Care must be taken in comparing costs across countries. Due to price controls on health care providers and vastly different accounting systems, international comparisons often use cost data that compare apples and oranges.

For 7 million or so .. with 98% coverage, the Swiss keep costs down compared to USA System as I recall fairly well.

Renal care is interesting. Even though they have an older population, the average of age of their renal dialysis patient is ten years younger as I recall. Swiss physicians often believe we have cowboy physicians who treat too many older serious ill patients, because of economic incentives. Renal care in Swiss is mostly outside the profit motive system . A physician friend of mind has introduced new German treatment system that costs 1/3 of typical renal dialysis system in his hospital. His guess is that it will never be introduced here because the hospitals , physicians and insurance companies will not see the high levels of reimbursement that they now see with this new system. What do you think John?

There is nothing transparent about the prices for the other services we buy in market economies. They seem to do just fine without transparency regulations. I would suggest instead that the problem is third party payment. RVRBS is Marx’s labor theory of value reincarnated by Medicare from the ash heap of history–it does a lousy job of substituting for the information contained in a honest to goodness price.

By the way Cuba has about 11 million and Canada about 33 million people.

This latter requirement is essentially aimed at all third party payers involved in the system (government plans, health plans, insurers), so that there can be no deals made on that published, transparent price list. Once the third party payer has made whatever payment they are going to make for the service based on their own policy benefit coverage (i.e., a maximum allowable fee schedule), and any required copayments (copays, deductibles, coinsurance), the patient then de facto is responsible for the balance. The provider is then, and only then, free to do whatever arrangement they wish with the patient with regard to that balance owed. They can forgive it, discount it, etc. The thing is that they should never be allowed to do that based on third party payer affiliation, or we get right back into the cost shifting mess that has been the main cause of the health system financing chaos we have today.

Having providers set their own rates (but be consistent) is the only way to bring order and creative responsiveness to the market that has never been allowed to work because it has been so distorted by the price controls/fixing of both government (Medicare/Medicaid) and large health plan network “discount” requirements. It is patently ridiculous, and administratively expensive and inefficient, to allow a given provider to charge a different “net billable” rate to two different patients based upon who their affiliated third party payer is. You would have an extremely difficult task to justify your statement that “Charging different prices to different people at different times is efficient. It spreads the load and makes more efficient use of labor and capital.” in relation to medically necessary (not any medically unnecessary or legitimate cosmetic or truly elective surgery such as vision correction surgery and tummy tucks) services. They are not the same kind of economic goods.

The system can achieve its greatest efficiency by applying rational process to something that society, whether it is liked or not, has deemed to be a “utility” that all persons are entitled to. That means creating a market environment where the basic economic transaction is based on consistency and fairness. Those transactions are those between the provider and the patient, and those between an insured and an insurer. Unfortunately, we have allowed there to be a “cut through” largely eliminating the patient/insured from the action. To get back to that requires a reasonable playing field for all the relevant parties so that a proper market equilibrium can be reached without the distortion created by hierarchies of fee schedules for the same provider, with none of them serving as a true benchmark for what the service really is going to cost.

By the way, the “time” element is an allowable variant to distinguish a “service,” so there is nothing inconsistent with having a consistent fee schedule and varying the price based on how far out you make the appointment – it is a different service. Just like package pricing might not equal the sum of the parts. It doesn’t matter so long as any such differential be charged consistently to different people, and that it be transparent so that the potential patient can weight it into their economic decision. The same can be said for variations in complexity – we already have that in the RBRVS system and others. There is nothing technologically difficult in service distinction.