What do Rosa Parks and thousands of civil rights protestors from fifty years ago have to do with combating the rising cost of healthcare in America?
I’m going to answer that question but first I’m going to demonstrate why healthcare costs are out of control. The demonstration will take about five seconds and is so simple that an idiot…or even a congressman…or for that matter the President of the United States…can identify the root cause of rising health care costs.
1. I signed in at the front desk and was giving a clipboard with several forms that I had to complete before seeing the doctor. One of the forms guaranteed that I would pay all expenses not covered by my medical insurance.
2. I met with the doctor, who diagnosed my condition, and explained my treatment options. I made the best medical decision I could based on the options presented to me.
3. The doctor treated me, scheduled a follow-up visit, and sent me on my way.
4. Some weeks or months later I got a bill for the balance due. The bill contained complicated procedure codes that I didn’t understand, that I had no way of determining whether or not these procedures were actually performed, and that I had no viable recourse for challenging. The bill also included a statement to the effect that if I didn’t pay the balance in full within 30 days, my account would be turned over for collection.
Do you recognize the problem here?
If you don’t, you are now qualified to serve in congress.
Let’s break it down.
The basic problem here is that I guarantee payment before I know how much it costs. Can you think of anything else in life—any other product or service that you pay for on a regular basis—that you agree to pay for without knowing how much it costs? Giving a physician an insurance card is like giving a sixteen year old a Platinum American Express card and telling them to shop. No wonder healthcare costs are out of control. The physician does not have to explain or justify the cost of his or her services to anyone either before or after treatment. Both the physician making treatment recommendations and the patient making medical decisions are making decisions without considering the financial implications of these decisions. For the physician, this is unconscionable. For the patient, this is just plain stupid, yet, we do it everyday because that’s how it’s been for what seems like forever.
1. I meet with the doctor, who diagnoses my condition, and explains my treatment options and—this is what’s missing—the associated costs. I make the best decision based on the cost and associated benefits of the options presented to me. If I can’t afford the recommended treatment, I ask for alternatives and/or a cost reduction or seek alternative care or an alternative provider.
2. Assuming the costs are reasonable and within my budget and the benefits of treatment desirable, the physician and I agree on the recommended treatment plan and associated costs. I guarantee payment, retaining the early disclosure of costs for my records, which I will compare to the final bill.
3. The doctor treats me.
4. If the bill is in order, I pay it according to the terms we agreed to at the point of care. If the bill is out of order, I challenge the bill based on the pre-treatment disclosure.
1) Cost Disclosure at Point of Care gives patients the information they need to make sound medical and financial decisions regarding their healthcare.
2) Cost Disclosure at Point of Care allows patients to negotiate costs with the provider and/or seek care elsewhere without first incurring cost.
3) Cost Disclosure at Point of Care supports price competition at the point of care, where decisions are made and before costs are incurred. Like any other product or service, once the costs are identified they can be compared against other providers. Mobile internet websites such as e-bay, Angie’s list, facebook, twitter, and google enable cost comparison in real-time.
4) Cost Disclosure at Point of Care empowers physicians by centralizing cost information from pharmacies, specialist, medical supply companies and insurance carriers at the point of care where it is needed. This supports better treatment outcomes and enables companies like CVS, Walmart, Walgreens, ___ etc. and hospitals to compete via real time offers based on price, availability, luxury, volume discounts, and coupon promotions, further improving cost reduction for patients.
5) Cost Disclosure at Point of Care provides patients with the information needed to manage medical bills by enabling them to compare pre-treatment cost disclosures against actual charges. The pre-treatment disclosure gives them a viable recourse for protecting themselves from overbilling, inaccurate billing, fraud, and abuse, further reducing costs.
President Obama and Congress with the help of medical providers, suppliers, and payors—the primary beneficiaries of the current system—have carefully framed the healthcare reform conversation around “insurability” rather than cost. Insurability without Cost Disclosure at the Point of Care is another way of saying, “protect the profits of the status quo”. By advocating universal healthcare coverage without first requiring Cost Disclosure at the Point of Care, the beneficiaries of the current system will add billions of dollars in new revenue annually to their industry. Only a politician would think that it makes sense to mash the accelerator to the floor when the gas gauge is on empty. Forty-five million additional patients passing through the current system without Cost Disclosure at the Point of Care will not only increase the cost of care for everyone, but it will also increase the tax liability for everyday, hard working Americans.
It is ethically and financially irresponsible to enact any legislation targeted at providing every American with insurance without first addressing the cost of care. I have a plan and it is simply this…require physicians to disclose the cost of treatment when the patient—you or I—is making a decision that has both medical and financial implications.
