I wrote about the Missouri Health Transformation Act (MHTA) when it passed the Missouri Senate last week, so I thought I would revisit the bill now that it has reached a stalemate in the House.

The primary point of contention in the bill (and the reason it has grown to the behemoth size I lambasted before) is how to insure uninsured low-income Missourians. The House wants to control costs. The Senate doesn’t.

Essentially, House leaders believe that low income Missourians should receive “vouchers” to shop for coverage that meet their needs, rather than receive generic broad coverage by the state. I whole-heartedly agree. If consumers shop around for the best deal, prices will be lower for everyone. This is the real problem with the existing health insurance model. Do you have any idea how much a doctor visit costs? How much does it cost to get your teeth cleaned or to get your appendix out? Honestly, I couldn’t even ballpark these things. All anyone focuses on is their insurance deductible. So if it costs you $100 out of pocket to get your appendix out, do you even care what the true cost is?

The lack of medical price transparency has two negative effects. One, we overuse our insurance because we have no idea what the true costs are and the costs don’t accrue to us individually. And two, medical providers have no incentive to keep costs down if costs can’t be compared. Would you have any idea whether or not your doctor charges a “fair” price? Prices of various procedures could vary widely from doctor to doctor but we would have no idea because our copay would be the same regardless.

The House wants to cover the uninsured in a way that keeps costs lower. It wants insurance providers to encourage competition and to publicly disclose medical costs.

But, as the Saint Louis Post-Dispatch covers in an article in this morning's paper, hospitals, doctors, and other groups are balking at the request.

I’d probably be upset too if I knew that doing so would reveal that I’m charging three times as much as the next doctor to perform the same procedure. That would suck for me too.