Problems

First, let’s do a basic overview of the current American health system and its flaws. We need to dispel the popular myth that the health insurance companies, brokers, and pharmacy benefit managers that now dominate the American healthcare market have any interest in containing costs, nor do the hospitals and other industry vendors with whom they deal. There is a profound disconnect between the actual cost of medical care and the cost assessed to the insured American consumer, whether that consumer is paying under an conventionally insured policy for individualsor a group benefits (employer provided) plan. That is because the thicket of middlemen in between the provider of medical services and the patient create a thick fog of secret deals that conceal the true price of treatment and drugs in a flurry of alleged “discounts” which are often higher than the cash price that providers are willing to accept, and even higher than the copays charged to the patient. These middlemen escalate costs for their own benefit, and raise walls of secrecy around their contracts with each other and with hospitals and other medical providers to prevent patients and the employers who pay to insure most of them from reviewing claims data and actual costs, and discovering the extent to which they as consumers are being exploited .Recent federal and some state legislation are requiring hospitals to post their prices publicly, and some hospitals and other providers do so on their websites . However compliance has been spotty and there are no fines of any significance to deter noncompliance. Moreover the employers who pay for most of the insurance held by Americans under the age of Medicare eligibility (65) remain passively trusting in the brokers and agents they use to acquire standard group insurance plans for their employees, or in the third party administrators (usually insurance companies) who administer employee insurance benefits funds which are provided by the employer.

In no other industry do we see such secrecy. Car buyers can see the manufacturer’s suggested retail price and the dealer’s sticker price, check Bluebook prices and consult other pricing resources such as Car Fax and Carvana for comparative prices to negotiate the best deal for themselves. Real estate buyers can readily find recent comparative prices from a buyer’s agent or on their own on the Multiple Listing Service (MLS), a published listing service, or by checking their local Registry of Deeds. However on the American health care scene , naïve consumers put misplaced trust in insurers and insurance brokers and agents to look out for their best interests when in fact self interest rules and conflicts of interest remain undisclosed and unchecked. We as patients and payers of healthcare need to awaken from this complacency and realize that that the money these middleman are playing with is our own and that we are the losers in this shell game as premiums endlessly rise. We can change the odds in our favor only by insisting on knowing all the price and claim expense data so we can tear down this parasitic middleman structure and replace it with a direct pay model that has employer paid and other group plans negotiating prices for medical services and procedures directly with providers and hospitals. Individuals whether insured or not should be asking for theirprovider’s cash price which is often less than their own insurance company’s copay, and everyone should be using drug cost cutting coupons to be found at GoodRx.com and equivalent discount drug sites to get the medication we need for less.