Can we return the principles of the free market to healthcare pricing?
"I'm not sure we ever started from that place," said Brill. "We certainly have slid far away from it." He pointed to Medicare as a countervailing payer power to the most concentrated healthcare provider. "It does an awfully good job. It's run mostly by the private sector, contracted out, and demonstrates that if you have one really big buyer in the marketplace it can serve to address the accumulated power of the providers."
Should the chargemaster be replaced?
Delbanco stated that the recent public release of chargemaster data was a great education for all about "how much variation there is [among hospitals] in the charges much less what people end up paying. What we need to work toward, and this will take a lot of work and time, is understanding exactly what the underlying costs are of delivering care and what cost it takes to deliver high quality care."
She noted that most hospitals and health systems "really don't know what it takes in terms of cost to deliver a unit of care." Without that knowledge, she said, it would be impossible to arrive at a "rational system to decide how much a procedure should cost."
What about consolidation's effect on pricing?
Sen. John Thune (R-SD) expressed concern that the coordination and integration of healthcare is providing an incentive in the market for consolidation and translates to higher costs. "What areas of anti-trust need to be re-evaluated if this trend continues to help put downward pressure on prices?"