Free market Republicans continue to talk up an experimental system of health care that uses every one of us as lab rats, expendable pawns, left to the will of a deregulated utopia of corporate good will based on profits. Good luck with that!
Below is a look at trying to change a convoluted health care delivery system into a consumer friendly menu of choices through reform. But throw in the possibility of even greater deregulation of the private sector, and few if any mandates, you’ll see the mess reported below balloon into a maelstrom of loopholes and junk insurance policies. Shopping for care is impossible, as you’ll see, and gamed by the private players that have billions of dollars to lose. Milwaukee Journal Sentinel:
A new law intended to provide better information on physicians' fees and the prices for hospital services offers consumers nothing of value so far.
The Health Care Transparency law, which took effect Jan. 1, provides no information that consumers might actually want, such as what health plans pay hospitals on average for a normal birth or an angioplasty or to repair a rotator cuff. Nor does the law, at least initially, provide accurate information on physicians' fees.
The law requires hospitals and doctors to provide price information on request. That information just doesn't have any relation to what you and your health insurance plan will actually have to pay. Rather, it requires disclosing the equivalent of a sticker price or manufacturer's suggested retail price - a price that almost no one pays ... opposition from insurance companies and hospitals.
Giving consumers better information on prices theoretically could help people become better consumers of health care and help make the health care system more efficient. The reality is more complicated because the price of a service is only one component of the total cost of an episode of care. What really matters is the outcome - whether the treatment works and how quickly the patient recovers.
"What you want to know is how much did the whole episode of hip surgery, including the physical therapy and other things afterwards, cost and could the patient actually go back to work or not," said John Toussaint, a physician and president of the ThedaCare Center for Healthcare Value. "That's what you want to know."
Price information also has become more important as more people have health plans with high deductibles. Prices for specific services can vary by thousands of dollars among hospitals and health systems. They also vary from health plan to health plan. That's because the prices are the result of negotiations between health plans and health systems. The result is that two patients can have the same surgery by the same surgeon on the same day at the same hospital but the bill for each will differ. And their bills may be thousands of dollars higher or lower than the price that a hospital across town receives for the same type of surgery.
Yet the prices negotiated by health plans and health systems are confidential. Health plans offered by Humana and Anthem Blue Cross and Blue Shield provide estimates on the total cost of an episode of care, including physician fees, at hospitals, surgical centers and other settings throughout the Milwaukee area. combination of sticker price less overall discount still has no relation to what commercial health plans pay for a specific service, such as a colonoscopy or carpal tunnel surgery.
"It's definitely not helpful for a patient to get a sense of the contract price when comparison shopping," said Coreen Dicus-Johnson, a senior vice president with Wheaton Franciscan Healthcare.
How will the "charge" information help consumers? "That's a legitimate question. What is the value that consumers will get from this?" Currans-Sheehan said. "I can't answer that. That's not my role."
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