> Her Stanford-affiliated doctor had warned her that the extensive allergy skin-patch testing she needed might be expensive, Winston said, but she wasn't too worried. After all, Stanford was an in-network provider for her insurer — and her insurance, one of her benefits as an employee of the state of California, always had been reliable.

And here we have one of the biggest problems with the American health care system: a) no one knows the cost of anything (except insurers), b) customers feel no need to be cost-conscious.

They tested her for 119 allergens, but from her symptoms they could probably have cut that way down, and tried an iterative process (trial and error) that should have cost much much less. But the patient "wasn't too worried" because the insurer "always had been reliable".

If we went back to old-style insurance (think Blue Cross & Blue Shield), you know, you pay 100% until deductibles are met, then they pay 80% and you pay 20% up to some cut-off after which they cover 100% up to some large max... then patients would become cost-conscious. Doctors (or their assistants) would have to be able to quote prices on the spot. All the per-network variation in prices would be reduced or eliminated. Patients would be able to negotiate prices with doctors!!

Imagine that, people negotiating prices. In a world where no one feels the need to negotiate, no one knows how to negotiate, and no one bothers to negotiate, and so when costs mount all we know how to do is complain.

A free market needs pricing signals. The American health care market lacks pricing signals. The American health care market isn't functioning very well like a free market. Indeed, there's a ton of regulation too that, along with the HMO/PPO/everything-but-traditional-insurance system serves to increase costs and hide this from the consumer until it is too late.

The most sensible reforms at this point would be those that make the system more transparent to the consumer before they consume.

On top of all this we have tremendous protectionism:

- it's too hard to become a doctor
- it's too hard to build new hospitals (you need a
"certificate of need" -- did you know about that
bit of protectionism??)
- FDA regulation makes generics manufacturing really
difficult (my father tells me how he can't sell
chemicals to generics manufactures even at 25% of
what they pay someone else because the regulatory
cost of switching sources is so high)

Our system is practically designed to produce ever more cost inflation for health care.

EDIT: Let's not overlook, either, the conflict of interest that the doctor in this (and every case) had! The practitioner in this case ordered practically every test without quoting the customer a price, thus ensuring a bigger payday for themselves. Sure, they said it might be expensive, and sure, the customer acquiesced without inquiring further, but the practitioner almost certainly didn't care whether the customer could afford this, and they didn't know the final price either. This conflict is unavoidable, naturally, but that doesn't mean that we cannot deal with it reasonably. Doctors should absolutely be required to quote prices to their customers prior to performing procedures or ordering tests, and generics substitution should always be permitted.