Here are three different ideas that are about what we do, for whom, for how much.
The first one is about a difficult reality: We spend vast sums on heroic measures trying to save frail elderly people who are very near death, people that everyone involved knows are clearly dying – big operations and invasive procedures that often not only do not help them, but actually hurt them, make them suffer more, prolong their agony, often against the patient’s true wishes. We need to change our expectations, and our standards of appropriate care, at the end of life.
Second, it may surprise you to hear that we could save money by banning discounts. How would that save money? Hospitals have a price for everything – and then they quietly negotiate deals with every insurance company, giving them huge discounts. If you walk in without insurance, you will likely pay two, three, even ten times as much as the insurance company for the same procedure. For railroads, and other “common carriers,” that has been illegal for over a century. If you are going to give discounts, give them to everyone. We need to get all the prices out on the table, which means making them real, and the same for everyone. No one can ever save money on anything if they don’t know how much they are paying for it.
Finally, instead of offering common procedures piecemeal, so you end up with a long menu of extra costs, they should all be bundled into products, the way other industries do. Like this: you need help managing your diabetes? That’s a subscription, it costs this much, and it covers anything needed. Need your knee fixed? That costs this amount, including everything from the MRI to the re-hab. Going to have a baby in our hospital? Costs this much, everything included. And – here’s our warranty – if we do something wrong, if we have to do something over, if you get a hospital-caused infection, we’ll fix it at our expense. There are people in healthcare already doing this, and it’s working. You can’t guarantee that the patient will get well, but you can guarantee that you use the very best known practices every single time. This brings down costs as doctors and hospitals compete, just like other businesses, to bring you the best product and service at the lowest price.
So: Change the standards for care at the end of life, ban discounts, and put procedures together into packaged products with prices and warranties.