It wasn't always like that. When I was a boy in the late 40s and 50s Doctor's posted their office visit fees. Our family doctor, Dr. Hitner, charged $5. Other Doctors charged $7 and some as much as $10. In those days patients were expected to pay for their office visit in cash when they left the Doctor's office. As you might expect Doc Hitner had more business than he could handle. He was also and excellent surgeon.

We went from a consummer driven health care system in the first half of the 20th to a system, to a system where most Americans have zero involement in the cost of their care. And some among us wonder why the cost increases are out of control? It should be obvious. Lasik eye surgery, for example, is consumer driven and guess what, prices are falling. The solution should also be obvious. Put consumers back in charge. Two changes would get the ball rolling quickly. HSAs for individuals and families. All bills up up to the point of a major medical kickin would be paid by the consummer from their own HSA account. Second all providers should be required to provide a fee schedule of common procedures.

I see one response was to go back to the first part of the 20th century and pay out of pocket what ever you need. At first that sounds like a good idea. But once you really think about it you realize that this is a losing proposition. One serious illness or injury, and you are deep in dept, and thanks to the conservative congress and president, you can not file for bankruptcy for medical bills. So you would loose everything that you have worked all your life for. Does not sound like a good idea to me.

I thought the idea behind medical insurance was to spread the risk to a pool of people. We all pay in, to cover the bills. This way if one of us has a serious illness or injury, we all share the cost and none of us is buried by the medical bill. Insurance companies were formed from this idea. They would be the ones to facilitate paying the bills and sharing the cost. They had access to the price structures. As time went on they had the information to see what the average costs were. In an effort to control costs, they were the ones that set the “usual and customary charges. For many years we were happy with the results. But as time went on we saw the costs going up again.

We all complained about the idea of paying after the services were provided, it was not an efficient way to manage health care, so we came up with the great idea of HMO’s. That was supposed to manage our health care, including preventative and lifestyles. It was a prepaid health care as well. Well that didn’t work to good because once again the charge is that we do not have enough involvement to contain costs. But the HMO’s made good money as do the insurance companies. They seemed to control costs well enough to keep profits for the investors to keep them happy. But they just added the costs to us.

The next item I hear is that because employers pay the bill we don’t care what the costs are. Again I think the employers form groups that get the best price breaks. But if we all want to get to the root cause of the price hikes, it is not just us, it is the system. If we would treat medical care decisions more like buying a car, we would choose differently. Those who say we need to pay it all out of our pockets or we don’t care, is not a true statement. For one to make an informed decision on this, one would need to have information on the doctor and his staff. If you knew a doctor was being sued for mistakes made in his practice you would keep looking for another doctor. The same would go for clinics or hospitals. That information is out there, but not to us as consumers! We have no way of knowing what the track record of the doctor, hospital or clinic is. Unless there is a complete transparency of the medical community on services and track records, as well as prices, so we can make an informed decision, all those out of pocket efforts are wasted.

I have noticed that some insurance companies are putting together a package with a catastrophic care that provides insurance after you spend $10k out of your pocket. So the rate for the insurance is for the catastrophic care, which is less than the HMO or traditional system. If you can afford to take the risk and spend the $10K during the year, it is a good plan for you. But how are you going to decide which doctor or hospital is right?