The Truth of Price Transparency
Welcome back Price Transparency, how have you been? Maybe it’s just me, but it seems like this mantra becomes the days hot topic for a New York moment or so on social media then fades into the background noise of healthcare advocacy for a few years. While the concept of Price Transparency in healthcare is ostensibly aimed at empowering patients and driving down costs, my analysis reveals that its implementation fails to address the fundamental barriers to access and affordability in the healthcare system, ultimately underscoring the need for more comprehensive solutions. Let’s discuss.
Today’s round of making Price Transparency the hot topic is a nonprofit group called Power to the Patients who are a nonpartisan, nonprofit organization who are “dedicated to “creating a more affordable and equitable healthcare system through price transparency.” To be fair and transparent (see what I did there), I am not familiar with Power to the Patients or the work they do. This post isn’t so much about them as it is about this idea of Price Transparency in how I consider it to be an old fashioned “wag the dog” idea.
To support my argument that Price Transparency is akin to the outdated tactic call “wag the dog”, I will share two personal medical experiences. After all, Price Transparency is supposed to be for the benefit of patients like me. Its stated purpose or goal is to provide easily accessible information so that I can search for the best care at the lowest possible price. In addition, my utilizing the best care at the lowest possible price, that should drive down the prices of all medical entities which benefits everyone. A win, win right? I don’t want to ruin the surprise, but the answer is a big NOPE.
Onetime I fell off a Cliff-
If you are new here, yes you read that right. A few years ago, I fell off a cliff while rock-climbing. Since I’ve wrote about this trauma before (My Climbing Story), I won’t dive too deep into the weeds here. What is relevant to this post is a couple of factors. First, my injuries.
The fall broke my left arm to the point my surgeon said it was pointing 3 inches in the wrong direction. To fix it my arm, Dr. Lamey had to insert 10 screws and a plate the day after I fell to put it back together. In addition to needing emergency surgery, the Emergency Room (ER) had to use 6 staples to close the cut on the top of my head. As my physical therapist use to tell me, I got “lots of hurt” that night.
Next, I did not have any health insurance when I fell. Not good. At that time, I was the lead delivery driver for a local family-owned greenhouse. To borrow from the kids, I was not making bank during this time. I had roughly enough cash in savings to cover basically cover 2 months of expenses assuming I ate a lot of tuna fish sandwiches for lunch and dinner. After 2 months, my finance life would be up to the whims of the universe.
Now that I have set up a medical scenario for you, it is time to ask the current question. How would having access to the most transparent pricing information ever changed my story that faithful night? How would it have improved my quality of care? How would it have determined which hospital I went too? How would it have helped me choose the best surgeon for the lowest possible price that night? Ok, I lied. There seems to be multiple questions of the moment.
The answer is simple, accessing transparent pricing information after my rock-climbing accident wouldn't have made a difference. It would have done absolutely nothing for me or my family at that time. Price was not important at all to me, I had lost control of my life and needed immediate medical attention to find stability again. Much like any other financial transaction in a capitalist-based system, need comes first. The difference in my case being need related to my quality life, and not my purchasing power or checkbook capability.
Caregiving, Dad and his Strokes
Friday, August 18th, 2017. It was a slower day at the office which meant I was turning in my final deliverable to the boss at 4:30pm. The final 30 minutes of my business day was going to consist of answering a couple of meals and then checking the local arrest reports online. It’s fun to see if I know anyone.
Dad, a retired one-star general and fight pilot, was a staunch believer in the sanctity of work. To give you an idea of what I mean, about 10 years earlier dad had his first stroke. During the stroke episode, dad decided that since my younger brother was at work, and I was taking a final for my second degree that he would drive himself to the hospital. To date, there is no evidence that shows he was a danger while driving to the hospital in that condition. Obviously, there was luck involved but also the old man’s mental fortitude played a factor too (yes that’s a humble brag). So, it was unusual to see his name on my caller ID at 4:30pm when he knew I was off at 5pm.
As I went to answer my iPhone, I figured dad was calling because he wanted a steak dinner and was hungry. Figured he wanted to catch me before I left work so I could go directly to the restaurant for the steak. In the past, I had received this call from him at 5:05 or 5:10pm, essentially when I was getting in my car. Like I said, it was unusual for him to be calling during work hours, but he was a general in the military after all which taught him that his way was the right way, so I wasn’t too worried about the call. Dad wanted a steak so that was the mission on that Friday afternoon.
Boy was I wrong. Instead of hearing dad’s voice after saying hello, I heard “this is Steve from the Boise Fire Department. We found your dad laying in his driveway asleep, bloody, confused, and barely able to speak. I’m calling to let you know an ambulance is taking your dad to St. Alphonsus right now, are you ok with that?” My stunned response went something like, “ummmmmm ok, I guess. What else do you need from me right now?”
After regaining balance from being stunned, my first reaction was to contact my younger brother. He was working a newish job at that time which meant I wasn’t sure if he would be available to talk. Sure enough, he was so we both agreed to leave work at converge on the ER at St. Alphonsus Regional Medical Center. Our first, and only priority at that moment was to get some kind of initial assessment of dad’s health and the new damage this stroke might have caused. Even if we wanted to start pricing care we couldn’t because his needs and requirements where not known at this time. You can’t price care, regardless of how transparent the info is, if you don’t know what care will be needed.
Conclusion
To begin with, let me modify some my thoughts on Price Transparency from the beginning of this conversation. I don’t think Price Transparency is a bad thing and shouldn’t be pursued. Much like tv’s, clothes, cars, or tax services, having easy and clear access to an items price is a good thing. As a stand-alone idea or concept, there is not downside to Price Transparency that I see fit. However, in the world of healthcare, I believe Price Transparency to be roughly equivalent to spending hundreds of dollars on a killer remote for a tv you haven’t bought yet. Yes, having a high tech remote makes watching tv easier, but you need the tv for it to work.
On a high level, I understand and know that a hip replacement surgery costs $50,000, I know a single pill in a 30-day supply of meds can cost $20 - $100s, and I know a 15-minute visit with a specialist will run somewhere in the neighborhood of $300 (check local listings). Having access to this information has never been a problem for a patient like me. The problem is the hip replacement surgery costs $50,000, out of pocket costs for medications can be thousands of dollars every month for a patient, and $300 just to meet a specialist is the definition of gross. Even if I can find a qualified orthopedic surgeon in a reasonable distance from my house that will perform a hip replacement surgery for 10% less, that’s still a $45,000 operation. The price of healthcare is preventing access to care, not the access to the price; there is a big difference.
Quick side note, many health insurance companies have programs where a patient like me can earn cash for choosing the 10% less surgeon. Sounds amazing right!? I don’t think so. What they don’t tell you unless you read the fine print is the cash must be declared as income on the patient’s taxes. So, there is a real possibility of patient’s facing penalties or withdraw from programs like food stamps if their income rises over a certain amount by taking advantage of these saving programs. Utilizing Price Transparency can hurt patients in the long run but that’s another post for a different time. Back on topic.
While Price Transparency initiatives may offer a superficial solution to the complex problem of healthcare affordability, it ultimately falls short in addressing the systemic issues that perpetuate inequities and barriers to access. Instead of investing resources in superficial measures, we must prioritize systemic reforms that prioritize patient well-being over profit margins, ensuring that every individual has access to quality care regardless of their socioeconomic status. Only then can we truly empower patients and achieve a healthcare system that serves the needs of all.
