pocketero-dan

That's an interesting proposal: make it free for members and eventually build enough membership that providers are actively wanting to join the network for a monthly fee.

To be clear, I'm happy with any pricing model that accomplishes the goal of helping people who are stuck paying out of pocket for healthcare. But charging providers doesn't seem viable because providers seem quite un-motivated. In fact, Pocketero's biggest challenge right now is getting providers to reply to invites to join the network. Not because they are opposed - they are willing to join if we can speak to someone. Rather they are overwhelmed with customers. They don't reply to emails/faxes/voicemails, they only seem to join if you get them on the phone and walk them through it. Because they are so un-motivated, part of my pitch is "it costs you nothing" - hopefully leaving no possible objections to joining.

But you pose a good question: "those who cannot afford healthcare are they in the position to pay monthly"? I'm starting to think sponsorship is the most viable model - small businesses, churches, etc. paying for memberships en masse. I just added the sponsorship feature on Monday, and may soon pivot the homepage to focus on sponsors. What do you think about that model instead?

Not exactly. It's more like, "You pay in cash either way, we charge you $10/month so you can get the best price instead of the worst price." (It's often a difference of 4x.) This way more people can afford to get the healthcare they need.

Proposed colossal change: a common practice of paying for healthcare out of pocket, instead of through healthcare insurance.

Yes, this sounds unreasonable right now because prices are so high. But bear with me for a second.

Most healthcare in the US is paid through insurance. Insurance creates moral hazard. Insured patients generally don't even need to know the prices of what they're buying, much less negotiate those prices. And here's a dirty secret: insurers don't care much either. They simply add a margin on top of their actuarially-forecasted cost. So healthcare prices rise dramatically over time, because relatively few people are directly exposed to them and push back on them. From this perspective, healthcare insurance is a problem, not a solution.

Don't get me wrong, there are admittedly some obstacles to patients paying out of pocket right now. My point is that we know properly functioning markets set fair prices, and we know our healthcare market is dysfunctional. Healthcare insurance plays a part in that dysfunction.

Patients negotiating directly for better prices eliminates moral hazard and restores market function. Strategically, that would finally restore pressure on healthcare providers, who have become accustomed to raising prices with very little push-back. Without some kind of push-back, providers will continue raising prices - because they can.