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Picture this: You’re
taking a beautiful Saturday afternoon drive and your car breaks down. A
tow truck takes it to a garage, the mechanic takes a look, finds a
problem — a cracked radiator — and says he can fix it. “How much?” you
inquire. “Not sure,” the mechanic replies. “I’ll tell you when we’re done.” A week later you get a bill for $348,925.62. Okay, you can probably figure out where I'm going with this. And
I can already hear you saying that this is nothing like a typical trip
to a US hospital, where patients often have no idea how much they’ve
been billed until they get it in the mail. Most patients are insured,
right? They don’t pay their own hospital bills. And the insurer that
pays has already negotiated costs with the hospital. Insurers are the
ones who need to know how much they’re paying and, for the most part,
they know. I’ll
give you all that. Most health insurers cover most of patients’ bills.
But increasingly, insurers offload health care costs to their membership
in copays and deductibles. Doctors and health systems don’t always like
negotiating with each other, which is why you end up with some doctors
who are out of plan and won’t accept your insurance. That’s where the
surprise bills come from. And who do those surprise bills go to? The
patient. The
Hospital Price Transparency Rule that went into effect in January 2021
is designed to give patients a clear look at how much they’ll be charged
for medical procedures. But a year after the rule went into effect, most hospitals hadn’t complied,
according to a study published last summer. Hospitals and health
systems are trying to implement the policy, according to the American
Hospital Association. The industry group pointed a study that paints a
rosier picture, finding that close to 70% of institutions were in
compliance. So
when I found out I needed to undergo a minor medical procedure in the
next few months, I thought I’d give the rule a test drive. I asked my
doctors how much the procedure would cost. And they had no idea. “It’s
a problem,” says Christine Cooper, chief executive officer of aequum, a
law firm that specializes in protecting clients against medical
overcharging. “Patients are building a relationship with the provider,
and one of the key components of the relationship is financial. How do
you trust a provider who can’t tell you how much they’re charging? It’s
the opposite of price transparency.” I
learned that the hospital has a website where I can request a cost
estimate. OK, that sounds like compliance. But what real purpose does it
serve? Suppose my Saturday drive resulted in a car accident. Am I able
to shop for a fairly priced emergency room with a face full of
windshield glass? The US is home to the world’s most overpriced health system, and by a lot. A recent Commonwealth Fund study
pointed out that Americans visit the doctor fewer times per year than
those in other developed countries, probably because they’re afraid of
how much it’s going to cost. Maybe that’s why US life expectancy ranks
so low and infant mortality ranks so high among wealthy peer nations. Everyone in the US should know how much their health care costs. Until then, we’re all getting taken for a ride. — John Lauerman |