How to fix health care, and other easily solved problems

I’ve been thinking a lot about our health care system. I’m a part of it, technically, as a health care provider, so I get a lot of questions from well-intentioned acquaintances about how to fix it. As if we’re all part of an enormous cabal holding the secret to health care reform, just waiting for the rest of the nation to ask.

Most days I think about it at the micro level. Me and my patient, in a room. What are we doing wrong? I (try to) do my part by minimizing unnecessary tests and treatments. The patient (ideally) does their part by not demanding unnecessary tests and treatments. Success! We’re totally gonna turn this ship around, you and me. Now, if only we can convince the everyone-elses, all the other providers and patients who aren’t being as reasonable and responsible as we are, to aspire to our shared level of greatness, this country might just have a chance.

But there are glimmers, hints, around the edges of my day, that point to the fact that it’s probably more about the mind numbing complexity of the system we’ve found ourselves with after all these years than how many CT scans I personally order.

Like when a patient asks me how much their Pap smear will cost, in the event that their out-of-state insurance doesn’t cover labs, and I am completely unable to give them an answer. And I’ve tried! Or when the patient with international student insurance – which covers basically nothing, unless you lose a limb while studying project management in The States – asks how much their chest x-ray will cost, and I’m again – well, you get the idea.

I give them a range – “probably somewhere between $100 and $1000!” delivered with a hopeful smile – but am forced to admit that I don’t have any way of knowing for sure.

THIS IS BANANAS. If you went car shopping and the salesperson wasn’t able to give you even a possible price range, you’d tell them off and stalk out. And then give them a crappy review on Yelp. “Can you believe this place? Their very existence offends me. If I could give them ZERO stars, I would. One star!!!!!!”

So now I read something this morning about the “new era” in health care ( where suddenly we’ll have price transparency because of a new law. You can check price tags, just like at TJ Maxx. We will all be the masters of our own healthcarespending destiny! WOW, I thought. How did I miss this?? And here I thought I was part of the cabal. (sad face.)

But then I read the article. The reporter describes the process for getting this “price tag”. All you have to do is spend a minimum of 20 minutes entering information that most patients don’t know exist, let alone possess – like NPI numbers and CPT and ICD-9 codes – and then 48 HOURS LATER you get a possible price range, maybe even with a several hundred dollar spread! IT’S A NEW ERA!!!! Sunshine and rainbows from hereon out!

So, um, yeah. I think we have the answer as to why health care costs so much (or at least a solid 70-80% of the answer, with responsible ordering and tort reform and reducing duplication blah blah blah making up the rest).

Because if health care pricing is so unbelievably complex that this is the best effort that a multibillion dollar insurance company, with their thousands of staffers, can put forth when asked for a quote, then it’s time to simplify your process.



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