| The theory behind high deductible plans (as the article notes) is that it'll make people shop around for health care and find better prices and so it should bring down healthcare costs the same way the free market works on other things. Some of the reasons this doesn't work: - A significant amount of care, especially the most expensive sorts of care, are not things where shopping around is something that's an option. (emergency care). - Consumers are not and likely will never be, educated enough to actually make informed decisions about costs. Yes, generic vs name brand is typically easy. On the other hand, there's a half-dozen different medications to treat this thing, all with different price tags. Do I know if the cheaper one is good enough? No, I'm just going to follow what the doctor suggests. Same goes for most other conditions with multiple treatment options. - Pricing is opaque, and not always unreasonably so. "What will this surgery cost?" is not a question most places can answer before you've had it done. Medicine is prone to wide variation in outcomes that make price estimation problematic. That surgery went well and you're discharged in a day? Cheap. It didn't go well and you're in intensive care for a week and with a dozen doctors working on you? Very, very expensive. Which one will you be? No one knows. ------------- To add to why it's breaking the market, high deductible plans are attractive to all the wrong people. They're attractive to: - Broke people, because they get more in their paycheck, even though they can't afford the deductible if they do need care. - The young and healthy who would be subsidizing the sickly in traditional plans, which is making the costs of those plans spiral. |
The incentive needs to go the other way. The better the outcome, the more money the hospital should get. Bad results should mean they get nothing or even pay out, even without clear malpractice. If the hospital gets less than normal pay because a procedure went badly, there are several options for where that money might go: to the patient, to an insurance company, to a government regulator... but it mustn't go to the hospital.