Stanley Feld M.D.,FACP,MACE
If we are going to be able to Repair the Healthcare System REAL Price Transparency is a must. There is a lot of noise about Price Transparency by hospitals and the insurance industry but it is all pretend. I suspect there is going to be little change in policy until the patients, future patients and physicians as well demand REAL Price Transparency.
Augus Deaton an economist at Princeton tried to be a well informed consumer. In his “Letter from America, Trying To Be A Good Hip Op Consumer” he points out the problems he had seeking good value in his health-care and being an informed consumer. It is a worthwhile read if you want to see what the American consumer of healthcare is up against. Consumer driven healthcare is just talk and will fail unless we want to walk the walk. He points out the lack of available appropriate information and the total opacity encountered when information is limited.
President Bush “Bush Seeks Better Health Care Cost Information” and the people at CMS seem to really want to do the right thing. They will not get better information. Their problem is they are up against a powerful vested interest lobbying machine that has been successful at contaminating every good idea that might hurt them. There is a total resistance to change. The fact is the change might help the vested interest stakeholders. The change would certainly help the consumer of healthcare. President Bush’s only chance will be if we create a public opinion outcry. Once again who is responsible? Unfortunately, we are because our surrogates have let us down.
Medicine is big business and the facilitator stakeholders want to keep control of the big business of Medicine. Checking on quality care was impossible for Augus Deaton. Understanding his potential financial liability was an even bigger chore. Surprise billings were ubiquitous. He could not even know what he was covered for until after the service was rendered. This lack of transparency is ubiquitous in Medicine and not getting any better. Aetna claimed a Price Transparency initiative in 2005. It affected a small group in Ohio and covered only 23 services. This sort of Price Transparency is a relatively meaningless gesture and will not help repair the system. The initiative did generate a lot of sound bite publicity for Aetna at a small cost.
Ohio announced that it is going to publish their hospital DRGs. However, they will not be ready for more than a year. Publishing DRGs does not tell you what the insurance company or Medicare is going to pay for or how much. Wisconsin published their DRGs. It is enlightening but meaningless because you as a consumer can not do anything about the price.
Is this right? My answer is no! We, the people are responsible for making the demand, and demanding it now in an election year. If we are going to be purchasers of healthcare with our own dollars we need to know what we are buying.