Monday, March 07, 2011

Problems with PPACA

Matt Yglesias has a post rightly pimping pricing transpency in healthcare but unwittingly illuminates a core problem with PPACA. Yglesias shares the following reader experience:
"I think you should do some posts on the lack of transparent pricing of medical services. My girlfriend just injured her knee. Her primary care physician referred her to a sports medicine doctor who said, it doesn’t appear to be major, but I think you should get an MRI. When she makes an appointment for an MRI she learns that it may cost at least $900 out of pocket because her health insurance has a $2,500 deductible. I tried to look online to see if there were any websites that provided comparative pricing for MRI services and could find nothing. She called her insurance company and they said they were unable to provide her with pricing information for the various providers in the area. When you call the providers themselves and ask, they say Ask your insurance company. I think one way we could improve health care in the US is to require providers to post the prices of their services so that you can compare. There are at least 15 providers in the immediate area (Chicago) so it is not for a lack of competition that prices are out of whack, it a result of opaque pricing that leaves the consumer of medical services powerless."
Yglesisas goes on to make the point the PPACA has provisions which are supposed to improve transparency in pricing. I agree that this is a good thing. It is fundamental to cost control. However, you also need to have the incentive to economize, not just the information that enables you to do so. In the shared scenario the person seemingly has a high deductible health plan and has an incentive to comparison shop because she actually has to pay for the care herself. She presently lacks the information to comparison shop but has the incentive to do so. PPACA will invert this problem by effectively getting rid of HDHPs so while people will have the information to comparison shop they will no longer have the incentive to do so.

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