"You know, for kids."
That was the best gag line in a lesser-known Coen Brothers movie called the "Hudsucker Proxy." Tim Robbins would say that to sell his idea for the hula hoop--while holding up a circle drawn on a piece of paper.
That's how I feel price transparency in healthcare is currently sold--someone holds up a translucent block (or maybe a drawing of one) and then expects everyone else to catch on. Except this product is for adults, and because it is so sorely needed, I'm not nearly as amused.
A recent study by Public Agenda supports my concerns about price transparency. The findings are pretty telling: the majority of Americans want price transparency in their healthcare services, have actively sought out pricing, and don't believe that there is a connection to price and quality.
Nevertheless, Public Agenda makes a blunt assessment in just the third sentence of its report: "Price information remains largely hidden."
The need for price data has become urgent. In order to rack up huge profits to mollify its shareholders, most health insurers systematically began to shift more costs to individual policyholders about 15 years ago when more powerful employer groups started to balk about carrying that extra freight.
Although the Affordable Care Act has sought to curb some of the most excessive practices of insurers, coverage purchased through the health insurance exchanges can still burden families with out-of-pocket costs of $12,000 or more per year. And as we have reported elsewhere this week, even cancer patients with insurance may have to pay $80,000 or more out of pocket for their care.
Yet the Public Agenda report concluded that consumers remain remarkably passive when it comes to obtaining price information for the care they receive. More than half of those surveyed who have insurance said they're unaware that prices may vary from doctor to doctor, while nearly half of those who lack coverage are unaware of such variances. Another 43 percent believe it's unreasonable to compare prices before seeking care.
It seems Americans want to know what they're paying for in advance when they seek healthcare. Yet at the same time, they appear reluctant to want to go through the process of doing so.
I feel that way whenever I have to deal with the Internal Revenue Service. It makes no difference whether it's filling out a tax return for my household or business; handling the 990 returns for a not-for-profit whose board I sit on; or in recent months, advocating on behalf of my in-laws.
I know what's behind the reluctance: Existential dread. I so want to avoid having to address the issue I will do anything to put it off and have it magically go away. I think consumers have those same anxieties when it comes to obtaining healthcare pricing.
The desire to focus on their health is pitted against the anxiety of what their bill might be. Overarching all of that is a fear of confronting what they imagine as a potentially monolithic force--whether it's hospitals or doctors.
And let's face it -- if a patient truly wants to know what everything is going to cost upfront, they have to jump through an entire field of hula hoops in order to do so (by contrast, dealing with the IRS is actually far more straightforward). As far as I know, only the truly radical doctors at the Surgery Center of Oklahoma let their patients know the entire upfront costs of their procedures.
Will this ever change? If so, it will take years, if not decades. Hospitals sense no real financial advantage to disclosing their full prices, so they won't unless they're pressured. But if patients are going to be swallowed whole by their bills, the pushback may eventually become so fierce that the provider community won't have any choice but to come up with transparency tools that are so universal even kids would know how to use them. - Ron (@FierceHealth)
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