Experiments designed to charge a predetermined fee for common surgical procedures offer a glimpse into the future of healthcare spending.

Wildly different prices for the same medical procedures often leave consumers bewildered and financially ruined. Charges are all over the map. Here in Southern California, the hospital cost alone for hip-replacement surgery typically runs from about $103,000 at UC Irvine Medical Center to $41,000 at Hemet Valley Medical Center. The variation is influenced by myriad factors. Facilities that offer expensive specialty services such as trauma centers, burn units or transplant programs tend to charge more for care. Meanwhile, hospitals often charge privately insured patients more to make up for what they lose on uninsured patients and relatively low reimbursement rates from Medicare. Caregivers and hospitals point out that they receive only a fraction of charges they submit, whether to insurance companies or the federal government. Like the patients they serve, they, too, welcome more predictability. Many providers and insurers say they are now ready to experiment with new ways to cut unpredictable healthcare spending.

In one closely watched test beginning in August, several of California's best-known healthcare providers -- including Cedars-Sinai Medical Center, the UCLA Health System, and Hoag Memorial Hospital Presbyterian in Newport Beach -- will begin charging lump-sum fees for hip and knee replacements. Doctor bills, X-rays, artificial joints, tests and hospital care are among the fees that will be wrapped together for commercially insured patients who would otherwise be charged for each service. The single charge will vary from hospital to hospital based on the fee each negotiates.

The lumped charges for hospitals and doctors will cover most aspects of medical treatment from surgery through 90 days of recovery. That's a radical departure from the traditional practice of hospitals and doctors charging separately for their services, a fragmented system that drives up costs while leaving no one to coordinate decisions about patient care. Hospitals and doctors say they expect to share in savings when patients recover promptly, while bearing the risk of additional expenses when complications arise.

The federal government already is testing similar "bundled" payments for its Medicare program in Colorado, Texas, New Mexico and Oklahoma. And President Obama's new healthcare law calls for exploring additional arrangements for surgical services for the elderly and the poor.

Congressional Democrats have begun pushing legislation giving government regulators greater authority to block big increases in health insurance premiums. The move, which comes less than a month after President Obama signed the healthcare legislation, is aimed at giving all states the power to stop premium hikes deemed excessive and allowing the federal government to step in if the states don't act.

While politically astute, these efforts will not result in lower health insurance premiums. Health plan premiums are a symptom, not a cause of the problem. The cause of high health insurance premiums is high health care costs. State insurance regulators have no control over that, nor over the administrative costs of the insurers. If insurance company profits are abusive, then regulators can pare back profits to a reasonable level. The problem is that insurance company profits are an almost undetectable portion of our $2.5 trillion national health expenditures. Dramatically reducing insurer profits will not even appear as a footnote in the report of our health care spending.

Unfortunately, the medical insurance industry has been and will continue to be ineffective in controlling rising costs. The government must provide the solutions to rising costs, but under the reform model approved by Congress and the President, there are no effective solutions.

What can you possibly learn from your doctor that is not available on the Internet?

The Internet offers unlimited amounts of medical information. Now everyone can now Google primary data published in scholarly medical journals. One might ask, "What can you possibly learn from your doctor that is not available on the Internet?" Indeed, physicians are struggling to figure out how best to use this technology in the interests of their patients and themselves. The Internet is reshaping the content of the conversation between doctor and patient. Some of the past imbalance of power between patient and doctor is being equalized.

Thank God for the Internet

"Thank God for the Internet," a friend remarked after receiving a diagnosis of prostate cancer. He had been given the biopsy results by a urologist, who had offered to schedule a prostatectomy within 10 days. Concerned about incontinence and impotence, our friend searched the Web for outcome data on other treatment options. He made appointments with a radiation therapist, who advised him on the risks and benefits of treatment using implanted seeds as opposed to external-beam radiation, and a medical oncologist, who discussed the pros and cons of "watchful waiting." "I'm still thinking about it," our friend said. "And I'm reading more on the Internet."

I just end up scaring myself

But many patients have not fared so well. One woman with recently diagnosed lupus told us, "I really don't want to read what's on the Internet, but I can't help myself." Her condition is currently stable, but she finds herself focusing on the worst possible complications of the disease, such as cerebral vasculitis. Although her doctor gave her detailed information, she cannot resist going on the Web to seek out new data and patients' stories. "It's hard to make out what all of this means for my case," she said. "Half the time, I just end up scaring myself."

Novel Therapies and Junk Science

Other patients are drawn to online forums and Web sites that make unsubstantiated claims -- assertions that macrobiotic diets cure aggressive lymphoma, that AIDS can be treated with hyperbaric oxygen, that milk thistle remedies chronic hepatitis, and myriad other fallacious claims. Falsehoods are easily and rapidly propagated on the Internet: once you land on a site that asserts a false rumor as truth, hyperlinks direct you to further sites that reinforce the falsehood. Material is perceived as factual merely because it is on a computer screen. Doctors sometimes find themselves in the uncomfortable position of trying to dissuade desperate and vulnerable patients from believing false testimonials. Doctors may be perceived as closed-minded, dismissive, or ignorant of "novel therapies" when they challenge such Internet rumors.

Internet Self-Diagnosis to be Avoided by Hypochondriacs

Patients also consult the Internet in search of self-diagnosis. Sometimes, doing so leads them to seek medical attention rapidly and to suggest what turns out to be a correct diagnosis. But the Web is perilous for anyone prone to hypochondria. The differential diagnosis for backache, for example, led one of our neighbors to fret that he had an abdominal aortic aneurysm. After a sleepless week of worry, he mustered the courage to call his doctor. With a normal exam and repeated reassurance, the backache resolved.