Health Care and the need for ‘free market’ dynamics

I haven’t posted for a long time, because most of the recent news, trends or policy debates just don’t seem interesting or to move the ball forward.    This op-ed in the Wall Street Journal captured my attention enough to warrant a post.   The title is Health Care and the $20,000 Bruise.   (paywall).   It is a (yet another) vivid description of how screwed up the health care financial/payment system is.    The physician op-ed author describes how the hospital billing department added an unnecessary $10k item to his son’s bill and the many efforts he had to go (reading CMS manual!) to get them to remove it.   Their insurance carrier did not catch it.     My strong belief is that in order to drive value (better health outcomes for the same/lower cost) in health care, there must be the feedback mechanisms of a real and scale marketplace.    That means buyers (in this case consumers) and sellers (providers) need to engage meaningfully in the dialog around value — price, quality, outcome, convenience and more.    The current framework of third party payers — either commercial or govt. — just doesn’t work.   Despite all of the excitement around the movement from fee for service to ‘value-based’ contracts, I suspect it is going to take consumers getting involved to make a real difference.    It is not going to be easy — for either the consumer or the system.      I know I have been personally spending a lot more time on my medical bills, EOBs, HSA payments and the limited value I receive from my health plan — but I will save that topic for a later post