The health care debate continues...

There seems be two sides to the health care debate.  One is in favor or stronger government intervention in the system overall and the other side that prefers more of a free market approach.  The current Affordable Health Care Act is slowly disintegrating. Some skeptics say that was the intent behind the design and was meant to force a move to single payer after it's inevitable collapse.   It's hugely complex and hard to pin down the places where innovation or change could make a dramatic effect.  However, there are a few that could have an impact.

Pricing is one of the areas that is almost totally opaque.  There are few if any purchases that you make where the price is unknown until the service is provided and never a central issue.  Even car repairs generally come with an estimate before the service is provided.  With the current system of insurance in the country the cost isn't borne generally by the insured and therefore becomes irrelevant.  Pricing is important if we want to get the overall cost structure down though.  It's hard if not impossible to reduce expenses if they aren't clearly defined and observable.

Second is the state by state laws that regulate insurance.  Insurance was first declared a state issue in 1869 due to a Supreme Court ruling.  And it has operated that way ever since.  Interestingly, many insurance products are sold almost nationwide, the exception being NY generally, but not health insurance.  Auto insurance, life insurance, long term care insurance is usually sold on an identical chassis with minor variations state by state.  Prior to the Affordable Care Act health insurance varied wildly.  If there is a positive aspect of the ACA the standardization across state lines is certainly one of them.  What would be a further improvement would be increased competition and access to markets within the US.  For this to be effective, however, you would need more transparency in pricing.  Just like houses that vary wildly in pricing from region to region so it is with health care costs.  

Ultimately, to make better decisions the consumer needs more information.  Anyone who has received a bill or statement from their insurance provider knows just how hard those forms are to understand.  There was a push years ago to make credit card statement easier for the consumer.  There should be a similar push for health insurance statements.  Simplicity and transparency are going to be needed to even begin to figure out which string to tug on first in the battle to decrease health care expenses.