I've worked as an ER/Critical Care nurse for 15 years, and this author is correct in saying that health care costs in this country are particularly opaque. I have absolutely no idea how much the stuff I do costs. That can be a good thing as well as a bad thing. I'm not tempted to ration care at all because someone doesn't have insurance. So, if you get sick, we take care of you regardless of ability to pay. We have to, it's the law.

But, the other part of the problem, is that people without insurance often come to the ER when they are ill, because they haven't established a relationship with a doctor or clinic. So, when they get sick, they go to the ER and purchase the most expensive care possible for their earache or sore throat.

Think about it, in the ER, we are trained and prepared to save lives in a heart attack, keep you alive long enough to have an operation if you get shot in the chest, or administer antidotes in case you get bitten by a rattle snake. We have all that equipment lying around just in case, and we're trained to use it. But, many of our patients have ear infections, runny noses, back aches and sore throats. Not exactly cost effective care.

A big reason for the lack of transparency in hospitl billing is that there are different tiers of payment depending on insurance. The hospital negotiates different rates with different categories of insurers.

Out of network private insurance pays full price or at times refuses to pay full price. In-network private insurance generally negotiates a 70-80% rate. Medicare and state public insurance generally pays a 15-50% rate. Non-Insured patients get billed at the full rate, but generally only 20-30% of those people fully pay their bills. So, many hospitals will give you a discount if you pay cash within a month or two of your visit.

Also, doctors aren't able to bill by the time they spend with you. Because of Medicare, the whole industry pays per diagnosis. So, if you get diagnosed with a pneumonia, Medicare pays a flat rate no matter how long you stay in the hospital, either 1 day or 10.

Finally, most hospitals, if they are making money at all, are operating on a 1-2% profit margin. It doesn't take much for them to go under, and they often need and get subsidized from the state or federal level.

15 years ago, I was very Conservative politically, thinking that market forces would sort it all out. But, the longer I work in health care, the more I think that we should just go to a single party payer system. I actually think that it would actually eliminate a lot of bureaucracy and cut a lot of costs. It'd be a hard sell in this country, though.

Just to kick this one off, I have had no health insurance for almost 15 years and go to a doc in a box when absolutely necessary. "Why that's insane!", you say. No, the US health care system is insane. This was immediately obvious to me when I emigrated to the US from Canada 20 years ago. The biggest hindrance to entrepreneurial activity in the US is the health care morass. I was discussing this with a friend 4 days ago. He just graduated college this past spring semester and longer has school mandated coverage. Hours later he took a mallet to the face playing bike polo and went to the emergency room where they told him that just to look at him would cost 400 dollars. Any services would would be more and they did not know how much more until he agreed to pay the 400 bucks. Fortunately a mutual friend is a nurse and he was able to text him and get a surgeon to unofficially give him a look over and let him know he did not need stitches. He was not convinced when first discussed the issue but less than 24 hours later he agreed based on his new experience as a member of the newly uninsured.

The tech sector had a crash (remember that one?!) and it was not based on decades of old technology. I fail to see how the banking sector is based on decades of old technology. If you ask my friends at GS or Citadel (who went to CMU for CS), I think they'd give you an earful for that line. It could be argued that the bubble was amplified by technology that made it easier to bundle and trade CDS's. Once we snip that bit, it becomes:

They lack transparency; they are overly complicated industries.

It should not be difficult to see how this encourages bubbles. In such industries, it'd be difficult to guess the real value being created, and we know from psychological research that people are apt to create speculative bubbles even without being given this nugget (see http://en.wikipedia.org/wiki/Herd_behavior).

"Text based and code numbers? That's like my insurance company -- but half of their software now has a GUI. (I'd also put my bank in there, but they got rid of their text-based system two years ago.) My optometrist and dentist both use paperless systems with pull-down menus (no code memorization) and intelligent forms. But the local hospitals? They seem to still use text-based entry forms circa Windows95. Sounds like old technology to me... It's enough to make a guy sick."

Whether an application is text based or GUI has nothing to do with how effective it is.

Paperless, pull-down menus, and intelligent forms can be programmed either way. In fact, many text-based systems are much more effective than GUIs because they are simpler; the user never has to worry about the mouse.

I have personally "deconverted" 3 large scale systems from GUI back to the original text based system, then enhanced those systems to do what was needed. In each case (which flushed over $10 million down the toilet), the PHBs thought the move from text to GUI would magically solve all their problems.

Too bad those PHBs knew nothing about systems analysis, business processes, or project management. Apparently, neither does OP.

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