It's funny how blog conversations come together. Last week I sat down to chat with Independent candidate for governor Mike Myers. Among other things, he mentioned that we should require hospitals to publish prices for all of their procedures.
South Dakota law requires that hospitals disclose all fees and charges for health care procedures upon patient request... although you have to be really patient. When my wife and I had to take our newborn to Sanford in 2006, we asked about prices and were told nobody could answer our price questions until the business office reopened on Monday.
A 2008 law (that year's Senate Bill 182) requires the South Dakota Association of Healthcare Organizations to post a searchable statewide database of hospital charges. However, SDCL 34-12E-13 only requires that hospitals report average and median prices for procedures, not the actual amount their chargemaster lists. When I look at the current entry for normal delivery at Sanford, here's the report SD PricePoint spits out:
Average and median prices for 2012. That's about as useful for my shopping as handing me Hy-Vee's Mother's Day flyer from 2012.
After I published the Myers interview, a friend and blog reader called to chat about Annette Bosworth. When we got done laughing, we turned to a discussion of real health care issues, and my friend, who hadn't read the Myers piece yet, brought up publishing the chargemaster. He said he spoke with a staffer for Senator John Thune about bringing legislation to require hospitals to make their chargemasters public (one of the ideas discussed in Steven Brill's landmark Time article on the high cost of health care last year). He said the staffer agreed that publishing the chargemaster is a good idea.
"So when will Senator Thune be launching the bill?" my friend asked.
Oh, heavens, said the staffer, we couldn't just up and sponsor a bill for one guy's good idea. We'd need to demonstrate some vast grassroots support to get the Senator to sign on.
Apparently one gets to be the third-most powerful Republican in the Senate by following, not leading. If the good ideas of constituents like Mike Myers and my friend aren't enough, maybe Senator Thune will notice the growing pressure from the healthcare industry itself for better price transparency, as hospitals deal with patients picking up more of their own costs in high-deductible plans. (What was that we were saying about oligarchy, about the political system responding only to the impulses of the rich, not the regular citizen?)
Another blog reader called the next day, initially to ridicule Bosworth (yes, Annette, everyone talks about you), but then to discuss real health care. This reader said that the trend toward patients picking up more of their health care bill is a good thing. She advocated more cash-only practices, or concierge care: pay the doctor a monthly fee out of pocket, get all the basic care you need, then carry catastrophic insurance for big medical events your cash-only physician and your pocketbook can't handle.
Those conversations led me to this article on how veterinarians appear to be beating people-docs on transparency and cost control. At peril of comparing humans to animals...
In the veterinary world, there’s no hiding the raw cost of vet care. The customer typically pays in full at the time of service, and even those with pet insurance must pay vet charges first and receive insurance reimbursement later. If a vet doesn’t offer good value, customers walk away. It’s more or less a free market.
Then there are the veterinarians themselves. This group spends half an hour listening and responding to concerns. But they’re more than just nice people. They don’t suggest expensive tests and invasive treatments unless there’s clear benefit; we feel we’re paying for veterinary expertise rather than unnecessary medication, superfluous staff or nice furniture.
Cut to any hospital room in the U.S., where a patient would be hard pressed to discern value. Nobody will say up front what that ultrasound, blood test or dose of ceftriaxone costs, never mind what a patient will owe when the bills arrive three months later. It may be that it’s uncomfortable to draw a direct connection between a sick individual and health care’s profit motive. Third parties handle most health care payments, and because each reimburses at a different level, initial prices must be high enough for negotiated discounts to still cover costs. Pricing must also account for the uncertain number of patients who can’t pay their bills. In other words, sticker prices need to be as high as the hospital can get away with, even if they bear little relationship to what is ultimately paid [Audrey Young, "I Envy My Dog's Health Care," Al-Jazeera America, 2014.04.15].
Young cites Brill. Young, a Seattle doctor, says we don't have a free market in health care. Young says we need price transparency so we can make informed decisions about whether a trip to the hospital is worth the cost.
Price transparency in health care is a good idea. We shouldn't have to wait for Independent candidates like Mike Myers to start a discussion on the topic. Every candidate should be advocating this sensible free-market reform. And Senator Thune should beat them all to the punch by getting his colleagues to amend the Affordable Care Act this summer to require every hospital to publish its chargemaster in customer-friendly format online to help control health care costs.
"Oh, heavens, said the staffer, we couldn't just up and sponsor a bill for one guy's good idea. We'd need to demonstrate some vast grassroots support to get the Senator to sign on" <<< That is option one.
Option two requires a substantial donation to help grease those wheels.
Thune didn't "work" for a summer in the service of a healthcare business for something like $500,000 for nothing.
Interesting about posting charges: a couple of years ago my doctor wanted Mr to have a bone density test. I talked yo multiple people at Average, in the lab, the billing office, the clinic, and nobody could tell me the cost. It is concealed from the patients as well as the staff. So I told the scheduled that if they couldn't quote me a price I wouldn't have it done.
And that inability to tell you the price would appear to violate state law.
SD State laws are only enforced against little people. Hospitals, banks, insurance, utilities are all just too big to pick on by actually enforcing laws that apply to them.
Yeah, my veterinarian tells me exactly what the cost will be. So does my dentist. So does my mechanic. So does my pharmacist. So does my plumber. So does my hairdresser.
Each of those professionals can tell me, to the penny, including tax, what it's going to cost me before they start.
And they can tell me how long it will take.
Thune doing his job, what a joke. I shouldn't write after a 15 hour day, tend to get a little cranky. A year ago I had a standard physical, by the time they were done, the bill was $1488, of which I got $460 after insurance, for a freaking physical. And I still need to have that machine rammed where the sun don't shine, not sure why I bother, the heart attack from the bill for that will kill me. Good night all.