A PATIENT’S RIGHTS

It’s Time We Knew the Costs of Healthcare

A while back, my shins were hurting very badly and my sports medicine doctor ordered a special kind of X-ray to see what might be causing the problem.  I made the appointment and the results were inconclusive.   Then, the bill came.  $5000 for an X-ray, not covered by my insurance.  I made a plea to the billing office, got the price reduced in half and created an interest-free payment plan.  Still, the situation brought me up short.  Why didn’t my doctor warn me?  I wouldn’t have taken the test had I known the cost.  Why didn’t the hospital tell me before starting the test?

The problem is that medical professionals don’t know the cost of the tests and treatments they recommend.  They often think nothing of suggesting a great new drug, not realizing how costly it will be.  Commercials on TV push treatments for hepatitis C, a common concern for Baby Boomers.  The leading drug costs $13,200/month, much of which may not be covered, especially if you don’t have the right plan.  Seriously?  I would be considering another approach.

Obviously, if you have a fatal disease with only one expensive treatment, your life is probably worth it to you. But too many of us find out only after-the-fact that we have indebted ourselves to the healthcare system, when we were never offered lower cost options, nor had any idea of what a treatment would cost.  Too many people are bankrupted by necessary healthcare and that shouldn’t be.  We should know prices upfront and be able to comparison-shop.

Still, the Leftist fixes of national health insurance don’t work.  In the UK, where I have family, people wait months, even years for necessary care and often, it is substandard or the person dies before their number comes up.  In addition, free is never free.  Many proven treatments are disallowed under the NHS, so people often opt to pay for their own private insurance to get more options.  (In Canada, it is against the law to have private insurance, so you’re stuck).

How Free-Market Capitalism Works

People have complained about capitalism since it started and yet, it has lifted more people out of poverty than anything else that has been tried or imagined. 

“Capitalism is the worst economic system, except for all the others.”

The way it works (when the government isn’t strangling it with regulations, favoritism to protected industries and other manipulation) is that free people trade money for goods.  When there are choices, people pick the best and most cost-effective choice that meets their needs.  What usually happens is  if you have a great product and it is cheaper than others, the other companies begin to lower prices to compete. We all win.  The other example is when a company has a superior product, despite a high price.  The iPhone has often beaten out competitors for rich and easy-to-use features, until the competitors are motivated to create something even better. 

How do we know what to pick when we’re shopping?  We have price-transparency.  The internet provides reviews, you can see features and how people like them before you buy and there is so much help for most products and services.  In the medical profession, you can see doctor ratings and reviews.  But you can’t see the price.

The Transparency in Coverage Act

July 1, 2022, a new rule was passed to make health insurers disclose pricing for covered services and items. It was mostly focused on Medicare, where people often have setups that limit their costs in any event.

There are a few problems here.  First, consumers have no way to compare prices across different practices.  They can’t opt to choose the best price because, in reality, insurers can control who you see.  The data is presented in a way unintelligible to most consumers.  We have no websites that allow you to input a situation and get out a list of the cheapest plans, with ratings to govern the success and satisfaction with the medical group or hospital.  Think GoodRx, where you can input the name of a drug you have to take and see what the cheapest price without insurance would be.  I know that I frequently do better with GoodRx than with Medicare Part D, so I always check.  And even with the new rule, few are complying.

Plastic surgeons and other optional medical procedures must disclose pricing or no one will consider their services.  There is no insurance for these kinds of elective treatments, so they have to tell you what they charge.  There is no insurance company between you and the doctor.  When Lasix came out to treat presbyopia and myopia, groups competed by offering lower prices to attract customers. This is how we Americans like to shop.  Even in pricey Marin County, when a much-disputed Costco opened (people shouting that the rich residents wouldn’t tolerate such a low-end store), that Costco is filled with customers every day and VERY popular.  Price transparency works.

What We Need

There are loads of ways to vet a doctor or a hospital.  But what we can’t know upfront is the cost.  When you’re sick or injured, you aren’t going to stop and search hard or question your caregivers on the price. And yet, shouldn’t you have the choice?

Cynthia Fisher founded Patients Rights Advocate (http://www.patientrightsadvocate.org), a non-profit dedicated to bring choice to the medical market. Fisher was a major player in the Trump price transparency executive order and tries to work with the Biden administration to pass better legislation.

The free market works.  Wait till you see what happens to your life when free market capitalism extends to the healthcare world.   Maybe you’ll rethink your antipathy to capitalism when you see how it works there.