Transparency and the Free Market

I went for a hike with my good friend Dave today.  We discussed healthcare, politics and religion.  Dave and I come from different places when it comes to these topics.  We both trust each others motives and values, so it always makes for an interesting discussion.  Dave's suggestion regarding how to fix healthcare revolved around two talking points that he's heard from some of the pundits.  We're going to hear a lot about these concepts in the coming months as those who are against Medicare for All try to propose alternative solutions to our broken healthcare system.  The two major talking points are transparency and the free market.  These two goals sound great, but they prove that simple solutions are not that simple.

The idea that price transparency will transform healthcare makes sense at a certain level.  If we understood where the money goes and who profits from every healthcare expense, we might be better able to evaluate the merits of that expense.  Unfortunately, the transparency discussion tends to focus on making prices themselves transparent to consumers.  This is not only misguided, but it's also impractical.  There's no way that a consumer is going to achieve substantial benefit from price transparency. Certainly not in an emergency situation, and probably not in most complex medical situations.  Transparency must exist at a different level, one where we see the financial benefits of specific healthcare expenses to the entities that are responsible for their delivery. We need to evaluate these benefits with the actual benefits of the care delivery itself.  For that, we need better outcomes measurements and evidence-based literature.  We're a long ways away from obtaining such data.  I'm not against transparency, but you can be sure that the health insurance, hospital, and pharmaceutical lobbyists will work hard to make sure that whatever system of transparency is developed, it won't shine the light on them.  We won't get real transparency.

I have long espoused the fact that the Medicare program is single-handedly responsible for the diminution of free market forces in healthcare.  Thirty years ago, if you were sick, you wanted to receive healthcare in the United States.  Our system was built on free market forces.  Medicare disrupted that connection, and since the incorporation of DRG's and HMO's, there has been no true free market as it relates to Medicare.  This has corrupted the rest of the healthcare marketplace.  I've written about how health insurance companies, hospital conglomerates, the pharmaceutical industry, and the AMA form the backbone of the healthcare-industrial complex that caters to the worst capitalistic tendencies.  They have been assisted by Medicare and politicians, through their lobbyists, to assure that they are hugely profitable, with little care for whether people are well served by the healthcare marketplace.  The devil is certainly in the details when it comes to putting the free market back into healthcare.  Taking regulation and oversight away might very well completely unleash the very worst in corporate nature.

Once again, I return to my soapbox.  We MUST return professional responsibility to the physicians to care for people.  However, if we don't assure that they're competent, especially as it relates to the care of older adults, we will all lose.  I became a physician at a time that we believed in the oath we took.  I still believe that physicians can be those people, but we must give them the training and the tools to do so.  A truly professional physician workforce, unencumbered by the constraints put on them by the government and insurance companies, will be the ones who can truly take advantage of real transparency and a true return to free market forces.