There are many things wrong with the bloated, expensive American health care system. I would like to complain about one small part of it: the prices. It's not just that the prices are high. It's that... where the hell are the prices?
Let's say you want to buy a car, or a house, or a diamond ring. You can visit a car lot, or a realtor, or a jewelry store. There, you will find an array of the products that you wish to buy, all with their various attributes and prices prominently displayed. If you're lazy, you don't even need to leave your house—you can look up the attributes and prices of all of these items online. Any of the countless websites that sells these items will tell you exactly how much they cost. You can comparison shop. You can find yourself the cheapest item, or the most luxurious item, or the item that you think strikes the best balance of cost and quality. You, the consumer, are empowered.
A car, a house, and a diamond ring all qualify as major purchases. We take it for granted that information about them is readily available before we buy them. After all, who would spend thousands of dollars without knowing a lot about the product? And who would commit to making a major purchase without even knowing the price?
You would, if you are a typical American who finds yourself in sudden need of some health care. If you fall down and hurt your arm, or are stricken with a terrible rash, or get food poisoning from warm sushi, you may immediately take yourself to the nearest doctor's office or emergency room. There, a doctor will render some health care unto you. They may order various tests. They may prescribe various medications. They may refer you to various specialists for various follow up visits. They may tell you that you need surgery, and schedule a date for you, and slice you up as necessary.
All of these things are major purchases. And it is extremely unlikely that you know what they cost.
I am not recommending that anyone opt out of necessary medical procedures because of a lack of price transparency. I am simply asking: Why is there such a lack of price transparency in health care? Where are the prices? Look up a doctor online. Do you see a price list? No, you do not. Can you comparison shop for non-emergency medical procedures quickly and easily? No, you cannot. Are you, the consumer, in any way empowered to make an intelligent purchasing decision by the amount of knowledge that you are given by the medical establishment? No, you are not.
Why not? ("Because of the Byzantine, illogical, and consumer-unfriendly nature of the private health insurance industry" is not an answer to this question. It is a description of part of the problem.)
What is so fucking hard about telling people how much a service costs? I am not asking here for a wholesale reform of our health care system into a national single-payer system like the rest of the civilized world has. (I will ask for that elsewhere, but not here.) I am simply asking doctors and hospitals and insurance companies to tell us how much shit costs. Yes, it is possible to get a cash price from a doctor, if you tell them you don't have insurance and that you need to pay cash. Yes, it is possible to get some sort of estimate from your insurance company, if you have infinite patience. Yes, it is possible to haggle and challenge certain medical billings after the fact, if you have a pugnacious determination and a tolerance for being on hold. All of these things are possible. But they are not easy. And for normal people, who have no medical expertise nor insurance expertise nor well-researched basis for knowing how much these things should cost, the very very least we can ask for, in a minimally fair system, is that we be told very clearly how much things do cost.
I am an average moron. I know nothing of the intricacies of medical care. A while back, I had to get shoulder surgery. I dutifully went to one doctor, then another, and another, and then followed his recommendations to get an MRI, and a physical, and who knows what else, and eventually surgery. I paid my deductible up front at the hospital. The surgery was fine. A couple of weeks later, I got a bill from the hospital. Then another, from an anesthesiologist. Then another, from the MRI place, and another, from another place. And here, crucially, is my point: I had no idea whether these bills were justified. I didn't even have any idea I was going to get these bills at all. When I got the services in question, I filled out the forms, gave them my insurance information, and that was it. Some weeks later, I received an inscrutable bill for hundreds of dollars for that service. Was that the right price? Was that how much these things cost? I had no idea. They didn't tell me. They didn't tell me anything. And I didn't know anything. In that situation, you can guess who got paid. (Not me.)
I am proposing this radical solution: prices. Available prices on health care. I propose that you should be able to know how much shit costs before you buy it. I propose that doctors post price lists for common ailments and procedures on their websites. I propose that doctors and hospitals tell you how much a surgery might cost you before you get the surgery. I propose that if we can't fix our fucking outrageously expensive and inefficient health care system itself, we at least make it transparent enough that people do not tremble in fear and ignorance when opening doctor's bills. I propose that if we can't have a decent system of public health care—if we are foolish enough to leave something as important as health care in the hands of the free market—then we must empower consumers to at least be able to comparison shop. The health care and insurance industries insist on defending their status as just another business? Fine. Act like a business. Price transparency is one of the things that makes the free market free. The average consumer is already at a natural disadvantage when it comes to bargaining for goods and services against the experts who actually work in an industry. One of the few tools that average consumers have at their disposal is the ability to say, "Well, that thing costs less across town." When average people who are not experts in the field are unable to get easy access to prices, we have set up a rigged game.
The average person is not an expert at ferreting out and haggling over health care prices. It is unfair to expect them to be. The onus for clear prices on health care should fall on the providers, and the insurance companies. Get together and work that shit out. Do this one little thing to protect the morons like me. We're already sick. We're about to be broke. At least let us know how broke we're going to be in advance.
[Illustration by Jim Cooke]