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Why doesn't Jim ask where the anti-trust charges are out of the Ohio AG?

I don't personally know Jim, so I guess that I can't say. If I get involved in this issue, I may ask him. I also wonder if you're interested in getting involved in more local efforts such as this. More to follow on that...

I appreciate your reasoning that many health industry practices appear to violate the logical interpretation of existing laws. However, my non-professional take on law is that custom establishes law as much or more than logical reasoning. A law that fails to be established, whether generally or in a specific setting (such as is the case in the current matter), ceases to be law. One approach: we can address the situation by reviving the previous law. Another approach: I think that it is reasonable to proceed with establishing new laws that more specifically address issues that have been neglected by previous laws (whether in their logical formation or their enforcement).

On the matter of my question to whether you would get involved in a state issue such as Ohio's pending law: my perception is that you appear fixated on solving issues on a national level. And I get it. These are national issues. Yet you also appear to share my skepticism that the federal government is too corrupt and dysfunctional to act on any real solutions.

So there is a practical consideration. Maybe state governments are more amenable to creating and enforcing common-sense laws. Or more local: municipalities or even non-government community movements could act effectively. Imagine if a community joined together to pressure their doctors to quote prices prior to services. Could that serve as a model to be replicated elsewhere on a grass-roots level?

I intend to play a small role in this kind of grass-roots effort. As background: a doctor recently recommend some ENT procedures for my daughter. He played the victim that his group's out-patient surgical facility recently dropped out of network. He further quoted some (ultimately bogus) numbers about hospital surgical costs to pressure me to pay cash to his group's facility. You can imagine the hoops that I had to jump through to learn that the estimated out-of-pocket cost of his facility would be $5000. For him to do the surgery at a hospital: $1400. I found a physician who can do the procedure at an out-patient facility that remains in network. Cost: $400.

I plan to return to this doctor and tell him that I hold him accountable for his role in these troubles. He is NOT a victim. I accept that solutions do go beyond just his efforts. But I hold him responsible to work to fix his practice. Of course, he has irrevocably lost my business...

Karl, I also believe that there are ethical considerations to promoting changes from more local level. The federal government WILL do us harm far beyond what I've seen you envision. To accept the false premise that solutions MUST be imposed at the national level is to fail to check the destructive mechanisms that the United States and other world governments are wont to take to cover up the deleveraging that we all know MUST happen.

I hope that my local versus national prompting isn't too far off topic. I do respect the work that you do. At the risk of going even more off topic and taking kind of a philosophical approach, I believe that it comes down to enforcing market mechanisms at macro levels (national, global) while recovering more socialistic attitudes within our communities. More concretely connecting to your ideas: I believe that the federal government tax lien idea, if it could be implemented, would be counter to your aims. It would dilute the market-price signal of medical pricing. I would much rather see communities step in to assist individuals who are unable to succeed in the market.

Again, I love the thinking and passion that you put to these issues. I don't mean to be presumptuous to suggest a change to the focus of your message. I'll continue to be an interested reader if you retain the same message and focus that you've been on.