Price tags for health care: how we can make it happen

Two days ago I wrote a post about why I think price tags could save American health care. One of the great forces of the U.S. economy is the price-conscious consumer. Collectively we manage to drive down the cost of everything from bar soap to tax preparation. Such is the nature of a competitive marketplace with transparent prices. So why not unleash that dynamic on the health care industry?

As it turns out, I’m not the first person to have this idea. In fact, there is currently a bill sitting in Congress that would do exactly what I’m proposing. On Feb. 25, Representative Steve Kagen—who happens to also be a doctor—introduced the “Transparency in All Health Care Pricing Act of 2010.” The bill is 429 words (that’s right—429 words, not pages) and already has 45 co-sponsors. I know a whole lot more about economics than I do about politics. Could someone out there please tell me how we can get this thing passed?

Here, read how brilliant it is:

SEC. 2. TRANSPARENCY IN ALL HEALTH CARE PRICING.

(a) In General- Any and all individuals or business entities, including hospitals, physicians, nurses, pharmacies, pharmaceutical manufacturers, dentists, and the insurance entities described in subsection (d), and any other health care related providers or issuers that offer or furnish health care related items, products, services, or procedures (as defined by the Secretary of Health and Human Services) for sale to the public shall publicly disclose, on a continuous basis, all prices for such items, products, services, or procedures in accordance with this section.

(b) Manner of Disclosure- The disclosure required under subsection (a) shall–

(1) be made in an open and conspicuous manner;

(2) be made available at the point of purchase, in print, and on the Internet; and

(3) include all wholesale, retail, subsidized, discounted, or other such prices the individuals or business entities described in such subsection accept as payment in full for items, products, services, or procedures such individuals or business entities furnish to individual consumers.

Combine that level of price transparency with insurance that incentivizes consumers to pay attention to cost—e.g., co-insurance, high-deductible plans—and I think we’d start making a real dent in health-care cost inflation in a very short period of time.

A lot of people commented on my original post, and I’d like to say thank you for the many kind words. I’d especially like to thank the doctors who said this is a good idea. These are people who are on the front lines of providing medical services and understand better than anyone else who truly benefits from keeping the public in the dark about what health-care services and products cost (you know, insurance companies, pharmaceutical firms—that much-loved crowd).

I was particularly happy to hear from doctors because my one genuine concern about this plan is that well-meaning medical-service providers might get squeezed. If consumers all of a sudden start demanding lower prices, will doctors (most of whom are small businessmen) be able to exert similar price pressure on their suppliers? To go back to my original example, Wal-Mart worked because it could turn around and lean on Procter & Gamble and General Mills to figure out ways to make soap and cereal for less. Would the same process play out in health care? The fact that doctors are for this idea and not afraid of it gives me hope that it just might.

So, seriously, folks, how do we get this bill passed?


Related Topics: health care costs, health-care reform, high-deductible insurance, price transparency, Steve Kagen, Economy & Policy
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  • ohiopapa

    Two ways to get this bill passed: Everyone who reads this post 1) calls their representative; 2) calls their senators, and demands that TAHCPA (need a better acronym!) be passed as is. And OK, 3) posts your post on their FB page to spread the word.

  • http://stupidassnews.wordpress.com Robert Feeley

    The Democrats are meeting in secret this hour – an SPN Headlines exclusive:

    http://stupidassnews.wordpress.com/2010/03/04/senate-convenes-aboard-nuclear-sub-for-final-health-care-vote/

    Keep smiling! :-)

  • http://www.rodgermitchell.com Rodger Malcolm Mitchell

    It would be nice if Barbara understood the difference between a labor intensive, personal service like doctor’s care vs. supermarket retailing of mass produced products like cereal and soap.

    She says, “If consumers all of a sudden start demanding lower prices, will doctors (most of whom are small businessmen) be able to exert similar price pressure on their suppliers?

    What suppliers are you talking about, Barbara? Somehow get a lower office rent? Or shall we cut the pay of the nurse/receptionist? Get real. The biggest expense a doctor has is his college education, his own time and his expertise.

    What you’re really asking is for doctors to take less pay. Or perhaps, spend less time with each patient.

    What a truly foolish way to improve health care. Shall we next cut teachers’ pay to improve education?

    Comparing a little doctor providing intimate, individual service vs a giant, mass operator like Walmart, which provides virtually no personal service, demonstrates an amazing ignorance about economics.

    Rodger Malcolm Mitchell

  • deconstructiva

    Barbara, price swings can be huge in other areas besides drugs (brands / generics) and equipment. I’m not a doctor (alas) but some of my architectural background included health care construction. A hospital is horribly expensive and nitpicky to build (superclean construction, level floors mandatory for heart patients, tons of space for equipment, piping, etc.). Many doctors’ clinics can be fitted into normal office buildings; most of the budget is for equipment …and we get most care at the clinics instead of the hospitals anyway. Hope this helps.

