I analyzed hospital price lists so you didn't have to

This is the one that's simple to enforce. No price, no bill.

"No, the solution to most social ills in America is to simply not be poor. If you are poor, stop "

In healthcare not being poor is sufficient. You actually have to be quite well off in order to not worry about cost.

Wrote Hacking Healthcare for O'Reilly, created ClearHealth/HealthCloud open source EMR, managed health systems for 15+ years, blah, blah, blah.

It is very good there is are the transparency regulations. It is worth briefly explaining some of the reasons why many facitilities are having a hard time complying. There are some bad actors, absolutely true. However "Hanlons Razor" -- never attribute to malice that which is adequately explained by stupidity -- definitely applies.

Many health systems are a lot more like "medical malls" than they are single monolithic enterprises. Lots of health systems use really, really old technology and also a lot of it from a company called "Epic". Epic does what it wants, when it wants and there is basically nothing anyone can do about it. There is rarely one central consistent mechanism and source of truth for pricing data because it gets generated from a complex web of different entities, systems, and processes. Herding all those cats is why it can take a health system a long time to comply. And also why a fine of even a million dollars can be small potatos vs the cost of actually complying in a timely manner.

Just one facet, MUMPS is a widely used technology which you probably haven't heard of and which very few technologists understand. Lots of people are struggling to create new code to meet the new regulations using 1970s era technology including MUMPS.

Another, a lot of health systems have been around a really long time. The insurers they work with also, (since the 1960s at least). They have Electronic Data Interchange EDI relationships built on the standard called 837. Business logic that surrounds pricing and billing is often buried in 50 years of tech debt. Everyone is deathly afraid of making too many changes too fast because when those systems break the money stops flowing and a health system will literally go insolvent. People still have hard physical lines connected to Medicare mainframes.

This is a similar situation to other regulated industries like banking, airlines, etc. Modernization is hard, time consuming and very expensive. These regulations are a good driver for all that, but it takes time. Having been in some of these boardrooms there is not typically a cartel of evil executives figuring out how to screw patients. A lot of the time it is a group of relatively normal people trying to hold up a technological and business process house of cards with chewing gum, paper clips and hope.

Disclaimer: I have been involved with the development of some of the fee schedules and health systems mentioned/criticized.

Here's a solution: Let doctors be doctors and not glorified algorithmic-assembly-line workers. Incentivize transparency through something better than Yelp reviews. Incentivize diagnostic outpatient facilities, make them more accessible and discoverable. Especially through telemedicine if possible, but make sure they can be seen in person by someone competent if needed.

I'm sure I'll get downvoted here for this part, but government shouldn't be micromanaging care standards, even through a proxy like medicaid and medicare claim criteria. Let the citizens regulate the system instead, and government's job should be to make it easier for them to do so.

Yes, transparency can come through price lists, but prices can never go down until quality goes up first. It's just like code quality: If it's bad, you'll have to spend more time dealing with technical debt than it would have been to invest in the quality up front. Bad medical care breeds more complicated patient situations, and the rate of seriously ill patients increases as a result. Supply cannot keep up with demand.

Analyzing price lists, shaming providers into lowering prices, etc., will not solve this, nor is that idea even novel. But it may be useful as a single part of a more comprehensive strategy to solve the root of the problem.

It's great for business, especially since Michael Moore's documentary made it politically incorrect to deny medical claims for terminally or seriously-ill patients. Still bad for life expectancy, but we'll probably need another "groundbreaking" documentary before the country really wakes up to the scheme.

And for Christ's sake, stop training doctors to ask "what are your symptoms" (when they are already reasonably aware of what the type of issue is), and use more yes/no questioning about specific symptoms. If doctors can't be trained fast enough to be able to do even that, I'd think about fixing that, too.

What is the penalty for non compliance?