The System Is Sick

People in profitable positions tend to align themselves with the politicians funding their movements. Is that part of the challenge here, or can people rely on the government to help?

Some of the biggest lobbying organizations in the country are health care institutions. There are hundreds of millions of dollars being fueled into Congress.

Still, we’ve seen some encouraging signs on the policy front, like the medical debt issue mentioned above. We’ve also seen other things with price transparency that have been a huge, huge benefit for consumers. The states of Texas and Tennessee recently passed laws that allow cash payments that patients make to be applied toward an insurance deductible.

Why pay cash?

The cash price is often lower than the discounted rate that your insurance company has obtained for you. So one of the first things I recommend to anybody, even if you have insurance, is to check the cash price. See if it’s lower than your insured price. And if you’re on a high deductible health plan, it might make more sense for you to pay cash instead of running it through your insurance.

What are the changes you want to still see in the health care system?

1. Show the prices. Consumers are entitled to know the prices of services up front, and these prices should be honored, without other types of fees or hidden costs. Clinicians and hospitals need to be upfront with their prices.
2. Know why any claim has been denied. There needs to be transparency when insurance denies payments. Right now, you’re seeing millions of claims get denied, but because of limited transparency, it’s difficult to appeal, and the process is lacking integrity.
3. Accountability for mistakes. One of our leading causes of death are hospital-acquired injuries, infections, and surgical errors. And there’s very little transparency about these. The details aren’t disclosed to patients, and they aren’t accurately recorded in medical records. Patients have a right to know what happened and a right to know that it’s been corrected, so at least they can be sure that whatever harm they’ve suffered won’t happen to other people.
4. Public access to ratings and information. Right now, there’s very little reliable, quality information that’s being published for the public about the quality of health care. Doctors should be reporting their complication rates. They should be reporting the volume of procedures they perform.

I always encourage people, if you’re going to any doctor for any type of procedure, ask them how many times they have done that exact type of procedure, and ask them what their complication rate is. And honestly, if they’re even measuring their complication rate, if they even have an informed answer, that’s already a real positive, because in a lot of cases, doctors aren’t measuring their complication rates.