Victoria Colliver of the SF Comical has been doing some excellent reporting on insurance rate hikes that has manged to call politicians like Diane Feinstein into something almost but not entirely unlike real action.

Well, no good deed goes unpunished and she has now been assigned to work with the Comical's beltway maven, Carolyn Lochhead, to bring us the real story: The huge nationwide insurance companies had to raise their rates by 30% to 40% because cartels of doctors and hospitals managed to raise their rates by something like 6% over the last year. Insurance companies are just passing on the costs.

Wonks Anonymous would dearly like to provide a link to this article and encourage people to hit the Comical's web site and bring in ad revenue. Unfortunately it is currently a dead tree exclusive. Memo to the Comical: I would work on making my website more user friendly. Better comment utilities would be a good start.

Doctors can do this because medical pricing is not transparent - there is no well established fee schedule for all of the various components of a coronary bypass operation and nobody posts their price lists on the web.

Plus we all need high deductible health plans because:

Consumers have almost no control over costs, no ability to shop and little incentive to do so because most patients neither buy their own insurance not pay their medical bills directly. But they foot the bill in skyrocketing premiums, deductibles and co-pays.

Next we hear from Keith Smith " an anesthesiologist and co-founder of the Oklahoma Surgery Center in Oklahoma city", who "posts his prices online." He feels aggrieved because Preferred Provider Organizations have become cartels who force insurers to avoid his fine institution.

Memo the Keith Smith and Carolyn Lochhead: A Preferred Provider Organization is a list of doctors who are all preferred because they will accept whatever it is that an insurance company is willing to pay them. Usually they belong to more than one medical group.

No mention is made of the fact that Dr. Smith can offer low rates for surgery because his facility has no emergency room and is therefore free to refuse service to all but paying customers. No muss, no fuss, no unpaid medical bills.

Yes medical pricing is a mess and some medical groups have power to set prices. When you are sick a doctor can have his way with you.

Posting all the details of pricing on the web and making us pay the bills directly is not going to make it all better. We are not in the market for cardiac testing, stents and surgeries. We are seeking care for our ailing hearts. Any pricing system that breaks this care down into component parts is pure fiction. It is like breaking down a muffin into its component parts - flour, sugar, blueberries lard and so on and presenting an itemized bill.

Besides, if nationwide health insurers are not powerful enough to bargain down rates for these medical groups how are individual patients supposed to do it?

If hospitals and medical groups have become so powerful then we need to pay them for comprehensive care. This means that everyone pays a fixed fee to an organized group practice. For example, the doctors of Brown and Tolland work together with say Sutter Health to form an accountable care organization. We pay a premium and they give us medical care with little or no out of pocket payment demanded.

If a medical group increases the services they provide they still get the same fee.

This creates two problems. First, large medical groups are effectively offering health insurance which leaves no room for fine health insurance providers like Anthem. Second, if we do not carefully measure and price the medical services consumed by patients then we have no way be sure that sick old people pay for to support the medical system in proportion to their illnesses.

And we would not want to make the golden youth, who will never be old or sick enough to use medical care, pay for such a thing.