  • Ivy_B

    So, seriously, folks, how do we get this bill passed?
    .
    Find a way to persuade the Republicans to allow a good Democratic idea to come to the floor?
    .
    I read your earlier column and comments as well. I know what my doctor’s visits cost because I have always looked at my bills. I went to one family doctor for twenty-five years until he retired. I found another I liked on the second try and have been with him for ten years. The reason I like these doctors so well is that their first approach is a conservative one. Sometimes the best thing is to wait and see. However, if I need further care, I trust their recommendations. One problem with care is that people pick specialists about whom they know nothing and sometimes they have the hammer and see every problem as a nail whether it is correct or not.

  • skgeek

    Price transparency in of itself is important and desired for markets to function efficiently. We do that pretty much in every market sector where consumers are involved, from brick-and-mortar retailers to online stores to stock markets to auto insurance, except, surprisingly in health care.

    How the market (health service providers and insurance companies) adjusts in response to price transparency, and how the health care consumers change their behavior, would be difficult to predict, as markets tend to be self-organizing once the rules of the road are set. However, what is more predictable is that consumers would get better value for their health care dollar.

    I don’t worry too much about small players getting squeezed out of the marketplace because they don’t have the volume to charge lower prices. What consumers want more than price is “value” (what you get for what you pay). Individual doctors can provide better service, in return for charging patients a little more than their bigger counterparts, and many patients would be willing to pay that premium. After all, we are talking about health, where the level of service is important, unlike some relatively trivial purchase like a bar of soap (for which also, consumers pay more for brands they perceive deliver more – Dove costs more than Ivory).

    Even in retailing we have Wal-Mart, Target, Grocery stores, Convenience stores like 7-Eleven and neighborhood bodegas, which all flourish in the marketplace and you can buy a bar of soap made by P&G in any one of them, albeit at different prices. They all provide different type of value, so attract consumers looking for that kind of value.

    Since P&G wants to sell as many bars of soap as it can, all these store formats are important to that company, even though some (like Wal-Mart) may have more leverage than others. So, P&G ensures that it does not charge the smaller type of stores much higher price than Wal-Mart, because that could distort the value those stores provide their customers, with the result that customers in these stores will simply not buy P&G soap and instead buy a competitor’s soap (who is charging reasonable prices), which is not in P&G’s interest.

    Similarly, suppliers in health care sector will not charge exorbitant prices to individual doctors (equivalent of the small store in the retailing analogy), and the price premium would generally be in line with premium that the doctor can charge the patients for providing better value.

  • deconstructiva

    …there are also those Minute Clinics and similar walk-in places / kiosks IN some stores and malls. Are those worth a shot?

  • skgeek

    – i think so, if these walk-in clinics/kiosks offer a type of value that certain critical mass of consumers want. Also, since we don’t know up-front what will work and what will not, in a market that is more efficient, experimentation is going to be important to maximize value for consumers as a whole, i.e., different types of health care consumers can find delivery formats that work for them.

  • faircaremd

    Thank you Barbara for this reporting. It is good to see a tweetable bill in congress. Perhaps that denotes the way to get it passed, tweet this story and the bill itself.

    I would like to lend support to the idea that doctors are in favor of transparency. I just spent the last four months researching this topic specifically in preparation for the Launch of my new online health care pricing service called FairCareMD. I dropped by over 2000 physician’s offices in New York City. My records indicate that 62% were interested in increasing pricing transparency with their own data. Yes, their own prices – not in some far off general sort of way but in an online forum where all could go and see them.

    So that is what we are setting up now over at FairCareMD.com.

    I also agree that Doctors are not Walmart commodities like diapers but they are already being treated as such by insurance companies and Third Party Administrators (TPAs.) TPAs manage some aspects of health care for insurance companies and take up to a 47% cut of the fee the doctor would get. For example, Medicare would pay them $656 for an MRI and the TPA will pay the MRI facility $330. Doesn’t sound fair, does it? This is just one of the many ways the doctor is not well treated by the existing reimbursement system and why 91% of them are reducing the plans they participate in (according to a 10/2009 Sermo.com survey.)

    It is estimated that not dealing with such middlemen would save a Physician 40% on overhead and increase revenue per visit, allowing more time to treat patients well – and isn’t that what we all want?

    To read more on my studies and this topic please be welcome to visit our blog at FairCareMD.com.

  • qqi239

    1. Huh? We are not discussing healthcare improvements we are discussing how to save at least something of it from the total collapse which is surely coming.

