As someone who has worked on all sides of the health care field (regulator, non-profit, for-profit) for 30 years, I was intrigued by the Steven Brill piece, “Bitter Pill: Why Medical Bills Are KIlling Us”. On the analysis of the problem, Brill was mainly on target, but he missed the mark on most of his proposed solutions.
For example, hospital competition is not the answer to getting lower prices and never has been. For instance, co-ordination of services among hospitals within a region is a far more cost-effective way to minimize duplicative purchases of expensive technology. Furthermore, group purchases of supplies, pharmaceuticals and capital equipment by large hospital systems has been shown to drive down vendor prices by up to 20% versus pricing given to small independent hospitals.
Brill glosses over the real solution to the cost of medical bills: a single payer system which forces hospitals to be more efficient. Medicare For All, incorporating quality measures, would eliminate all the “chargemaster” game-playing. The inefficient providers would be paid the same as the effective ones. With higher costs, they would be driven out. Likewise for the ones with poor quality. Plus, the 20+% adminstrative marketing costs currently charged by private insurance companies — versus just 3% with Medicare — could be put back into direct care where it belongs.
Jack Bernard, Monticello, GA