In addition to teledoc and walk in clinics, M.D. entrepreneurial activity in the form of quitting networks / cash pay is best of all. Then perhaps we will have more of a competitive marketplace. How can doctors compete as long as they take third party payment based on rigid procedure codes and eg. the CMS or BCBS fee schedules that is uniform for massive service areas? Another challenge is the moral hazard from 79% (not my number but the idea is right) of individual dollars that are spent above the HSA minimum deductible. Incentives to the insured is the missing link to bringing pressure to bear on [hospital] prices above the deductible, and entrepreneurship is certainly the missing link that will prosper this idea.

Steve Bassett

Wealth is only one marker of wellbeing. Health is a vital other marker. So when health is threatened, then the pursuit of wealth becomes secondary, both for producers and consumers. The finest entrepreneurs in the health industry are the researchers who break exciting new ground and make real advances in health. They are not entrepreneurs of classical economics. They are entrepreneurs of wellbeing. Their advances can only be captured by an expanded view of economics.

An obstacle at present is, of course, the complexity of getting repaid from the insurance company that holds your HSA. And, of course, many HSAs don’t have credit cards because no one can tell quickly enough what the insurance company is willing to pay out of your HSA for a doctor in their PPO network. What a mess!

The problem is not FFS per. se., but government or insurance fixed payment for fixed procedures. Let doctors post their prices and let patients pay directly from their health account funded by the government and by their employers and by themselves. And, of course, catastrophic insurance is funded from the same account.

You said somewhere “global competition from medical tourism could have an impact on American health care similar to the impact Japanese automakers have had on the U.S. auto industry” I agree. And how do you think services are bundled through the medical tourism companies? Should U.S. payers and the docs they employ (I’m sure you would say this is a “legal mis-statement”), continue with their inefficent contractual arrangements?