Universal Health Insurance. What About…?

 Authors McLure, Enthoven, and McDonald make a thoughtful argument about good health is a good investment. We are all pushing a rock until the incentives change to reward doing more with less.
One point, and one question.
The point. Our system is NOT ready for effective price transparency and education. That will be a major undertaking of a generation. Even simple stuff is difficult. Just this morning I took my son in for what looked like (another) strep throat. I did not have a say whether a throat culture was taken (he was alone with the PA), and had no idea what all this would cost going in or coming out. I asked, what’s the cost for today? “Oh, you’ll have to talk to billing. They open tomorrow.” Good grief. This is just a minor illness. Last time we did this it cost us over $700. How do I shop if I don’t know what I’m buying?
The Question. Will a medical (restorative) system and a preventive (public health) system unwind the wasteful market forces driving prices today? If I’m a hospital CEO what incentives have changed so that I would  NOT invest in upgrading my cancer center even if my regional competitors expertly meet quality and capacity needs of my community? Today, competition is so fierce I’ll refer my patients 100s of miles away just so my cross county competitor won’t get the business. Won’t I still invest the $30mm even though it provides zero improvement in outcomes and would be better spent on preventive care, or say, on public transportation for better access to food or jobs? If we changed the incentives to pay more for preventive care and less for restorative/specialist care, don’t I still need to compete?

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