Reforming health insurance, once seen as the third rail in American politics, is back in vogue again. John Edwards described his plan in detail recently, something few other politicians have been willing to do, and Paul Krugman reviewed it quite positively in a recent column.
One thing that is rarely mentioned, though, by Democrats or Republicans, is much less expensive and much more pervasive — the fact that medical bills are darn near incomprehensible. And that makes it impossible for the consumer to exercise any kind of reasonable control.
There’s the “list price,” which nobody actually pays, the negotiated price, the provider discount, the plan discount. There’s the doctor fee, the lab fee, the hospital charge, equipment charges and various extras, mostly listed in the most generic language possible. There are multiple bills, each with their own subset of these costs, some of which overlap. “Explanation of benefit” forms often don’t even mention the doctor’s name.
Bottom line? Medical services are the only thing we buy for which we don’t understand the bill and for which we don’t know the price in advance. Can you imagine buying a TV that way? You’re browsing at Circuit City and the salesman says, “This HD model is fantastic. Great picture! We’ll be happy to load it into your car — and once you get it home and installed we’ll tell you how much it costs! All you have to do is sign this little piece of paper indicating that you are legally responsible for payment. Do we have a deal?”
But, imagine if it was different. Imagine that every doctor was required to tell you what a service or test was going to cost — before it was performed. Or imagine an even simpler change: a requirement that all medical bills and explanation of benefit forms forms itemize in plain English what services were performed and by whom.
Either or both of these things would give consumers all kinds of power. You’d be able to compare diagnoses, services and prices. And you’d be able to check the bill and the insurance payments and catch mistakes.
We’ve certainly got the computer power in place to make this happen. So what’s stopping it? I don’t know, but my intuition is that both the doctor and the insurance company, each for their own reasons, wants us to remain in the dark. Nobody’s pushing for clarity so clarity doesn’t happen.
Last night I received the Robert Wise Award for “Journalistic Illumination of the Art of Editing,” at the American Cinema Editors’ 57th annual Eddie Awards banquet. It was a wonderful night for me, the culmination of nearly 20 years of work in this community. This morning, I’m still basking in the glow of the support I felt from so many friends and colleagues.
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