Ever noticed how tourists strolling our cities’ streets not only pause and peer into the windows of restaurants but they also invariably make a beeline for the menu posted out front? That’s smart consumerism, right, and so common sense that, hey, why doesn’t such price-checking work in medical care, too?
Well, think again: The nation’s in the midst of yet another experiment to try to make clearer and more transparent the soaring prices of medicine. With the dawn of 2019, Uncle Sam decided that hospitals needed to make available online their “chargemasters,” the giant list of their supposed prices for facilities, services, and prescription drugs.
Good luck, though, to consumers to find this important document, as required now by law, on hospital websites. Good luck, too, for patients in determining just what the sizable Excel spreadsheets mean for their finances and budgets.
In case the evidence needs to be tangible for this post, try clicking here to access the chargemaster for various hospitals that are part of the Johns Hopkins system. Or maybe try clicking here for the “standard services price guide” for George Washington University Hospital — yes, to see that document you’ll need to check enough boxes you’ll wonder if you gave up your first-born in the process. How about clicking here for the chargemaster for a major Los Angeles academic medical center, which battles with its familiar designation as the “hospital to the stars.” Ah, you’d prefer to see the price list for the local institutions in the MedStar group? Good luck — a modestly web-savvy colleague spent a half-hour scouring online without locating the document(s).
OK, if the spreadsheets were spread before you, what would they show? As the independent, nonpartisan Kaiser Health News Service reported:
[W]hat is popping up on medical center websites is a dog’s breakfast of medical codes, abbreviations and dollar signs — in little discernible order — that may initially serve to confuse more than illuminate. Anyone who has ever tried to find out in advance how much a hospital test, procedure or stay will cost knows the frustration: ‘Nope, can’t tell you,’ or ‘It depends,’ are common replies from insurers and medical centers. While more information is always welcome, the new data will fall short of providing most consumers with usable insight.
For chargemaster data to be useful in smart consumer choice-making, patients would need a long list, too, of all the components of the medical care they would undergo, so they could hit the price roster and compile all their charges.
Even then, however, they could not get an accurate reading or even a reasonable guess. That’s because they can’t and won’t know what if any discounts or deductions their insurer may have wrung from a given hospital and doctors who practice there. In some instances, employers also strike deals with medical providers for lower costs. Patients still would need to determine their health coverage deductible and whether it has been met, and whether providers’ charges would be paid for by their insurers at the in- or out-of-network cost.
Hospitals may charge different prices for facilities, services, and medicines due to where they’re located and who their patients may be (what they can afford). The chargemasters may include acronyms, abbreviations, and procedure names or descriptions that differ vastly from one institution to another.
This all, frankly, makes nigh impossible the comparison shopping that free-market proponents love to advocate for curbing medical costs.
So, is Uncle Sam’s chargemaster requirement just an exercise in price futility? Maybe not. It is yet another way to keep alive the conversation as to why hospital costs not only are so high but also why they vary so greatly.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent medical care, especially as procedures and prescription medications get ever more complex, uncertain, and expensive. It’s crazy-making that patients may not be able to ask their own doctors and get good, honest, and accurate counsel about the costs of their medical care — many doctors say they don’t know the information themselves. And research shows this, perhaps, willful blindness doesn’t affect costs, pushing them higher or lower.
What does seem to matter is that hospitals “spitball” too many of their prices, with guys making too much money and wearing expensive suits figuring how much they can squeeze out of patients. Medical bureaucrats and political partisans act almost with glee in adding to the financial terror that too may patients live with — that their desperately needed medical care may make them just a bit better even as it bankrupts them and their loved ones. The fiscal fright has become a palpable part of American medical care.
It occurs in sharp contrast to the experiences elsewhere in the industrialized world, for example, in France, where author Erica Rex wrote recently for the New York Times Opinion pages about the benefits she has enjoyed because she managed to qualify for French nationalized health care. Recovering from a recent surgery, as well as having weathered breast cancer in French care, she visits a doctor’s office and finds advantage and camaraderie in what might be a tense milieu stateside:
Medical chat is common in French waiting rooms. If the wait is long, everyone comes to know everything about one another’s complaints. To my friends in the United States, this casual attitude seems foolish, even risky. But in France, medical privacy is irrelevant. No one will lose her job because of a lengthy convalescence. There is no possibility that pre-existing conditions will make insurance unaffordable. Unemployed people still receive treatment. Huge medical bills do not reduce ordinary citizens to a state of existential terror. The absence of unease over health care alters the texture of French experience. We get cozy in waiting rooms.
That’s not all, she observed:
In France I can rest assured I will not be refused care for any treatable condition, including a painful bunion — or yes, even a recurrence of breast cancer. All the same, I’d rather have been able to get coverage without emigrating. Too many Americans do not realize how much better off they would be if they felt safer about access to medical care. Imagine what might happen if everyone felt safe — safe enough to talk about ailments in waiting rooms.
Mon dieu, we have a lot of work to do to improve the medical care on which we spend $3 trillion annually in the United States and get poorer outcomes than our peers in other western industrialized nations.