Various web sites will let you look up doctors and find out where and when they went to med school, but good luck answering even the very, very obvious questions: how many cases like mine have you treated? What's your success rate? How much do you charge? Do your patients think you're any good? Review sites like Yelp are rocking their world, and they're responding in some cases with lawsuits. This needs to change.

Data on your medical history is overprotected as well, much moreso than your bank balance. HIPAA inhibits research, prevents us achieving integration efficiencies, and imposes an ongoing cost on basically the whole system. This also needs to change. If people are going to enjoy health care subsidized by someone else, it's reasonable they make some concessions in the area of privacy. Besides, at the end of the day, the world cares about your rheumatism rather less than you might like to think.

So what I meant was that even if we can get to the point of having good databases, there's still another hurdle to cross.

Which is another familiar pattern from other industries. As you computerize, rationalize, and centralize, you disrupt a lot of little fiefdoms where people are used to making their own decisions. They fight. Eventually the boss has to come in and tell them they don't really get a vote, and progress is made.

Globally, doctors see billions of cases of everything it's possible to come down with. That data should be put to work, and we should be learning from it. Diagnosis ought to be a finely-tuned probabilities business, and tests should be done based on how likely they are to tell something new. Of course, that can't happen so long as all the data lives in paper folders.

It's true that the outcomes don't correlate in scale with the degree of cost increase, but that's where we have hard decisions to make. I can't imagine that anyone would say that none of this is working therefore we should have the medical profession turn back to the standard of care that we had in the 70s- so clearly we do feel it's 'working' in some sense. I think you could quantify that better if you look at each specific disease category and I don't know if there would be a 5-10% increase in longevity but certainly survival times have increased from the onset of diseases like CAD, many if not all cancers, and diabetes. Looking at overall longevity doesn't work because deaths from violent crime, accidents and suicide will skew dramatically. That doesn't mean that the extra years that we've bought with the medical advances are necessarily worth the extreme costs, but it should be the starting point for the debate on that, so that we can then decide what's cost effective and what's not.

I think you will find that the prices for individual treatments like strep tests or basic office visits have risen considerably without a corresponding increase in quality, and almost all of the increase goes to wages. The problem is not that a few people are getting paid 10x what they used to, despite groups like nurses' unions with a hammerlock on their corner of the market, it's that there are too many people on the payroll. Government keeps minting new regulations, the system keeps getting more complex, and everyone has to hire more people to keep up. The bureaucracy expands to meet the needs of the expanding bureaucracy.

As far as day to day expenses go, it's *lack* of technical advance that has driven up prices. Every other industry has been computerizing records, automating workflow, integrating information silos to drive higher efficiency. The health care industry is dead last to abandon paper-based systems.

Or rather, it will be once it finally gets around to it. I still cannot walk into a doctor's office without seeing a wall-full of patient folders and a staff of two or three people needed to manage them, nor without being handed a clipboard with paper forms quizzing me about my medical history. Compare that with, say TurboTax, which automatically downloads my W-2, bank statements, and sends my return to the government, and settles my taxes via direct deposit (or withdrawal). Healthcare's backwardness is a scandal.

Why wouldn't the increased aggregate 'healthcare cost' be due to use of more services and higher priced services- meaning higher priced not in the sense of inflated prices for the same service that was previously available at lower cost, but 'higher priced' meaning newer technologies, imaging services, etc that are naturally going to add higher dollar amounts to the per capita health care expenditure numbers?

Am I missing something?

Wages are the highest costs in all of those organizations. Note I said healthcare provider not physician.

And you'll do that while I don't fund part of it how, exactly?

If you want to bear the cost of your health care yourself, go for it. That's why God made checkbooks.

Are you kidding? How about hospitals, nursing homes, home health care, physical/occupational/respiratory/speech therapy, radiology, labs, medications, durable medical equipment, etc, etc, etc.

If it does not meet the needs of its customers, it will fail as a business, right? Why are you afraid to let a non-profit model into the market? I think you know your insurance companies couldn't compete and maybe you're stockholders. Who knows why you are so intent on keeping us who can't afford or don't want their crappy and increasingly expensive coverage to try another model. I promise to pay THE FULL COST of covering me. Why are you so anti-competitive?

Shrinking the role of insurance–private or public–and getting people paying for more directly would do wonders for the system. You'd get more people asking, “why are you charging me $200 for a 10-minute conversation and a tongue depressor?” and shopping around for a doctor who didn't. Quality, efficiency, and accountability would go up, prices would come down.

Here's a graph, produced by Wells Fargo Insurance Services, that might convince you. From 1970 to 2005 the CPI has gone up about five times and healthcare costs have gone up nearly 19 times. Remember that according to the JAMA, insurance administrative costs are at most 30% of total healthcare costs. What makes up the rest?

Legal costs and malpractice insurance costs are both in the small one digits so they don't explain it. Drug costs are rising fast but are only something like 10% of the total. What's your explanation. Mine is wages.

Well I told you where my numbers are from, where are you getting yours?