It is time to introduce the free enterprise system into medicine. A simple change will do this. The patient should pay the doctor the full cost of the service at the time of delivery.
This will address several important points: The patient will be aware of the real cost; the doctor will receive immediate payment; the doctor will not have to file insurance forms, reducing his costs; and the patient will file for reimbursement from his own insurance (if any), including any co-pay arrangement.
The doctor would have to publish the cost of service so that a patient knows what it is before engaging the doctor's services, remembering to get the best price. The patient could select an insurance company that would allow for online filing and immediate reimbursement. A hospital would have to discuss every charge before adding it to the patient's bill ($10 for two aspirin, no thanks).
A recent front-page story in The New York Times contrasted the cost of a hip replacement in the United States ($78,000) and Belgium ($13,000). Same device, same (or better) results, more care. Americans spend twice as much as patients in the next most costly country, with mediocre results.
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It's time we got into world-class medical care.