[AnEro]

I've built and audited medical billing systems and billing practices. It isn't an economics issue in a traditional sense. Infact it would drastically reduce complexity of these systems and payments over time, even allowing private insurers to exist but have to compete with a base general coverage. (many smarter people than me at princeton did economics showing this worked out as a net less expensive than what we are doing now) The biggest reason why its not the simplistic solution, is politics of all the middle men (me) making exponential returns from solutions to these systemic issues.

Too much money in the system being flawed, look at pricing for any HIPAA safe products and thats just technology. Money is so hard to get for healthcare providers it is its own industry of revenue cycle management and thrid party billers. Most of these physician lead practices charge more is because planning your account around reemburcement cycles from insurance companies are 30-120 days if your lucky is an advanced accounting problem. (Thats excluding complexities of audits, LOPs, network rates etc.) Medicare/medicaid the fraud side has lots of tiny wins through leaning on tax information more, taking the model from the successful basic income studies and trials worked out.

[nradov]

I'm not sure what you mean by pricing for "HIPAA safe products"? It's not particularly expensive to comply with the HIPAA Privacy Rule, and honestly that level of privacy and security is the minimum we ought to expect in any industry that deals with sensitive consumer data.

There aren't as many physician-led practices anymore. Most of them have been rolled up into larger health systems in order to achieve economies of scale and increase negotiating power with commercial health plans. Which is one of the factors driving up overall healthcare system costs.

[AnEro]

The ops is crazy expensive, any service you get or buy into also instantly gets at least a 30% mark up. Look at the price of transport EDI clearinghouses vs healthcare! Yeah, it is stuff we should be doing for all data, but one mistake will leave you(business owner or contractor) with intergenerational debt or leave you criminal liable.

> There aren't as many physician-led practices anymore. Most of them have been rolled up into larger health systems in order to achieve economies of scale

There are plenty, in name at least many states have regulations to force this. Those larger roll ups are still clusters of smb doing 1-10m revenue monthly. They constantly fail and change hands behind the scenes, and are usually only protected by government regulations that reduce risk room to investors normally don’t have in other industries businesses. Their margins are like gambling almost and it’s a key driver of the service issues Americans face.