By KIM BELLARD

Even before the war – oops: special operation, excursion, or whatever your preferred term is – with Iran started, people were complaining about how expensive things are. Home ownership for first time buyers seems out of reach. Sure, egg prices may be down from the late stages of the Biden Administration (thank you so much, bird flu!), but most of us are still dismayed by our grocery bills. Health insurance costs what a house might have cost fifty years ago and what a new car might have cost twenty years ago.

The latest findings from the West Health-Gallup Center on Healthcare in America show that a third of Americans have cut back on expenses in order to pay health care expenses. We’re stringing out their prescriptions, borrowing money, even skipping meals to pay our health care bills. Even among those with health insurance 29% are cutting back; 62% of those without health insurance are making trade-offs, and I’m surprised the latter isn’t much higher.

Similarly, Kaiser Family Foundation found that 4 in 10 Americans have not taken their prescription medications due to costs, and 6 in 10 worry about being able to afford prescription drugs for themselves or their families. Even among those with insurance, a majority worry.  

Gallop also found that Americans are delaying major life events due to their health care costs, including taking vacations (29%), surgical or medical treatments (26%), or changing jobs (18%). Even a quarter of those with family incomes over $240,000 report such delays.

Meanwhile, the average cost for a new car hit $50,000 in December (although it declined slightly in January). Edmonds reports that 1in 5 new car buyers have payments of $1,000+, a new record The average new car payments were $772, also a new record. Even the percent of used car buyers with $1,000+ payments hit a new record. If you think you can still find entry level cars under $20,000, Kelley Blue Book says forget it.

And, of course, even once you have a car you have to pay for gas, insurance, and maintenance, all of which are also going up noticeably. Navy Federal Credit Union’s Cost of Car Ownership,(COVO) Index found that the cost of car ownership has gone up 42% since January 2020, going up at twice the rate of inflation.

“Americans are frustrated by Whac-a-Mole inflation,” said Heather Long, chief economist at the credit union. “It’s difficult to plan and leaves middle-class and moderate-income consumers constantly on edge about what will shoot up in price next.”

If you’re wondering why all the talk about cars it is because of a fascinating article by Imani Moise in The Wall Street Journal about a new way to buy – or, at least, to negotiate for – cars: hire a middleman. For a flat $1,000, 33 year-old Tomi Mikula will negotiate for you, using the expertise he gained from a decade of selling cars.

His company is called Delivrd, which now includes five other professionals. Its slogan is “Skip the Dealership, Not the Deal,” and it promises “A seamless, enjoyable car buying experience tailored to your busy lifestyle.” He even livestreams some of his negotiations.

Mr. Mikula pits dealers against dealers, looking for the best deal. Some have started to refuse to deal with him, while others relish the challenge. Even his expertise can’t always result in a good deal; for some popular models, he says, ““You’re paying for me to find you one.”

Here’s the quote I loved: “You’re hiring a middleman to deal with the middleman to make the middleman more efficient,” Mr. Mikula said.

That sure brings me back to health care.

In the Republicans’ perfect heath care world, consumers would control their own money, purchasing services wisely, with transparent pricing. It was a point of contention in the recent efforts to expand the expanded premium credit for ACA, but goes much further. President Trump recently amplified this in his State of the Union: “I want to stop all payments to big insurance companies and instead give that money directly to the people so they can buy their own healthcare, which will be better healthcare at a much lower cost.”

Of course, they always gloss over the huge differences in health care expenditures, where the top 5% of people account for half of all spending.

“Transparency” has been a rallying cry for conservatives for the last twenty years, with some progress but little impact. There are tens of thousands of “services,” each of which have prices that vary by payor, and few of which are meaningful unless you happen to have a medical degree (and, even then, not always).

Even prescriptions, which would seem like something that should be simple, are maddeningly opaque. Is it on formulary, is it in-network (or not only in-network but “preferred”), is it brand or generic?

Cars, on the other hand, are much simpler. A new car model from Dealer A is the same thing as that model from Dealer B. You can easily find the list price, the safety record, the consumer and expert ratings. Even for used cars, you can find suggested price and vehicle history record. All the data you should need to negotiate like Mr. Mikula should be there.

Yet, I daresay, few of us leave a car dealer feeling we’ve gotten the best deal, no matter how much homework we’ve done. The information asymmetry has been lessened, but not eliminated.  Thus the opportunity for “a middleman to deal with the middleman to make the middleman more efficient.”

I suppose we could create an industry of such middlemen for healthcare. They’d have to deal with the problem that the service you buy from Hospital A is not the same service you might buy from Hospital B; in fact, the service you buy from Dr. Z at Hospital A is not the same as the service you might buy from Dr. Y at the same hospital. Health care is not a commodity, and we don’t really know how to quantify exactly what we’re buying.

Middlemen or not.

In theory, health insurers should be our middlemen, dealing with health care practitioners and organizations from a position of more volume and more expertise, but most of us view them as acting more in their own interests. And even those middlemen have hired their own middlemen, such as PBMs.

If we want to make things more affordable, we need more than transparency, and presence of middlemen is a sign that a market isn’t working, not a way to make it work better.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor