Just so

Over at TNR (still waiting for you to fix my digital subscription, guys), Royce Flippin (who is new to me) writes about the current state of our health care system:
One of the reasons people pay so much for health care is that average people are not told what their fees will be at the time of service. And even if a patient takes it upon himself to ask, getting the full answer is far from easy: He can usually find out the basic charge for an office visit--but what about a scan or a lab test? And how about the cost of those prescription medications being swiftly scribbled down? Most likely, the doctor or his or her staff will tell the inquisitive patient he has to wait for his insurance statement--or worse, the bill--to arrive in the mail.


While the national debate over health care reform boils and bubbles, I have a simple proposal that I believe can help contain rising health care costs without requiring any changes in the way health care is delivered and paid for: Require our nation’s medical care providers to publish a complete price list for all their services, procedures, medications, and tests. This price list would be required of all doctors, hospitals and emergency departments, consulting specialists, freestanding radiology labs, visiting nurse services, physical therapists, and any other institution involved in providing health care services.
I think this is perfectly sensible. In fact, legislation to require disclosure of this information was recently introduced in Maine, though I can't find information about it online.

Truth be told, I have no idea what most tests or medications cost. I know how much our office visits cost, but that's about it. I know which medications are available in generic form, but that doesn't always translate into a good guess about price. Giving this information to patients would make them more informed, and thus theoretically better, consumers.

Now, this will inevitably lead to patients choosing to refuse medication and treatment that they need because they know up-front what it will cost them. Is this better, on a grand scale, than treating them and then socking them with a big bill? It depends on what the treatment is, and how badly they need it. But, the fact that we can reasonably foresee that people would defer care they might need because they know in advance how little they can afford is an argument for why we need universal health care, including a public health option.


  1. May I suggest a heretical idea? Thanks.

    We *need* patients to refuse medication and treatment because of the cost. There is no other way, short of "deat^H^H^H^H cost efficient practices" panels determining eligibiity for care, to bend the cost curve down. Simply having Obamacare or Kennedycare or Medicare isn't enough; there is an infinite demand for a "free" service ("free" meaning one that everyone else pays for). Medicare ought to prove that well enough.

    BTW, I'd suggest an article from The Atlantic as presenting a serious look at the problems of American-style healthcare and the problems that need to be addressed. See How American Health Care Killed My Father.

  2. Can you imagine...asking to try a heretical idea like refusing medication and treatment? This is to be filed under "insane". A person has to be seriously on the edge to suggest patients refuse treatment and medication. How about those with out of control blood pressure or congestive heart failure? How about the child with asthma or rheumatoid arthritis or even cancer? Yes folks, let's all get together and deny ourselves life-saving medication so the rightwing wackouts do not have to buy insurance or participate in a decent health plan. Those unwilling to go without insurance because they are healthy, deny coverage to all because they will not participate in the system. The smaller the pool the larger the costs. By the way, my insurance has a ZERO co-pay for each of the first 5 generic prescriptions and ten dollars for every 90 day supply after that. For a brand drug it cost sixty-five dollars for a ninety day supply. Granted, we have a very large insurance pool, but the results for all of us in this pool are amazing... and by the way... when I was very young and very healthy I had insurance as did my partner who had cancer. Thanks to insurance coverage he only paid a couple of hundred for his deductible. The bill for surgery alone was nearly 60K. Two years ago I had an inguinal hernia repaired. I was in the hospital for 14 hours and my bill was slightly over 29K. It cost me two-hundred dollars. Oh yes.... I did get a couple of Rx's for pain and they cost me four bucks. Our insurance does not cover the cost of Viagra as they consider it to be recreational in nature. How was that done? It was done by the board appointed to oversee the purchase of drugs. This board is the same board that prohibits employees from anything related to birth control pills or abortion procedures. That my friends is the Republican slant on my BCBS plan. Other than that it is a great plan, (for now anyway). I presume leaches would be fine under Gadfly's non-insurance plan. Go to your local stagnant pond and get sucked on by leaches for two hours. Follow that by lighting a fire and letting the smoke rise to the gods or perhaps even a sacrificial lamb.

  3. There is not an infinite demand for a free service, that's plainly ridiculous. Aside from hypochondriacs and some people who have nurse/doctor fetishes, nobody wants to spend time in a doctor's office.

    No offense, Dan :)

    Most people want to spend as little time as they can in a doctor's office. Very few people are going to want to order a CAT scan on themselves, and at any rate even if medical care was completely subsidized, it still wouldn't be "free as in beer" - doctors aren't going to order an MRI for absolutely no reason whatsoever, and nobody's proposing that patients ought to get to order them on their own.

  4. UJ, I don't think you understood me, so I must not have been clear. I'm not suggesting that anyone be coerced into refusing treatment. But patients should have the choice. For example, a dear friend had a recurrance of breast cancer, and she chose not to undergo a second round of radiation and chemo for her own reasons. She died a few months later, but it was her choice and her body.

    What I'm suggesting is that for cost containment to succeed, individuals will need to evaluate the costs and benefits, and make a choice. An elderly person might choose not to have that expensive treatment. Much better an informed choice than a "death, errr, medical advisory panel" saying "no, you aren't worth the cost."

    As far as infinite demand, of course in the mathemtatical sense that isn't true. Infinite demand means significantly more demand than supply (the demand may as well be infinite, it won't make any difference). That is an observational fact from Medicare, Medicaid, VA medicine, and so forth. All those programs have grown far more and far faster than anyone estimated. I see no reason that Obamacare will be different. Of course, I am open to hearing reasons why this time, it will be different.

    And by the way, you have hit upon the preferred rationing technique of government medical programs the world over; waiting time. Just keep people waiting in doctors' officies, and the demand for service will go down. One way to keep down demand has people considering the value of their time, the other the value of their finances. I'd prefer the sick get treatment sooner and make the decision based upon finance rather than get treatment later and make the decision based on wait time.

  5. gj "I don't think you understood me" No, he understood full well what an idiot you are. Let me say one thing, you were clear. Clearly an idiot. Even when you try to contribute you come up with gibberish. "Individual need to evaluate the costs and benefits, and make a choice." Ummm, sure. Maybe after 10 years of advanced training a person can make a determination themselves of the best course of treatment, there is a reason why Doctors are Doctors and have to go through years of advanced training and certification you complete jackass, so that they (THEY) can best determine what is an appropriate course of action, now of course there is disagreement amongst Doctors, which is why a second opinion can be advisable, but the second opinion comes from another doctor, it should not be based on saving money. Yes, people have the right to refuse treatment (if they are willing to suffer and die) but outside of terminal cases who in their right mind would do so? I will tell you what, next time you break your arm, treat yourself and save the world some money. Oh, wait, it is other people who should refuse treatment, right? The world must never be spared your jackassery.

    You really, really need to get out of your mothers basement and see the world. Japan has UHC, has better outcomes at 60% of the cost. It is one reason why Toyota makes cars cheaper than the US. But keep thinking things should go on as they are.


  6. There is not an infinite demand for a free service, that's plainly ridiculous. Aside from hypochondriacs and some people who have nurse/doctor fetishes, nobody wants to spend time in a doctor's office.

    No offense, Dan :)

    None taken. Hell, I wouldn't spend much time here, if I could help it.

  7. No one I know likes to hang out at the auto dealership showroom, either. But if they were handing out "free" (as in publicly funded) sedans, I expect the lines to get in would be long.