Creating a consumer-friendly health care marketplace

A true marketplace for health care creates provider competition, and competition drives prices down while increasing quality and access.

A true marketplace for health care creates provider competition, and competition drives prices down while increasing quality and access. (Shutterstock)

“A wise and frugal Government, which shall restrain men from injuring one another, shall leave them otherwise free to regulate their own pursuits of industry and improvement.” – Thomas Jefferson, First Inaugural Address, March 4, 1801 

Like it or not, health care reform is tied to the next election. In 2024, who we elect to represent us in Congress and state legislatures will determine our own health care. We would do well to ask candidates what they plan to do about the U.S. health care system.

Health care is too expensive, too complicated, access is becoming more difficult and wait times are increasing. Although quality among physicians remains high, there are severe and growing staff shortages across the medical profession and as a result, a decline in quality has begun.

There is no single or simple way to fix what is wrong with U.S. health care. There are, however, several significant changes that can move it in the right direction. What is the goal of that “right direction?”

Reforms that create a consumer-friendly marketplace for health care services, products, and devices is a most critical starting point. Why? Because a true marketplace for health care creates provider competition, and competition drives prices down while increasing quality and access.

These seven tools create a medical care marketplace that functions like the rest of our U.S. economy. They are built on the foundational principles of our country — our unalienable right to life, liberty, and the pursuit of happiness. These are American ideas, and they work.

  1. Simplified price transparency tool

The recent federal laws creating mandatory provider price disclosures are of good value, but they are 1) far too complicated, 2) not easily understood, and 3) exceed the powers the Constitution grants to the federal government regarding commerce and liberty.

Does a useful, easier to use transparency tool exist? Yes, to the extent that it provides a quick comparison of the prices any provider will accept. Once a consumer knows this price point, he or she can make an informed purchase decision. It is called a Medicare Percent. Each provider is required to disclose this single number — the percent of Medicare they accept as payment in full for services, products, and devices.

  1. Consumer health care information websites

There are few among us who have never been to Amazon to buy something. Shopping there, you are able to see the product, product description, a retail price, discounted price if any exists, and most importantly, customer reviews of the product or service.

Health care consumers should be able to access “Amazon-like” Health Information Websites that describe providers. Information includes their Medicare Percent, their credentials and experience, then information about facilities, location(s), medical and health care products and services and, of course, their medical staff.

On these information websites, patients will share comments and experiences, plus rate their providers. Everyone will be able to see this information.

For instance, search “Neck and Spine Surgeons,” enter a zip code, and see them all. Then see their Medicare Percent, credentials, and read what patients say about them. You will have basic information necessary to make a choice.

  1. Access to any willing provider

Today, insurance companies set up provider networks that limit a patient’s access to medical professionals and services. Networks contract with providers and require insured persons to use them. This is contrary to how consumer markets work.

Markets work when individuals can freely choose their providers, when they know the provider’s price beforehand, and can find background information on them. Their health insurance plan (newly designed to serve a medical marketplace) will still help pay the providers under the terms of the insurance contract.

  1. Allow competition to flourish

Eliminate artificial barriers to the creation of new medical facilities — hospitals, clinics, outpatient surgical centers, urgent care facilities. Let the marketplace sort how many hospital beds are needed, where they must be, the services they choose to offer, and how much they should charge.

Break the stranglehold of Big Corporate Medicine and their anti-competitive schemes that limit competition. Prohibit health care payers from also providing care — it is a major conflict of interest.

The marketplace can decide the best way to pay health care claims. Maybe it is a few major financial institutions, or perhaps tens of thousands of them. The marketplace can determine where medical clinics should locate and open up opportunities for a physician to innovate in how he or she delivers care.

  1. A vibrant physician-patient relationship

The best care outcomes result from patients taking ownership of their own health care — being their own best doctor. Patients should work closely with physicians they choose, whom they know and trust. This critical relationship should extend from the primary care physician to the specialists to whom the doctor refers patients. Letting Big Medicine decide which specialist a person can see results in rationing of care by payers.

  1. Be honest with people

Discard cultural restraints on provider truth-telling. Train physicians to always square up with patients, and then protect them from outside pressures. Physicians are not responsible for the choices made by their patients that lead to illness, but they are responsible to clearly counsel patients on the potential problems their choices present, and help them as much as their training, experience, science, and good sense allow them to.

  1. Reduce government over-regulation

Over-regulation forces small medical providers to consolidate their practices until the only surviving providers are big corporations.

Over-regulation adds trillions in cost to commerce, especially true in the delivery of health care. Over-regulation has led to massive consolidation by health care providers, payers, producers, and reduced patient choices.

No one suggests getting government out of protecting human life and commerce with necessary laws and regulations. But no honest person believes we need more regulation.

Reduce unnecessary regulation and instead, encourage the creation of more small and independent medical practices and facilities. Let a free market determine the best way to distribute and pay for health care.


Dave Racer

Dave Racer, MLitt, is an author, publisher, commentator, and teacher. He has 22 books about health care to his credit as author, co-author, or editor.

Greg Dattilo

Greg Dattilo, CEBS, is an employee benefits consultant with more than 45 years of experience.