Volvo-driving, latte-quaffing New Republic editor Jon Cohn has passed over David Gratzer’s latest gaffe. Gratzer is the Manhattan Institute’s resident Canada-basher physician. Believe it or not, the article in the Weekly Standard is called Putting Patients First. Either Gratzer doesn’t realize who used that title before or he’s being heavily ironic with his title, as it was the tagline used by Tony Blair’s left-wing Labour party in the UK as the rubric for his health reforms in 1998 — and that was when Blair was just another socialist before he became a messianic crusader and the darling of the American right.

But taking shots at Gratzer is too darn easy. He again claims that HSAs will bring consumer forces to bear on incomprehensible health care pricing schemas. Maybe, but the example he uses is that of his uninsured wife’s hospital bill. Leaving aside the logic of why a supposedly bright guy who is an MD would allow his wife to be uninsured in the first place, he claims that HSAs would be the solution to the incomprehensible pricing that is anyway “negotiable”.

Well the answer is that hospital bills and prices are “negotiated” but they’re negotiated by the people who pay them, who are almost always third party payers — either insurers or the government. (I grant that he might not think of Medicare’s fee schedule as being “negotiated”, but it is after a fashion). And there is lots of negotiations between the two sides, and no one uses the hospital chargemaster much as a basis for that. High deductible health plans, which go along with the HSAs he’s talking about, have a deductible that is basically wiped out immediately by a hospital admission, leaving the patient no incentive to negotiate. Any negotiation happens between the insurer and the hospital — that’s one of the things you “pay” an insurer for. It’s possible that wealthy and uninsured people might start to negotiate more than they already do,but I can assure Gratzer that this isn’t big enough of a population for hospital administrators to care much about. Of course they will happily tell anyone who listens that the poor uninsured don’t pay their bills.

And of course Gratzer doesn’t even get close to talking about the basic math problem that he, Hubbard, and all his ilk continue to ignore…