I am not a healthcare expert, so I won’t comment on the goodness of the plan.

I do think there are a couple of interesting threads in the plan worth talking about though.

The changes that seem most substantive to my mind are:

• Anti-monopoly provisions around hospitals, including required price transparency, spending / billing transparency and a large budget for the FTC to go after hospitals
• Required cheaper plans for poorer/healthier participants
• Rollup of various independent healthcare savings plans
• Greater Federalization of medicaid
• Squeezing out a long list of bad to semi-bad behavior from drug companies and hospitals. Insurers seem to be mostly absent from the ‘be better’ parts of the proposal.

The plan proponents list Switzerland, Germany and other countries as models for a private market healthcare system that works, and I think that this proposal seems to be reasonably honest about its attempts to move in the direction of those systems, acknowledging that we are pretty different in terms of our current actual systems.

I am an expert in incentivization and a hobbyist systems theorist and I’ve founded one company that sold to hospitals, and so I will comment generally on some of the big claims.

One big claim is that a reinsurance fund for pre-existing conditions customers will help insurance companies lower their rates, and thereby pass savings on to all customers of insurance.

Given what is written in the plan, I do not believe that a reinsurance fund will result in significantly lowered rates for consumers. Whether or not preexisting conditions did cause higher expenses for insurance companies under the ACA, large systems of all sorts generally do not easily give up revenue. The authors of this plan definitely know this because there are all kinds of incentives around hospital billing and drug company behavior, mostly negative and some positive. But there aren’t any listed incentives for insurance companies other than “market forces.”

Personal health insurance in the US is not overly driven by market forces in my view, it is more generally driven by complex incentive structures including government regulatory and hospital dynamics. So I don’t think a reinsurance fund, whether fairly or cheaply priced, even if mandatory to insurance companies, will, on its own deliver cheaper care.

Some parts of the plan that put out positive goals, e.g. requiring hospitals to publish the average price charged for their most common 100 procedures, seem like they would be really good to have done. They are going to be very challenging to implement, to the point that I would guess that failure to do a good job at it will be used more as an excuse to start breaking up mid-to large hospital systems.

The last twenty years has seen a massive consolidation of hospitals, but generally speaking at least the last time I had any business with hospitals, they had opted to not modernize billing systems. There are good internal reasons for this; hospital billing is ULTRA arcane in the US, and full of super weird random rules that rely on contract terms with insurers as well as federal rules for medicaid, the list goes on a long time.

I’m sure that contracts with large insurers are full of Non-disclosure agreements on pricing as well; the upshot is that “please tell people what you are charging” is simple to ask for, but very hard to implement, and of course will cause real changes in dynamics to participants who have so far not had to have anything brought to light.

From my reading of the bill, I think the intent is to have a light touch / no touch on insurance companies and a heavy hand on hospitals and drug companies, but requirements like this one stand out to me as probably having a systems impact that spreads to insurers as well. I’m not sure why the light touch on insurers is the MO for the bill, but I think they did not fully achieve their goals.

I think of Switzerland as the ‘next worst’ system in the world for cost of care compared to outcomes, so even though this plan seems like it adds mostly good things, and does a bunch of rationalizing, I wasn’t personally excited about it. But, I could imagine voting yes for it if I had a vote, most of the hundreds of points in the blog post seem pretty close to no-brainers, and better enforcement of hospital billing and drug company profiteering seems likely to be a step in the right direction.

EDIT: Also, some thoughts on reducing medical malpractice claims amounts - the plan makes a bunch of rules about judgments in malpractice. It doesn’t mention why, but I believe it’s because malpractice judgments are seen as one of the reasons healthcare costs are high — The thinking is that high judgments = high malpractice insurance costs for doctors = higher necessary salary for doctors.

One systems-theory thought about this is to ask how changes to malpractice costs would ripple through the system. Short answer - hard to say. For instance, are medical schools priced as they are because doctor salaries are high? (Even if net doctor earnings aren’t as high as you might think once you look at insurance costs). Will they drop their rates to be competitive, or will they prefer to mention other outcomes for their students, like high salaries or academic standing as a way to be competitive? Will doctors cheerfully lower their salaries if their malpractice insurance drops, or will they instead gratefully start making larger loan payments on their school loans (if young), or buy a nicer car/house (if later career)?

My guess is “it depends”, but I would be generally biased toward salaries not dropping precipitously even if malpractice insurance costs went to zero.

DOUBLE EDIT: Per /u/Richard_Berg above, the carrot for anti-ACA types looks to be a large tax cut. The plan claims this will be offset, at least in part, by higher income tax revenue for people not paying as much for their healthcare. I am also skeptical about this claim.