should not be allowed to charge less to overseas buyers than US buyers. There can be volume discounts but they have to be across the board. Medicare and Medicaid should get the same volume discounts as everyone else. This idea will end the drug import discussion.

Medicare/Medicaid: Medicare should be no different on foreign care or shopping around. Right now, those over 65 simply do not care much what things cost. Incentives are necessary to make sure they do. This includes forcing overseas treatment for those able to travel.

Pooling: More pooling seems welcome. But I fail to understand one phrase: “so long as the organization does not condition membership on any health status-related factor.”

Is age a health status-related factor? If not, we are going to see pools based on age.

Also consider a pool of those enrolled in college. How many people would take a class if it saves them a bundle on insurance? This idea may require much more thought than was covered by Paul.

Right to Die: No one should be kept alive if they want to die. Nor should someone be artificially kept alive if they do not have insurance, or their spouse or designated appointee wants to pull the plug on someone’s behalf.

Right to Refuse Service: If someone is not insured, hospitals should have the right to refuse service.

Patent Restrictions: Patent laws need to be revised to prohibit making minor changes and renewing patents for extended periods again and again.

Mish Synopsis

My proposals provide significant cost savings opportunities forced on drug providers, allowed by hospitals, allowed by insurers, and encouraged by insureds.

I invite doctors, insurers, and others to chime in on my proposals. Hopefully, we can quickly come to a solid consensus on a majority of these ideas and get them into the hands of President Trump and Senator Paul.

Addendum

Some people questioned my word “standardized”. I am not proposing government sets a price. I am simply saying there cannot be a different price for the same procedure for blacks than whites, or insured vs not insured. I do not propose all hospitals have the same price. I just want them to have a posted price. No more, no less. When you buy an item at WalMart, it has a price. The price is not set after you walk out the door. Nor does one ever pay $100 for an aspirin.

One can argue government should stop Medicare, Medicaid, etc. Ideally they may be correct. But forget it. It’s not going to happen. I am shooting for realistic proposals that may make a huge difference in bringing down health care costs.

Addendum Two

Published fees revised from “People without insurance should not have to pay more for services than people with insurance. Fees for routine services, medicine, rooms, and operations need to be standardized.”

The new wording more accurately reflects my original intent. Thanks to reader “Fitz” for parts of the revisions.

Mike “Mish” Shedlock

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