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I lost my health insurance the other day – and I'm not going to look for it.

I have reason to be very glad this didn't happen last year, given the cancer-for-Christmas gift I received at my mammogram last December.

Now that I'm in the self-pay column, I called the imaging practice where my next mammogram will take place to ask what the cost would be.

I have seen Explanation of Benefits (EOB) statements from my insurer – when I had one! – that listed the above-the-line cost as $600 to $1,000. Then there was the 'negotiated discount', and the other horse-trading hand signals that brought the cost down to around $350, which the insurer then paid the doctor.

Every EOB I've ever seen had this sort of dance on it – high initial cost, the insurer does a 'look what a great deal we got for you!' discount jig, and hey-presto, the final price is reduced by 50%-or-more.

So, when I called the imaging center, I was bracing myself for sticker shock.

I did get sticker shock, but in the other direction – a screening mammogram is $135, a diagnostic mammogram runs $120-$180, and ultrasound, if necessary, adds another $75.

Meaning the worst-case cost scenario is….$255.

Mention health care in any circle, and you'll hear cries about costs spiraling out of control, of doctors who lose money seeing HMO patients, of hospitals taking it in the shorts on equipment and supply costs, of patients paying $200 for an aspirin (I guess that's 'cause a nurse delivered it in a little paper cup?), of that last week of dad's life when his hospital bill hit $100K.

Here's a question – could it just be because of managed care that costs have managed to careen out of control?

I'm old enough to remember that, back inna day, you went to the doctor and paid for your visit on the way out. 

If you had a prescription, to went to the pharmacy and got it filled…and paid for it.

Needed lab work? You went to the lab, and paid the bill when it arrived.

You had insurance coverage against the day – which you hoped to avoid – when you'd have to go into the hospital.

Here's a suggestion for Tom Daschle, and the incoming Obama health care team: you don't need to invent a new system. Just go old-school, and add technology to it. Give consumers control not just over their care, but its cost.

When you're in the exam room with your doctor, thanks to managed care that's you, your doctor, and fifty people you can't see involved in decisions about your medical care.

That's fifty people who all want their 'taste', who add their cost – for administration, for oversight, for just taking up space in the transaction – to the cost of the actual visit.

That's the first way to attack cost – admit that the Great and Powerful Oz, the whole 'managed care' monolith, is really just a venal clerk behind a curtain who's inserted himself into the medical care system.

Putting patients back in control of their own medical care – really – would not just help control costs, but it might also drive actual patient ownership of their health. Now there's an idea.

So here's a suggestion – kill managed care. And don't have a funeral.

That's my story, and I'm stickin' to it…

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