The structure created by current law creates a high health care inflation for those items that are covered by health insurance.  Those items not covered and “shopped” by the consumer for price, has seen a higher quality and lower prices. 
If a health care provider is being reimbursed by insurance they have likely signed on to their reasonable and customary payments.  In an effort to capture the highest price on each item, and knowing they will have to accept the negotiated price, the price will be set high.  Other insurance companies will just cut a certain percentage off the bill.  
Obviously, health care providers will raise their prices very high so that they can still make a profit even with the percentage discount.   Providers ‘play’ whatever game is necessary and insurance catch on and demands a deeper percentage discounts, leading to providers increasing the costs again.  This often prices 'covered' items out of reach of the poor. 
A lot have been said about “A War on Women”.  While a few women might be benefited by insurance covering birth control, many of the less wealthy women without insurance are harmed by raising prices created by the mandate that birth control is covered.
Different heath care CRA's and health insurance CRA's could come up with different policies to see which could work the best to keep prices down.  It is clear to some, although not to those making the regulations that price controls drive up prices.

One CRA could have insurance that paid out "reasonable and customary prices," and also not mandate that providers take that as payment in full.  Which is to say, the patient could pay the difference, thus creating a “shopping” effect to keep prices down.  All doctors would be “In Network”.    



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    Bill Haley


    July 2016
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