A new Trump administration policy requires all hospitals to disclose their prices for people without insurance as a means to help people shop for health care. This policy will never help people save money or get needed care. Nor will it ease their stress about hospital costs. Without Medicare for All–which does away with deductibles and coinsurance–health care costs will remain a burden, forcing people to make choices about their families’ care that no one should have to make.
Today, people with and without insurance have little clue what their out-of-pocket costs will be in hospital–unless they have traditional Medicare. Hospitals can hide the amounts they charge different insurers for different procedures; insurers, in turn, neither disclose nor limit people’s out-of-pocket hospital costs. People with commercial insurance are regularly surprised by how high they are.
Hospitals rates tend to put patients at serious financial and health risk. Even with insurance, between deductibles and coinsurance, hospital costs are often beyond their means. Until we eliminate deductibles and coinsurance, the US will continue to ration care based on people’s ability to pay.
For these reasons, the Trump administration policy requiring hospitals to disclose their charges for the uninsured is of little, if any, benefit to people. It provides no information for people with insurance. And, even if there were full hospital price transparency–information on rates for the insured and uninsured–it is hard to imagine how it would ever help people.
In short, you should not be expected to shop for health care. You generally have little control over the services you receive in hospital. Moreover, hospital fees for a procedure are an amalgam of different provider charges. The surgeon’s fee might be lower at one hospital than another and the anesthesiologist’s fee higher. But, you could not very well go to one hospital for anesthesia and another hospital for surgery.
Most important, price should not be the driving factor in choosing where to get health care services. Quality matters. You would never buy a car or a home without factoring in quality. You certainly should not do so with health care services. Yet, we have virtually no good public information available on quality of these services.
To be clear, hospital price transparency is good public policy even if it cannot help patients. It allows policy experts easily to compare costs for different services, among hospitals, in a particular area, and across the country, for different health plans, and for people without insurance.
Full hospital price transparency would reveal which insurers are getting better rates for different services and reinforce the point that the health care marketplace sets arbitrary and unreasonable prices and fails to rein in costs. It would expose lack of competition. And, it would help show why we need Medicare for All, fair rates for everyone no matter where they live or which hospital they use.
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