Pennsylvania healthcare remains expensive and imperfect. Is the solution more regulation or less?

HARRISBURG, Pa. (WHTM) — For her first decade in private practice, Dr. Kimberly Legg-Corba of Allentown did what a lot of doctors complain they do: charge patients a lot but give much of the money to insurance companies and other middlemen, while asking patients to do things that made little sense: come back for a separate appointment, for example, even though they were already in her office for something else, because that’s what an insurance company required.

Not anymore.

“I decided to stop participating with insurance and switched my payment model to direct primary care,” Corba explained this week in a webinar organized by the Commonwealth Foundation, which describes itself as a free-market think-tank.

Now, Corba says, she provides whatever treatment she and her patients agree they need and charges prices they both agree are acceptable. She even fills some prescriptions in her office, because why require patients to make an extra stop at a pharmacy?

Dallas Riley, a nurse practitioner, remembers when Berwick Hospital Center, where she worked in north-central Pennsylvania, suddenly closed, and she and a few former colleagues “kind of pulled up our bootstraps and started our own primary care clinic” to fill the void.

They do a lot, she says, but not as much as if they had the full-practice authority their peers have in other states.

Corba’s progress and Riley’s lingering frustration are examples of what the Commonwealth Foundation says something called “the personal option” for healthcare could help solve.

The group says Americans could save money and get better care if they could — for example — shop around for the best price for an MRI and share the savings with their insurance companies rather than simply going where they’re sent in the current Byzantine system.

The system, in other words — in the Commonwealth Foundation’s view — is overregulated. The group does favor rules that would require things like public disclosure by hospitals of what they charge for different services.

Steven Herzenberg, of the left-leaning Keystone Research Center, says there’s nothing wrong with more disclosure. He says full-practice authority is worth discussing, as are other ideas advocated by groups like the Commonwealth Foundation — for example, “no one can really argue with the potential benefits of more telemedicine, particularly in areas where rural health care systems and hospitals are closing” (although Herzenberg is quick to add: “That’s the market at work, leaving big rural areas without any health care delivery.”)

But overall, he said, “Consumer choice in the market works great if consumers are repeat buyers of standardized products like hamburgers and cars” — not of specialized things they use once in a while, like particular medical procedures.

Herzenberg says the answer generally is more regulation, not less. He says the 2010 Affordable Care Act, sometimes known as “Obamacare,” has made modest progress in flattening the growth of healthcare costs and improving access to care — and could do more if it took a fuller form opposed by conservatives.

Herzenberg says specific areas of healthcare like long-term care facilities have made notable progress over the decades, partly thanks to things like price transparency and quality report cards favored by some free-market advocates but largely because of regulations like patient-care ratios. And he said countries with more unified healthcare systems like the ones favored by American progressives have cheaper healthcare costs and longer life expectancies than America has.

Get the latest news, weather forecasts and sports stories delivered straight to your inbox! Sign up for our newsletters .

He said in developing countries, some wealthy consumers get good care through direct relationships with doctors and hospitals, but most people can’t afford that.

Progressives call American healthcare an example of a market failure. Free-market healthcare advocates say America has never given their ideas a fair chance.

For the latest news, weather, sports, and streaming video, head to WTAJ - www.wtaj.com.