Imagine for a moment going to a restaurant that charges a small cover charge, perhaps $5 or $10, where the menu does not list prices but cryptically says that your dinner will probably not cost less than $50. Now imagine you order, complete your meal and upon inquiring for the bill, the waiter politely informs you that he doesn’t know how much your meal will cost and will get back to you in 1-12 weeks. Sounds ridiculous, doesn’t it? And yet that is exactly the system we have devised for taking care of our health care bills. Nobody can tell you with any certainty how much something will cost before or immediately after it is done. The opaqueness of these transactions dramatically inflates the cost of everything, severely limits patient choice among competing practices and adds tremendous difficulty in really understanding medical costs.
How do we solve it? Well that does get a little complicated — because of insurance policy and health IT — but by no means impossible. Two future posts will discuss tiered billing and retail medicine that would go a long way to solving the problem, but in this post I suggest regulation. No practice should be able to perform a service without providing a written estimate as to exactly what it will cost, or a clear time-based hourly rate. This is the standard we hold all other professional services to, and a very reasonable one at that.
Already I can hear providers saying this is impossible because they don’t know how much they will get from the insurance companies ahead of time; that is true. To solve that will probably take another post, but to put it briefly, the specific rate table on a code-by-code and diagnosis-by-diagnosis basis (CPT and ICD codes for the technical folks) between you, your doctor and your insurance need to be made readily available in a public and electronically-understood format (like Excel, etc). That way, different combinations can be compared and you’d know exactly what to expect. Insurance companies are loath to provide this information; they hold it as a closely vested trade secret. But just as we would ridicule a restaurant or mechanic who tried the same tactic, we need to ridicule these parties as well. The time has come for transparency, and only strong regulation will make it happen.
For a similar take on the issue, see: http://www.pbs.org/nbr/site/onair/transcripts/090801c/
Fixing Healthcare in 365 Days 