In the first Trump White House, I spent my days arguing with PhD economists over whether letting buyers see prices might lower them.
Like arguing with physicists over whether gravity is a thing. I tell that story in detail here.
But after years, and since Spencer and I recorded this conversation only a few months ago, the economists have come around.
In June, the White House Council of Economic Advisers estimated that banning certain anti-competitive hospital contract terms could save workers and employers about $45 billion a year in premiums. Two days earlier, DOJ proposed a settlement requiring OhioHealth to stop using the challenged provisions. Its case against NewYork-Presbyterian remains open.
Welcome aboard, fellas.
But there’s another contract problem I think deserves attention.
When self-funded employers rent a network, those agreements can require them to use the network’s rates - even when an employer and provider might happily make a better deal directly.
Spencer asked whether we should even be comparing networks anymore, or stripping them of their power over price.
Now you’re speaking my language.
We spent a good chunk of the episode on why I believe those restrictions deserve antitrust scrutiny by DOJ, what a post-network world could look like, and why the endgame should be much simpler: providers competing on transparent cash prices.
We also got into my concern that AI in the exam room may be accelerating upcoding, the changes coming for PBMs and fiduciaries, and my “school choice for health care” idea: put far more of the money currently spent on someone’s coverage into an account they control and let them choose how to spend it on care and coverage.
And yes, we talked about Washington’s affection for incremental HSA changes when I’d rather see much bigger structural reform.