As I often do, I recently attended a public meeting of our Department of Commerce and Insurance, moderated by our Commissioner. As a member of the NAIC and an appointee to their executive committee, she was very proud of the work they were doing. The feds charged them with overseeing the suggested writing of the regulations regarding the rating practices of the insurance industry. It was clear that insurance companies should expect the toughest scrutiny possible as a result of their suggested word smithing. Overlooked by the feds, and the NAIC, is the fact that most of the fraud and abuse in the healthcare system has come from the provider side - can you say HCA Medicare - including multiple doctors billing practices.

The truth is, and government will never understand it, charging more for something than it should is not a crime; unless there is a mandate and government regulation. Tote-Your-Note car dealers have been doing it for years. Your down payment is what they generally have in the car. Everything else is profit. Is that wrong? No. It is commerce. It is establishing what something is worth. How do you do that in America. I asked my son-in-law, an expert on baseball cards, how much a particular card was worth. His response, "What ever someone will pay for it." How does that apply to health care costs?

Almost no one asks a provider what something costs. Why? They know their cost, their deductible or copay. They don't need to know what it really costs. The insurance company, or actually the employer providing the benefit, pays the real cost. The provider establishes what they will charge based on what the insurance company will pay or the government in the case of federal programs like Medicare and Medicaid. Who oversees this establishment of cost? The provider community and their professional societies. Are they being overseen by the NAIC? No.

This is another argument for why it is imperative that both sides of this equation be addressed, finance and delivery, if we are to ever fix it.