bobwyman · HackerTrans

It is not correct to say that Medicare "would not allow" online pricing. Medicare doesn't care what hospitals charge. Medicare ignores hospital charges. It only pays what Medicare calculates is a fair price based on what hospitals report as their actual costs. It would be more reasonable to say that Medicare will ignore any posted prices whether or not they are posted online.

bobwyman

13 anni fadiscuss

At hospitals in the US, every payer is charged a different price. Large insurers and HMO's negotiate large discounts which shifts costs onto smaller insurers who get smaller discounts and thus pay part of the costs of their larger competitors. The non-poor uninsured, who often can least afford to pay, are charged the most -- often 5X, 10X or more than what Medicare or a large insurer would pay. In all states other than Maryland, which has state-wide "all-payer" pricing, what you are charged depends more on who you are and how much negotiating power you have than what was done for you.

The solution is to let the "free market" work. Of course, that means we need to regulate the market to fix the existing "market failure." Free markets are regulated markets. (Although not all regulated markets are free.)

All states should pass laws saying that hospitals are free to charge what they want but that their prices must be posted and apply to "all-payers" without discounting. Additionally, states should develop all-payer databases like those advocated by: http://www.apcdcouncil.org/

Much has been said about Medicare in the comments here that isn't quite accurate. The reality is that Medicare ignores hospital charges (except in Maryland) and pays according to their own calculations of hospitals' costs. In most cases, that means they pay much less than they are charged. However, in some cases, it means that they pay more.

For some additional background on this issue, from a New York perspective, see my PDF on the subject linked to at: http://bobwyman.blogspot.com/2013/04/RFC-FRAND.html

bobwyman

17 anni fadiscuss

Eugene, I wasn't actually a formal member of the standards committee, however, since my products at DEC (ALL-IN-1 mail, etc.) were some of the earliest to use ASN.1, I was very involved in the standardization process. ASN.1 is everywhere whether or not people realize it. Just about all telecommunications systems (cell phones, etc.) use it internally. As you say, SSL uses it -- since public key certificates are encoded in a form of ASN.1 also the IETF SNMP protocol relies on ASN.1. Other examples would include X.400 and X.500 standards and the LDAP which is a simplified version of X.500. You may be interested to know that internally at Google, we use the "Protocol Buffer" format instead of XML for all internal processing. That format is, like ASN.1 a "tag/length/value" binary encoding. For more information see: http://code.google.com/apis/protocolbuffers/

bobwyman

18 anni fadiscuss

The reason there are few Googles or Microsoft's, etc. has more to do with the structure of competition and markets than it does with the factors outlined in your essay.

The reality is that the companies that grow largest are those that foster the growth of an eco-system of smaller dependent companies. The large "focal point" companies, by the nature of their particular market disruption, create opportunities for others to grow new businesses or do old businesses better. But, at the same time that they create opportunity, they limit it (intentionally or not) by ensuring increased competition for the dependent companies.

Creating opportunities means lowering barriers to entry and lowered barriers means increased competition, lowered returns and limited capacity to grow as large as the "focal point" or "platform" company that creates the opportunities.

If anything, VC's have been too liberal, not too conservative, in funding companies. I recently wrote about this at some length. Please consider reading my post at: http://bob.wyman.us/main/2008/04/liquidity-and-c.html

bob wyman