When it comes to paying for our medical care, I’m glad I’m not the one responsible for creating a reasonable system! But I do believe one needs to be created (see my last post), and I don’t think the health care law  known as PPACA (or the Affordable Care Act), having a single-payer system, or tweaking the free-market system we’ve been living with for years would do the job.

Here are some attributes I hope this new system would have:

·        There would be competition, and consumers would have a choice among providers.

·        Providers could set their own rates, on a service-by-service basis or in bundles.

·        The charge and payment systems would be transparent. Consumers would know what they are being billed for and how much it costs.

·        Providers would charge all patients the same rate for each service or bundle.

The free-market system, at least as currently administered, falls far short of these ideals, and it’s an easy target for me since it created the mess I wrote about Monday. There is competition, of sorts, and to some extent providers set their own rates. However, not everyone has choice among providers, and transparency in the current system is a joke. I don’t think very many people know ahead of time how much they will likely pay for medical services to be rendered. Under the current system, even services that are pre-approved by insurance companies often end up costing patients more than the co-pays we are required to put out in advance.

But a totally government-driven system doesn’t appeal to me. A single-payer system wouldn’t necessarily have to make all health care workers employees of the government, but it still would have to be supported by a huge bureaucracy. That would likely mean replacing the current inefficient mess, which saps at least 15% out of medical payments to support private systems, with a similar one embedded in the government that could end up costing even more. All health care consumers would be more vulnerable to the budget-cutting pressures we see threatening Medicare. Ultimately, it could slow the delivery of critical services to people in pain or in need, while they wait in line for capacity to be freed up to deal with their conditions.

So far, I think PPACA has the best shot at offering us some relief. If given a chance, it might actually bring enough people into the system to equalize some of the rate disparity caused by our commitment as a society to take care of people who don’t pay their share. New rules set to take effect next month will require providers to take steps toward cleaning up some of the mess that keeps them from receiving timely payments, steps aimed at improving the efficiency of the system.

It will only do that, however, if it forces health care providers into a more transparent set of forms and practices – one designed to provide actionable information and encourage consumers to pay their bills rather than set them aside until they have the time, strength, and stomach to wade through and figure out how much they really owe. 

That’s where this started on Monday, and that’s where I’ll leave it now. Feel free to comment. There’s plenty more to be said on this subject.