It should go further. End the in-network / out-of-network crap. One price per procedure that is the same for all customers. All providers should accept all insurances. The system we have is insane.
Let's say we remove this, and now we have a doctor who wants to charge $200 and an insurer that wants to pay $100. How should it be resolved?
Some of their customers will go to a doctor where a procedure costs $200, some where it costs $50, some where it costs $100. If the prices were published patients could actually make a choice based on that information.
If the patient could choose any doctor because they aren't limited to in-network only and the doctors couldn't charge different prices for insurance vs. cash, and if patients actually knew what the prices were beforehand there would be actual competition and downward pressure on prices.
This implies that there are enough doctors. But current reality is that supply is artificially limited and there are not enough doctors.
This isn't unique to healthcare, though it's worse in healthcare than other places. Say I hire a plumber to put in a toilet, and when they open up the wall to run their pipes they find major problems that need dealing with. It wouldn't be code compliant to seal things back up without fixing them. Now it's going to cost me $10k instead of $1k. (Analogy to complications during surgery, though it's less time sensitive and I would have the option of evaluating multiple people to fix the bigger problem.)
Insured patient: Doctor gets $100, can't bill the insurer's patient any further. If the doctor isn't happy with this, he can refuse service to patients insured by this insurer, or he can find a new line of work.
Uninsured patient: Doctor can bill this patient $200
In the case of surprise bills from hospitals this is a big improvement, but in the normal case of "my work gives me Cigna but my long-term doctor I'm very attached to doesn't take Cigna" it means people can't stick with their doctor.
The solution is right in front of America’s nose, but too many are running around with their fingers in their ears screaming simultaneously about the communists and how much they hate the system they’re advocating for.
Those insurance contracts can keep you from paying cash for services. If they can do that the in and out of network is much simpler to defend in court.
Recently had a situation where we were pressed for time and was waiting on insurance approval. I offered to pay cash and the Dr had to ask permission from the insurance company.
The most efficient solution is an "all payer rate set system" - aka One price per procedure.
YES, the system we have is insane.
NO, unfortunately none of us are doing anything about it because we don't think beyond "single payer" system which itself has its own set of issues no one digs into because "single payer" is so awesome.
Everytime I mention "all payer rate set system" the discussion halts as if I am an alien from outer space.
If we are make ourselves go through an overhaul, and all the pain and suffering it entails, our sights should be on an "all payer rate set system" that's already proven to be way more effective than whatever people mean by "single payer" system.
I'd like to hear more about this. According to Wikipedia [1], Maryland uses an "all payer rate set system", and it had one of the first per-capita costs. On the other hand, Germany also has the system, but much lower healthcare costs. What's going on?