There likely are many millions of Americans who want a “free-market” health-care system, as President Donald Trump and congressional Republicans keep insisting. But what would that take?
Information, to start. Markets don’t work unless consumers can compare prices.
No one would think of making a major purchase such as a house or car without checking out prices. But Americans undergo expensive surgeries all the time without the ability to shop around.
A health care plan built around free-market principles would force hospitals and doctors to disclose – publicly and clearly – their going rates for that heart bypass, knee replacement, IV drip or Caesarean section.
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Unfortunately, nothing in the GOP plan to replace Obamacare does that. And the absence of such a provision suggests that House Majority Leader Kevin McCarthy, Speaker Paul Ryan and other pushers of Trumpcare have zero interest in promoting free markets.
In fact, the House Republican plan, which would slash health insurance coverage for tens of millions to give the rich a huge tax cut and further deregulate insurers, would actually make it harder for Americans to get a square deal or shop intelligently for care.
In fairness, price transparency has been a distant dream, even under the Affordable Care Act. The reason doctors and hospitals don’t post price lists is that prices depend on what each insurer negotiates with each provider.
There’s an Anthem price, an Aetna price, a Medicare price, a Medicaid price, even a price for people who have no insurance – and insurers and providers get to treat them as trade secrets. So far, as with efforts to shed light on drug prices, lobbyists for insurers and providers have thwarted most attempts to change that.
The Obama administration tried, but its Medicare and Medicaid price database is all but opaque to laymen. A tool put together by the California Department of Insurance and Consumer Reports is far better, but still can’t compare real-time prices at specific hospitals and providers because the only information it could legally access is aggregated, regional and two years old.
Some states, such as Massachusetts and New Hampshire, have moved to kill trade-secret protections for health-care prices. But they’re small. California isn’t.
If state lawmakers here wanted to take a real practical step toward protecting Californians from Trumpcare, they should require doctor, hospital, lab and drug prices to be public, Insurance Commissioner Dave Jones told The Sacramento Bee editorial board last week.
It also would help to require payers of health-care services, including large self-insured employers, to report paid claims data to an independent organization, so that consumers in need of hospitalization or outpatient care could comparison shop.
At least two health-care transparency bills were gutted or killed here last session by the California Legislature. But Jones is right to wonder what kind of free market keeps price tags under wraps.