Shopping for Care: How to Reboot the US Healthcare System

A response from Sesame co-founder Mike Botta about a recent New York Times op-ed on America's broken healthcare system.

Today in the New York Times, an excellent guest essay by a pair of economists, Drs. Liran Einav and Amy Finkelstein, highlights how America's fragmented approach to providing health care has us spending a lot but getting a little. It's no surprise to those of us at Sesame -- in fact, our CEO wrote about the same themes in 2013's Catastrophic Care.

It's shocking to see that, despite large-scale reforms like the Affordable Care Act, the United States still spends twice as much, proportionally, as other countries for health care. Despite that, we spend just as much of a share of our economy on public financing for health care, compared to countries with universal insurance. We spend much more in total, but have a fragmented system that leaves millions in need.

Even for those theoretically not in need -- i.e., the large number of Americans with insurance -- that insurance is less generous than ever. The authors highlight the startling fact that 3/5ths of medical debt is actually held by Americans who have health insurance!

We have the worst of both worlds: a more expensive system that provides less.

Their solution is a reasonable one: "reboot" American health care. Provide a universal basic health insurance program, and let Americans shop for incremental upgrades - those might be specific services, or new forms of extra insurance

But what readers need to know is that they stand to benefit from adopting these behaviors now. For anyone who lacks comprehensive coverage, or has a high deductible plan, learning to shop for care (when and where that is possible) is critical. You can save money by sourcing direct rates from doctors, labs, imaging centers, and other care providers; don't assume your insurance has negotiated the best discount - they often have not! You can save your own money by getting prices directly from providers. That's what we do at Sesame; we have providers list their direct pricing and availability, so you can find the care you need at clear, affordable prices. And that's a model we think will work for the rest of the nation.

As the authors of this New York Times piece make clear, a system with universal basic health insurance won't solve all problems, but it will give Americans some guarantee that a catastrophic illness won't bankrupt them, while allowing them to shop for the additional services they want and need. What many people don't realize is: for millions of Americans - particularly those with high deductible plans -- they already live in exactly that system. Sesame can help.