Crazy Nite, huh? What it takes to Survive: Proof that Healthcare is Not Complicated

Another sunny day in San Diego and business as usual. Last night on the other hand was a different story. I woke unexpectedly in the middle of the night to find I was starved and needed to act quick. I urgently researched local grocery stores that were open late hours. I was not quite sure what food I needed or what store would carry the food so I took my chances with the nearest one. It was like an episode in the Twilight Zone! When I parked in the lot I realized I was not alone, there were countless cars in the lot. Wrapped around the building in a snakelike pattern was a line of people waiting to get in.

A few hours later I made my way to the front and was greeted by an employee. He informed me I would be in good hands and needed to answer a few questions to better evaluate my needs. He asked for my patience as he described to me an expert would be of assistance to help make an informed decision as to my next steps. The expert arrived with a cart filled with groceries and explained her assessment assuring me the goods were perfect for my situation because a group of super talented vendors provided the quality products. The cart was neatly organized in those cool, environmentally safe plastic bags you see on Cheddar posts, and were loaded into my car. I drove home, unloaded my groceries, ate and felt much better.

A few months later I got a bill in the mail for a couple thousand dollars, negotiated for a few more months with a company that offered to cover a portion, paid the remainder, and went on with my life. In the year leading up to presidential elections in the US, healthcare becomes a key variable of debate and for good reasons. Hundreds of doctorates contemplate models in attempts to close loopholes of fraud, over-utilization and medically unnecessary claims developed by strategies from the tens-of-thousands of doctorates/masters/bachelors/other on the business side of the equation. Medical doctors apply education, training, and experience fulfilling orders while still being directed by Boards, Executives, Corporations and margins. Patients who receive the actual goods and services, are simply incapable of making informed decisions.

In a tech-era where we are all experts at everything, I know we need support to guide our decisions. As government and commercial business strategize over various game theories to gain a competitive edge, the Patients are the ones flipping the bill in some form or another. One thing that never made sense to me as I learned the industry of healthcare was how prices were never part of the equation at the time of service. In a world of big data, AI, and decision-making software, somehow it is impossible to let a patient know a cost comparison of alternative options on the spot.

I get it, there are uncertainties of what can and cannot be covered based on diagnostic codes, etc. Medical doctors are not billing experts, but if there is logic to the outcome of the exchange then there are real-time cost-comparison estimates that may be predicted before the patient leaves the grocery store. Couple this with the Singapore model of savings and voilà, we have a system where patients have a choice in the decision-making process and prices are driven by the market. Since health insurance is regulated by government then there must be regulation in the hidden scheme of payment, partnership, and profit.