You might have a point about creating this market for primary and preventive care (if you give the poor money for preventive care as you mentioned in your mammogram guidelines article), but how much will solving this problem really change the true cost drivers?

I have a loved one right now who is in the critical care unit at one of the largest, most acclaimed, highest rated hospitals in Indiana. She was on a ventilator and in a drug-induced coma for several weeks before they decided to perform surgery that could send her home much faster.

My occasional doctor visits (and especially my annual physicals) are not what’s really driving these high costs…it’s how we treat the sickest patients near the end of their lives.

And I’d emphasize Stephen’s item 2. As a family practitioner who submits about 30 insurance claims a day plus a bunch of resubmissions due to complicated coding issues plus a bunch of rebillings of patients for their “coinsurance”, which was incalculable when they checked out because I did not know what the “contracted” rate for my services was until I got back the EOB (explanation of benefits) from the insuror a couple months later, plus patient billings because the EOB reveals the patient still has a deductable—I could continue but are you getting the picture of just how much time and expense would be saved if there actually was a price for my services and I could collect the appropriate amount from patient and insuror at my check out window? My average office visit charge equates to, say, a two thirds full cart at Walmart. If their clerk collected a $25 copay then billed a recalcitrant third party for the balance then discovered butter was a customer expense as was a $33.13 coinsurance then, a couple months later, sent the customer a bill, there would be very few savings left on any of their aisles! Stephen states 300-400 billion dollars and I’ve also heard 30% of the health care dollar is wasted on insuror plus provider billing expenses. Scott

On another issue, doesn’t your article actually argue in favor of a part of the Obama/Senate/House that suggests that there is very little competition among insurers. You seem to suggest that this is indeed true in 24 states.

It seems that the only way to have the insurance industry regain some semblance of health is to reduce the underlying costs they are reimbursing and get them to stop reimbursing for what amounts to the 3,000 mile oil change for our cars (the annual check-up in the health care provider’s office. This level of care simply should not the goal of insurance.