By Josh Stevenson at Brownstone dot org.

[This article was coauthored with Emily Evans, a Managing Director in charge of health policy research at Hedgeye Risk Management.]

Their record isn't just spotty; it is downright awful. The Emergency Medical Treatment and Active Labor Act of 1986 was designed to prevent "patient dumping" by hospitals of emergent patients without insurance.

The unintended consequences of that law are hotly debated. What is not in controversy is the hospital lobby's insistence that the law drives up their operating costs. That argument has done decades of service to protectionist policies that limit competition and protect prices.

Then there is the Affordable Care Act. It was a compromise between advocates of "universal health care" and the "Third Way" or "New Democrats" who viewed big business not as an obstacle to their ambitions but a facilitator. The latter group was successful beyond their wildest dreams. The former is still trying.

In the wake of an unprecedented government shutdown, Congress is taking up another attempt to make the American health care system behave. Unfortunately for the American people, they seem completely flummoxed by the problem. With apologies to James Carville, "It's the prices, stupid."

A simple question of "How much will this cost?" is met with howls from the mandarins of a system who believe there is something so unique, so special about the sale of health care services that we must all support its protection from market realities.

Concepts like "adverse selection" may be foreign to your average American but it and others seem to overrule all other considerations like the impact of health insurance premiums on take-home pay. The economic realities of America's households have been ignored to protect margins at health insurance carriers with the full-throated support of Congress.

Instead of hanging on the prospect of another disastrous policy effort, the White House and Congress should fully deploy the most powerful tool available to contain costs. Health care price transparency is bipartisan - its statutory authority rests with the Affordable Care Act, ironically. Both Trump administrations and the Biden White House have made incremental progress on providing guidance and implementing enforcement.

Thus far. What the transparency data tells us is that health insurance for the young and the healthy is mostly a tax. At one Alabama hospital the discounted cash price for a screening mammogram is $148.33. According to their disclosure the hospital is paid anywhere from $67.55 to $385.28 by insurers.

For the privilege of paying $500 to $1,000 per month in health insurance premiums, an insured woman in Alabama saves $80.78 negotiated by her insurance company.

Mammograms are generally excluded from cost sharing. A knee arthroscopy is not. That same woman in Alabama could pay a cash price of $1,651.33 or have her insurance company negotiate $3,075.26. If Miss Alabama has met her deductible, she will pay 20% of the negotiated rate. If she has not, she will pay the full cost of the negotiated rate, not the cash price.

When wages are growing, health insurance premium increases are less of a concern. That was the case from 2017 until 2022. Add the economy-wide inflation the US experienced from 2022 until just recently and you get what you got, a cost-of-living crisis. Health insurance for the young and the healthy becomes a nice-to-have instead of a got-to-have.

The most economically sound response to the current environment is for the young and the healthy to purchase health insurance with the highest deductible with which they feel comfortable and pay cash for everything else.

The Affordable Care Act's employer mandate makes such rational behavior nearly impossible. Anecdotally, it appears some hospitals actually prohibit cash payment for their services!

There will be no shortage of economists and policy apparatchiks offering advice on risk pools and pre-existing conditions an...