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Insurers like to portray themselves as gatekeepers who help prevent runaway prices for medical procedures. After all, if they pay less for medical procedures, their costs are less, which theoretically should mean more profit. In this model, the insurers and patients are aligned in wanting low prices at clinics and hospitals.

KFF Health News published a piece explaining that the incentives that insurers face might actually tilt the other way. After providing examples of seemingly outrageous prices, the article explains that "Insurers aren't incentivized to lower prices, because high prices mean they 'get a slice of a bigger pie'... when prices rise, they can pass on the increase to customers in the form of higher premium costs... [which] mean less money for the patient and more profit for the insurer." The article notes that "Medical inflation has steadily outpaced general inflation for years, with bills for many brief, routine procedures reaching tens of thousands of dollars." Patients are affected by the high prices because even with insurance, they often need to pay the deductible or co-insurance, which can amount to several thousands of dollars.

KFF Health News highlighted a Family Connects program in New Orleans, where the city offers mothers of newborns free home visits by nurses. "The nurses arrive with diaper bags filled with newborn essentials, from diapers to nipple cream. They weigh, measure, and examine the babies, and check in with the mothers about their health and well-being. They offer referrals to other programs across the city." As background, "Louisiana is among the worst-performing states in maternal and infant health outcomes," giving officials strong motivation to try a different approach. Research based on the Family Connects programs in other communities show promise: reduced trips to the emergency room, earlier diagnosis of postpartum depression, and cost savings ("Research on North Carolina's program found that every $1 invested in the program saved $3.17 in health care billing before the child turned 2.").

This intervention seems like a positive policy development, in which an early investment yields better patient health and fewer costs later on. This idea has been the premise for other programs as well, but the results do not always fulfill the initial goals.

Providers have been required to publish some pricing information, under the theory that patients armed with better knowledge will naturally select better options. KFF Health News published an article on why pricing transparency efforts might have not gone as smoothly as hoped. One reason is low compliance, with "only about a third of facilities had complied with the regulations" after ten months of the policy being in effect. Another reason is that the data is difficult for patients to use. Lastly, even if this data were readily understandable, it is unclear the extent to which patient selection of healthcare services relies on other factors, such as physician recommendations. Interestingly, the article noted that "Research shows that transparency policies can have mixed effects on prices, with one 2024 study of a New York initiative finding a marginal increase in billed charges."

One of the reasons that companies might not have developed tools for patients to use to easily compare prices across providers is that there might not be a strong enough of a business model to support such efforts. As the article points out, "Two babies might be delivered by the same obstetrician, for example, but the mothers could be charged very different amounts" -- meaning that a website that compared prices could at best offer a range, which ultimately might not be that useful to patients.

Much alarm has been raised about the expiring subsidies for health insurance (specifically, the plans bought off the Affordable Care Act marketplaces), with some people effectively experiencing premiums that doubled. KFF Health News reported on an observed drop of 1.2 million enrollments, which is better than one forecast of 2.2 million. However, the final numbers are not final, since some people might have renewed but find themselves unable to pay for the pricier premiums and those cancellations will become realized later. A few states used state funding to offset the increased premiums, with New Mexico fully replacing the reduction of federal tax subsidies.

One political party was willing to shut the federal government down last fall over the expiring subsidies. It seems that as people face the much higher effective premiums, the other political party might suffer some loss in popularity.

There is a shortage of primary care doctors, and KFF Health News reported on some organizations' attempts to integrate technology to address that shortage. The newer aspect of this movement is to use artificial intelligence (AI) to interview patients and automatically suggest diagnoses and treatment plans, streamlining some work for primary care providers. The second step is that patients can meet primary care providers virtually, expanding geographic reach. The person who was profiled in the article noted that "I think I got an appointment the next day or two days later... It was just such a difference from being told I had to wait two years." Interestingly, researchers have found AI "to be slightly better at identifying 'critical red flags' and recommending care based on clinical guidelines, though the physicians were better at adjusting their treatment recommendations as they spoke more with the patient."

This solution seems to alleviate some short-term challenges, but the current state seems inadequate for long-term care. The technology could improve, or society in general could invest more into primary care. It is perhaps not surprising that some of the primary care doctors who were interviewed wanted organizations to adopt a different approach: "they want less spent on AI and more used to attract and increase pay for primary care staffers". As self-serving as their proposal might sound, it is probably the case that the pay disparity between physician specialists and generalists should be narrowed.