Top down fixing stuff hardly ever works. Organic systems just don’t work like models– “close enough” works when the wiggle room is, say, the wear of calibrated parts that are changed every 1000 working hours, but people vary from day to day, let alone different people.
Even if folks really, really give their all to trying to fix a system, there’s something off– I think it’s best explained as they focus on the theory. Folks trying to make a living in the system will focus on their bottom line; folks trying to use the service provided by the system will focus on getting the best for the buck. This is over simplified, and there’s levels to it– for example, the folks managing the providers will use strategies to bring in more users, sometimes the users look at intangibles rather than raw services….
A major consideration for the HSA patient is the fact that medical fees are grossly inflated by Medicare and insurance companies that draw up contracts with physicians including “discounts” from imaginary retail prices. When I retired from private practice, I had 176 contracts with various insurance companies and HMOs. Medicare will punish a physican who provides a cash discount to a patient. Balance billing is also prohibited.
The result has been reluctance on the part of physicians to see Medicare patents or HMO patients, both of which have poor reimbursement schedules.
Solution: go to cash services, bypassing the various legal and paper complications involved accepting Medicare, or insurance that’s too much paperwork.
I think this is a good start.