1.  Can We Break This Cycle?  ·  Causes of Our Health Care Crisis  · Solutions

1.  Health care costs high are because health care prices are high. 
     Prices are the problem.

• Health care prices are secret—doctors, hospitals and drug companies don’t tell us their prices, and they don't tell us how much less they actually get paid by the insurance companies, either.
• Pricing secrecy allows price increases to be concealed.
• Secret prices allow discrimination, where different people pay different amounts for the same care.

2.  The middle class is the biggest consumer market in the country, but we
     can’t afford to pay for our own medical care without employer and
     government subsidies.

• Doctors and pharmaceuticals have priced themselves right out of their primary market.  How do they get away with it?
• By hiding their prices behind the health insurance industry's non-disclosure agreements.

3.  Health insurance companies keep both providers’ prices and their insurance
     payments secret.

• Secrecy hides and protects all price increases except the insurance premiums—and the insurers can blame the providers they are shielding for those premium increases.
• Health insurance prices are also discriminatory—the biggest groups get the lowest rates, while individuals and small businesses pay either the highest premiums or, if they have no insurance, they pay the providers' maximum prices.

4.  Starting with its founding in 1847, the American Medical Association’s
     Statement of Ethics…

• did not allow doctors to compete with each other.
• advised price-setting, so area doctors would agree on minimum fees to charge their patients.

5.  Doctors 

• eliminated competitors by using standard-setting to close 38% of the nation’s medical schools between 1910 and 1922.
• still use the "hospital privileges” today system to keep out competing doctors.

6.  We pay insurance premiums for primary care - routine and preventive health care and chronic disease management - although it is not insurable, because it's a universal need, and there is no shared risk

• We can restore the direct, long-term doctor-patient relationship, and reduce physicians' costs, by expelling the insurance industry entirely from primary care.

Solutions

1.  End the secrecy.  We cannot manage our health care costs if we aren’t
     allowed to know what they are.

2.  Prohibit price discrimination.  All the customers of each provider pay the
     same price for that provider’s products and services.

3.  Stop anti-competitive practices like the hospital privileges system.

4.  Train more primary care doctors.

5.  Restrict health insurance to major medical events only, like hospitalizations,
     catastrophic medical events, and medical errors, because these things
     don't happen to everyone.  They are shared risks, and therefore insurable.

6.  Use an average-annual-cost system with monthly payments for our primary
     medical care - after transparency and competition bring prices down so the
     middle class can afford to pay out of pocket, with no employer or
     government subsidies.