Thursday, December 9, 2010

on price transparency in health care

Are you concerned with the cost of "health care"?  I think everyone in the States is concerned, but there appear to be a few critical disconnects and troubling social phenomena around the topic.

A few thoughts, in no order:
  1. health insurance =/= health care.
  2. a lot of people know what they pay for insurance, but a lot of people have no idea what they pay for health services
  3. "people" hate the idea of "socialized" medicine, except (apparently)
    1. when they qualify for medicare
    2. when they are on a group plan through work
    3. when they live in the States
  4. there exists a deeply entrenched, "selfish actor" hypocrisy in the rhetoric around health care

The next time you go to the doctor or the pharmacy, ask them for a price list for their services/products; take note of their reaction.

If you want to take it to the next level, ask if there are different price lists for different payers (insured, medicare, cash, etc) and ask what they expect to actually get in final payment from those various payers.

It's my opinion that there exist some rational and fairly straightforward "fixes" to the health care cost explosion, but that most people don't actually want to change the system.


  1. We just took our kitty in for a scary medical procedure. We left her there, actually... she's still at the UT Vet-Med Center now. She's scaring them to death, they think she's a sabre-toothed tiger.

    But the point of this, aside from bragging about how poorly behaved ZoeTheCat can be, is that they have a price list. Even when it's an extended stay, things-will-come-up situation, they provide an estimate, itemized, and a sum at the end that represents the reasonable range of likely bottom line cost. It's very straightforward. I wonder how much the simplicity of that presentation is due to the fact that it's just them providing services to the people who pay for them, rather than there being a giant strange loop of game playing responsibility shifting whatnot between the care given and the payment received.

    Have you tried asking for a price list at a doctor's office? Now I really want to do it... but I don't want to piss off my caregivers!

  2. [sending "get well soon" wishes to Zoe the Sabre Toothed, Princeton educated Demon from the Top of the Closet]

    I'm encouraged by your price list experience at the vet...I wonder if some of their perspective is affected by being a publicly funded facility.

    In my own experience, I have not had the opportunity to ask the question in a while. My most recent visits to the halls of medicine have been for my pregnant wife and future son, and I have feared that asking about money in those visits would result in my sleeping in the dog house.

    In prior experience, I have negotiated with caregivers at check-in and check-out, offering to pay cash/credit on the spot for a discount, and this method has proven successful. I'm very aware that my situation is in many ways idiosyncratic, in that I have been mostly healthy and I'm a well paid, comfortably middle class guy; I get that my version of health care doesn't easily scale to people in every sort of situation, but that fact alone doesn't render my vision of US health care broken.

  3. Zoe appreciates your kind wishes, or so I'm told. She's in isolation, what with all the glowing poo she's producing at the moment.

    The non-UT vet has a similar kind of sheet. They'll readily say, "Do you want to do this urinalysis? We would very much like to see the results in order to feel confident of our diagnosis, but it will add $43 to the cost of this visit."

    I wonder, though, if it really would piss off the docs to have you ask... why would they care, really? You don't have to be argumentative, nor do they have to take the question that way. I may try it next time.

  4. Why would doctors care? About the question of price? This is a good question, and I have some answers, but they may be best suited to a full future post.