Being born in 1952, I came into this world in a Catholic hospital. Most people did as the history of the hospital has been a decidedly Catholic creation.

Prior to the 1960's Catholic hospitals were the norm. Not until the 1960s, with the advent of Medicare and Medicaid -- when Catholic and other hospitals regarded as "voluntary" institutions began to be paid for services they previously provided for a minimal or no fee -- did Catholic hospitals suddenly find themselves actually making money. Then Americans' use of hospitals grew dramatically and expansion became the new order. The new money in medical services triggered growth, but it also triggered corporate America's realization there was a previously unrealized buck to made in health care.

The for-profit hospital came into being. What had been a social service turned into a Wall Street profit center.

The Reagan administration instituted programs that made inroads into health care provision profit margins by cutting Medicare and Medicaid reimbursements. Patient stays were drastically reduced.

It doesn't surprise me that New Jersey's deregulated its hospital system in 1992-93. Such a move was not done out of consideration for the people of New Jersey. That charges are used as a negotiating starting point reminds one of a bazaar. On top of that, what patients pay for their surgeries is directly correlated with the highly fragmented nature of our American health care/health insurance system.

I'm sure the people behind the New Jersey Hospital Price Transparency Report are well intended but the hope to rein in the wildly disparate charges of hospitals with something equivalent to a "Blue Book" value from which to negotiate the price of our medical care is wildly optimistic.

Canafdians are definitely aghast at the third world type health care that so many Americans have. While many Americans make a big thing of 150 Canadians a year being deceived into getting treatment and surgery in the US, Americans never mention among themselves the 1.5 MILLION Americans who come to CANADA for treatment and surgery they are either refused by the insurance company bureaucrats who run the US health care system, or are unable to afford in the US. Just as an example, a liver transplant and subsequent follow-up care costs $450,000 in the US. In Canada, the same liver transplant and and subsequent care would cost an American (not being a Canadoan citizen) $200,000. For a Canadian citizen, that liver transplant would have NO OUT OF POCKET COST.  

This is how Canadians see Canadian health care and how we see it as superior to the health care that most Amercians get.

http://www.youtube.com/watch?v=T6i3RZdu7_k

http://www.youtube.com/watch?v=x3EoziMcFvE

http://www.youtube.com/watch?v=VQFX32Ed7ZQ

I don't see the "blue book" materializing, either. Especially, with a newly-elected Republican governor who complains that the regulations make NJ too unfriendly to businesses. He'll talk a good game and it will stop there. And, of course, like any "blue book", the pricing would have to be adjusted for options, those subtle differences and unforeseen conditions which make us human.

I have to wonder, as well, how many people really have time to shop the "bazaar", as you put it, prior to going to the hospital. I know that when I need a hospital, something is broken that I can't fix and can't wait out. If I have to stay, I want it to be close to home and family.

What the report does underscore is the need for us to negotiate as a bloc, in advance of need, and agree only to the lowest cost for all procedures. If the hospitals push back, it can be easily pointed out that charging more doesn't seem to keep them out of financial distress and charging less doesn't put them in distress. Makes you wonder why we can't get the Feds to put some forensic accountants on the nations' hospitals.

You can only fix the problem after you identify what's broken. The legislation wants to identify best practices as both a cost controlling measure and delivery improvement. That's a good thing but, even where we arrive at those best practices, we will not have identified the major cost drivers. Worse, we'll be confronted with the same lines, "Well, what is your life and health worth? Can you really put a price on that?" and the profiteers will continue albeit with improved services which they will use to justify inflated costs.

Martin, you spoke of the inevitability of hospitals becoming regulated utilities, maybe that needs to be nudged along so we can open the books to the public sooner rather than later.

Thanx John Murphy!

Great videos!

Harold,

I spoke of the inevitability of the insurance industry becoming a public utility.. Unless the American people are a bunch of castrates, having been forced to purchase health insurance, they will demand a benefit rate above 90% and get it, or burn down the buildings out of which health insurance is "sold."

Health insurance companies were originally contracted to negotiate with providers for affordable health care. They failed deliberately. As provider rates increased , insurance rates increased. Thus, profits went up for providers and insurers who raked an increasing percentage off the top of the premiums their "members' paid.

When health insurance becomes a public utility, it will once again fulfill its contract to negotiate affordable health care with hospitals, doctors, and medical suppliers. If it does not, the government will negotiate these fees as in France. Yes FRANCE!

Read next post!

Let's not forget that the quality of care in France outstrips not only the US but Canada and Britian, by far.

While their private insurance industry is healthy, it is not the profit-creating investment giant that we are accustomed to. France also has a far more active electorate which embraces a social ideology the like of which is not known to more than a fraction of the people in this country.

I think the American people are angry enough and ready for change but the large majority, while ready to oppose the amassing of great wealth at their expense, will not embrace the changes to laws and the system of acquisition because, deep down, they believe their number could called or that they don't have the right to stop the next Sam Walton.

I dearly hope you're right. I hope that being told to sit down and shut up, wait until the end of 2013 and some of the reforms kick in to see if it works, doesn't silence the anger.

Ms. Pelosi has graciously decided to build on the Senate bill, not the superior House bill, in compromising us and our reform. This cannot end well.

It's the US that has rationed health care and always has. Insurance-run health care rations health care by denial and recission. US health care is rationed by the size of the person's wallet. 

International rankings do put France #1. Canada ranks #6, Britain ranks #17 and the US ranks #19 and dead last.

That's of the 19 industrialized nations, of which the US is the only one not to have universal health care.