The only way to reduce the cost of healthcare in America and improve access to it is to disclose cost at the point of care when medical and financial decisions are made. An informed consumer can exert pressure on providers to lower costs while making sound medical and financial decisions for him or herself.
I know what you’re thinking…okay, that sounds good but how do we get there?
I thought you would never ask. The one thing we can not do is outsource the problem to professional politicians who have done nothing to reduce the cost of healthcare over the last thirty years. The healthcare problem, like all of the major problems in America such as high taxes, rising unemployment, violent crime, rising dropout rates, etc., is but a symptom of a broken representative democracy.
The key to effecting change is exerting tremendous financial, political, and social pressure on the gatekeeper of the system, the primary care physician. Specialists, like cardiologists, surgeons, etc., depend on primary care physicians for referrals, hospitals depend on them for admissions, drug companies depend on them to write prescriptions, and insurance companies depend on them to provide services to their clients.
On this last one I know you are scratching your head thinking “but I thought insurance companies were on my side and negotiate doctors to reduce costs on my behalf?” The truth is easy to see when you put it in the right perspective…would you pay for BCBS or for any medical insurance if there were no doctors in its plan? Hell no. The stark reality is that insurance carriers are dependent on physicians for their income and as such, actually have little bargaining power over them.
There are only about 250,000 primary care physicians in America. That means that 300 million Americans can beat the crap out of them—rhetorically speaking—and exert tremendous financial, political, and social pressure to provide cost disclosure at the point of care. The other medical providers and the insurance companies will follow in line because, like I said, their income depends upon the primary care provider and because they would look like greedy, self-serving bastards if they didn’t get in line behind the patients they serve.
Here’s my plan and the answer to “What do Rosa Parks and the hundreds of thousands of civil rights protestors from fifty years ago have to do with combating the rising cost of healthcare in America?”
Remember the great generation of Americans who fought for civil rights in the 1960’s? They showed us the way to fight the status quo and proved that their strategy works. They risked their lives to fight injustice and to protect their rights by taking their proper seats at lunch counters, on buses, and in classrooms. And, that simple action—civil disobedience—produced astounding results. The arrests created publicity and the public changed America.
We’re going to do the same thing. At a designated date in the near future, a Patriotic American is going to walk into his or her doctor’s office, sign in, and, when the doctor walks into the exam room, say “I’ll pay you a fair price for the services you provide but require that you disclose your fees in advance so I can make an informed medical and financial decision.” When the doctor refuses to comply, the patriot will refuse to leave. And, when that patriot is joined by five or six others, all of the exam rooms—like the seats in the all-white lunch counter--will be occupied and the practice will come grinding to a halt. The cops will be called, and the great American patriots will be arrested. The next day protesters will stake out the practice and the media will come to cover the story...just as it did during the great civil rights struggle. The movement will spread from one practice to another until the public outrage reaches the tipping point.
At this point primary care physicians will have to take a good honest look at themselves in the mirror. Are they violating the Hippocratic oath, which says “first do no harm”, when they inflict financial hardship or ruin on their patients, when their recommendations force their patients to decide between food or medicine, between paying the mortgage or paying the hospital? Doesn’t financial harm create stress that negatively impacts health and reduces quality of life?
The idea that a medical decision can be made without consideration of cost is ridiculous.
So the question is simply this…Who is the Rosa Parks of 2009? Who among you will be the first to accept personal responsibility for reducing healthcare cost in America? Who will be the first to demand in advance to know the cost of the medical treatment they are receiving, which is something they should have the right to know anyway?
Consider this, many of you will see a doctor today or tomorrow and you will be forced to make an honest assessment of yourself as an American. Are you a sheep, content to follow the herd to financial ruin, or are you a wolf, prepared to fight for your financial rights and in doing so solve what may be the greatest problem our country has ever faced? I say be the wolf. Exercise your freedom of speech and the power of your pocketbook.
The only ones who think we can’t get what we want are the politicians in charge, but remember…if we can kick the crap out of 250,000 physicians—again, rhetorically speaking—456 congressmen shouldn’t be a problem.
The irony of the recession is that with so much going wrong, we have both the opportunity and the leverage to force cost disclosure at the point of care. The healthcare industry is in line for an adjustment, just like every other industry America, and we must be vigilant to make sure that the adjustment doesn’t come at our--the American tax payer’s—expense.
Remember that the politicians didn’t alter the status quo with respect to civil rights—the people did, regular, working people like Rosa Parks and the thousands of people like her who had had enough, who demanded change, first as a consumer by hitting the powers that be in their pocket books, then at the polls.
Be the wolf.
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