AV's recent inpatient surgery experience - she had a cervical dystectomy (relatively common neck surgery) - reminded of how fundamentally flawed our US healthcare system is. Almost every industry/market that's "efficient" functions on some basic common principles/dynamics: Customers make purchasing decisions based on cost, quality and service and producers/companies compete on the basis of these 3 core product/service "differentiation" dimensions.

Let's take the retail industry as an example. Walmart is all about being low cost and has build a business model that continuously wrings cost out of the entire supply chain for the goods they sell. A store like Nordstrom on the other hand tries to be more upscale, so it competes on service and to a lesser extent quality (by carrying brands perceived to be higher quality). And Louis Vitton, Tiffany, and other luxury brands compete largely on quality only (with quality being defined as a combination of style/perception, brand value, material, cut, etc.).

The key to the above tradeoffs occuring, of course, is information (transparency) about the 3 differentiating dimensions, particularly quality and cost....to enable consumers to evaluate different companies and make their decision based on what matters most to them. But none of this is possible in healthcare - an industry that is almost a fifth of US GDP!

In healthcare, you make a decision with no idea of what it will cost you and really no way/system of getting such a cost estimate without significant effort. And quality is an entirely different matter. Where cost is difficult but not impossible to assess, quality is. There is absolutely no data available to consumers to help them understand the experience level and output/performance (aka "outcomes" in healthcare) of the doctor they choose to go with. And did I mention there's no systematic way of finding a doctor that meets your needs? The whole system of finding a doctor is primitive - you ask around to see if anyone you know (including other doctors one might know) have a recommendation (which is again, largely based on perception/reputation and not facts).

I am definitely a believer that government led investment in infrastucture is a key tool to help get the US out of the current economic crisis (while making sensible investments which will pay off and are required for our long term health). I would love to see the Obama administration address some of the issues above to help get the US healthcare industry more nimble, competitive and no doubt efficient.

2 women walk into a hospital with acute stomach pain. One is a highly paid lawyer at a top law firm who is covered by her company’s health insurance plan and the other is a working class American without health insurance. Both women get the exact same diagnostic tests and medical care, and both stay in the hospital for the exact same number of nights. Do the two women pay the same amount for the health care they consume (in total, including payments made by the insurance company on behalf of the lawyer who has health insurance)? Likely not, if the above happens in the USA.

Does this make any sense? I believe the answer is clearly no….and yet this unfair practice has been allowed to go on for decades….and is still going on today. The reason for this is that insurance companies in America directly negotiate “bulk pricing” directly with hospitals and other healthcare providers. This pricing is usually significantly lower than the “list price” of a product or service. However, when an individual (e.g., uninsured worker, foreign national, etc.) who is paying for their health care expenses out of pocket walks into a health care provider, they pay the “list price”. It’s ironic that this leads to price discrimination against the same (generally poorer) individuals who couldn’t afford health insurance in the first place.

So here’s a simple solution for ending health care price discrimination in America: Mandate that every hospital or health service provider can only charge uninsured individuals the average of the pricing they have negotiated with their health insurance companies. This would eliminate much pain and suffering….and right a basic wrong in our health care system today.

November 1, 2008 Update:

Today, I received an "Explanation of Benefits" Statement from my health insurance provider which I think proves my point above:

Service Date: October 16, 2008
Type of Service: Outpatient Services (a generic term to say this is for a minor outpatient procedure performed about 2 weeks ago)
Total Billed (to health insurance company): $5,665
Patient Savings: $4,767
Coinsurance Copayment Amount: $89.80
Claims Payment: $808.20

In other words, the total cost to the insured party (in this case me) and the insurance company was $898...or 16% of the amount billed. So we saved $4,767 for only one reason: we had the insurance company negotiating with the provider, auditing the bill etc.