    2. Price tags is a usual moronic gimmick it would not change anything as long as we use insurance to pay for routine medical services. Atlantic has a real nice article about it a few months ago.

    http://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/7617/

    3. And the bigger problem is that Dims are unable to honestly discuss these issues and hence come to some reasonable solutions, instead they are trying to sell this “save at least something” effort as an improvement.

  • Terry Bond

    Cute idea, but not very well reasoned.

    Even something as simple as getting a splinter removed from your right thumb can justifiably vary wildly in price. Your medical history and mine are different, and this difference must be taken into consideration by the provider. My unique medical history might complicate the numbing agent applied or require other special considerations. Just publishing the doctor’s price list for each procedure code does nothing to actually inform the consumer as to what they will actually pay for anything.

    Does the consumer understand the difference between a procedure code of 99211 and 99212? Should they?

    Like most lay understanding of the current healthcare industry, you have ignored one very important aspect of the problem. Healthcare in the U.S. is NOT just a transaction between the consumer (the patient) and the provider (the doctor). There is a third party gumming up the works – the payer (the medical insurance company).

    You want visibility, let’s get some visibility on what these payers are actually paying our providers! Right now thats not even legally possible due to Sherman and Stark laws.

    The only way your simplistic solution could work is if we went back to indemnity-base medical insurance. Neither the consumers nor the medical insurance companies want this, albeit for very different reasons.

    We must find a reasonable way to ‘reform’ the relationship between the provider and the payer to create appropriate levels of visibility and control.

  • faircaremd

    You raise two good points Terry:
    1. The transaction will change when the patient gets to the office

    2. The Payer is not the patient

    I had the same concerns, which is why I did my market research prior to starting our web development. Here is what I found.

    In response to the first reasonable position: Physicians see the FairCareMD system as a good start to the conversation about price but not the whole discussion. We seek to be far better than what people and providers currently can do, but not a perfect pricing solution. If we tried to build that all sorts of privacy violations would result and we would never have anything useful.

    Furthermore, we are not using the AMA codes much, more like general lay descriptions. Besides, the AMA wants to be paid per the user on the site if we use their codes and that is prohibitive. More importantly, do you really need to practice medicine by the code? If they did not exist, how would you charge patients? Would you invent them? We chose to allow doctors and patients the freedom to invent their own codes and care offerings. Does it really matter which extremity is being scanned in an MRI? 15 minutes in the scanner is 15 minutes in the scanner.

    To your second point. According to the most recent CDC data (2009, Q1, Q2) over 22% of all people with private insurance have high deductibles. With about 6% of the population with HSAs, more people without insurance, and more procedures not covered every day I estimate up to 25% of healthcare spending is coming out of pocket these days. I run the numbers in this blog post: http://faircaremd.com/2010/02/cash-for-care/. With over 30% of Americans paying significant amounts out-of-pocket I would say that we have been moving back to the indemnity model, for better or for worse. Will Obamacare change this? Perhaps, or perhaps we will have even more HDHPs and HSAs.

    There is a pretty good visibility tool online now. Granted, it is in summary form, but it is a start. See http://www.HealthcareBlueBook.com. More is coming from other sources too.

    The current system is not working for doctors or patients. For thirty years the benefits have been shrinking for patients and providers. I think if we wait for a government or payer based solution we will see a continued decline of care and access. FairCareMD seeks to provide an alternative to traditional insurance payer based reimbursement for physicians. It is not for everyone but for providers who seek a better way. FairCareMD is a change we can make today for a better care paradigms now. As for transparency, you can’t get more transparent than paying for it yourself. We also will produce reports of what people are really paying for care on average.

    Stay tuned and thanks for your feedback.

  • Terry Bond

    I do not see the FairCare site as being any sort of answer for healthcare.

    All independent practices must use the CPT/HCPCS if they expect to get paid as this is the one and only system of documenting procedures acknowledged by all payers.

    Although we might not be concerned with the exact details of 15 minutes in an MRI from the cost of service standpoint, we are concerned with which extremity is involved from the diagnosis standpoint. In fact, the whole purpose of the new ICD-10 international standard is to better understand diagnoses and begin to actually study trends and most effective clinical pathways.

    The best answer for actually getting a handle on the cost of delivering healthcare would be for all providers and all payers to agree to a standard scale of work effort associated with each procedure. Then we could talk about price per unit of work and reimbursement per unit of work and cost per unit of work. If we would all use this scale, we would have a foundation for comparing cost, reimbursements, and prices.

    This scale exist and is called the Resource-Based Relative Value System (RBRVS). It has existed since 1988 and is maintained by the AMA. However, to date the only payer required by law to use it (and in fact the only payer using it) is Medicare/Medicaid.

    Not that I want to edict what any payer can reimburse, mind you. A payer’s rate per unit of work should still be negotiated between the payer and the provider.

    But we would at least have a level playing field that all parties could agree on.

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