The majority of people in the US have health coverage from their employer or from the government, which means patients do not negotiate directly with physicians or hospitals. The insurers and politicians determine the price of care, access to providers, biotechnology, and pharmaceuticals. There is no need for price transparency because there are so many stakeholders involved. Only when the consumer needs to buy care directly, do they need to know the price.

Fast forward to COVID-19 and we suddenly see the system for what it is. Politicians negotiating with suppliers, hospitals without resources, surge pricing, and a confused federal response. This response was entirely predictable based on the framework of the existing system. Physicians, shut down along with the rest of the nation, quickly switched to telemedicine to remain in contact with their patients. While hospitals struggle to care for the critically ill, elective care has been and most likely will remain a second priority. This has created a difficult situation for physicians, both independent and hospital based, as their practices have lost revenue and may not easily recover.

In addition, many people have lost their jobs along with their benefits. Employers will rehire, but can’t if they are out of business. Even the biggest companies are vulnerable and the number of bankruptcies is growing. Patients will need direct access to affordable care, and the old system of smoke and mirrors is no longer viable. The government and the insurers will still maintain important roles, but direct to consumer healthcare will emerge as a major force in the marketplace. The wide adoption of telemedicine and the inevitable shift of elective services away from expensive hospitals toward independent surgicenters or offices has created better and more affordable options, and unlike a two tier system, price transparency is a necessity.

The COVID-19 pandemic has reminded us how important our healthcare system is to our lives and to our economy. We have the best care in the world, yet for years we have been weighed down by the burden of bureaucracy. Yet in a crisis, we answered the call. Perhaps it is time to re-think the system. Negotiate prices only for the big stuff, let the doctor and patient figure out the rest. Both depend on each other and with the right technology, it can be that easy.