By Victoria Powell, MS3
Short White Coat, Inc., blog, Aug. 2, 2013
The Surgery Center of Oklahoma has been in the spotlight recently because of its decision to post all of its prices for its procedures online. This has been heralded as increasing transparency in healthcare costs and implicitly demonizes other hospitals in the area that haven’t followed suit, like traditional academic centers.
Why haven’t hospitals done this a long time ago, so the uninsured can bargain shop for their knee replacement instead of being stuck with a huge bill they’ll have to go into bankruptcy to afford? It’s an attractive idea, especially when presented as oversimplified as it has been to the public.
In isolation, price-posting is just another market-based artifice, more zeitgeist of our accelerating entrenchment in our broken, healthcare-as-commodity model than any real solution. Nothing illustrates it better than this quote in the NYT opinion piece from the co-founder of the Surgery Center himself, “Patients are holding plane tickets to Oklahoma City and printing out our prices, and leveraging better deals in their local markets.”
HOLD UP DOC. There are a few BIG assumptions here:
1) The medical procedure you need is known to you in advance – that is, it isn’t an emergency.
2) You have the ability to pay SOMETHING, but either don’t have insurance or lack specific coverage for the procedure, etc.
3) You are physically and mentally able to bargain shop for the healthcare you need. There are many people who need healthcare services who aren’t able to do this – people with dementia requiring long-term care, a person in a coma from a car accident, a person with a debilitating psychiatric problem – it’s not hard to bring examples to mind.
We find that what this really represents is a very specific marketing tactic to a targeted audience – mostly healthy people who need an elective surgery to improve their quality of life. Clearly a very important demographic, but it by no means representative of everyone seeking healthcare.
This approach might works for certain places, like outpatient surgery centers, because they don’t have to deal with people who can’t pay. They can throw their hands up and say, “Don’t blame us! This is a fair deal. Our prices are listed with no small print – pay or don’t receive services.” These are not hospitals – they are centers that offer specific, non-comprehensive services.
Meanwhile, other hospitals in the area, like Oklahoma University Medical Center, take care of people who can’t pay.
The NYT opinion piece basically sums the problem of healthcare costs as a lack of knowledge on the part of the consumer. That IS a problem, but the real problem is summed up simply in one word: profit.
When there is a market-based healthcare system like there is now, we get comical (but tragic!) comparisons like the NYT piece where finding cheap airline tickets through Kayak is used as analogy to “shopping” for health care.
Anyone without a stake in the current system, any American that needs life-saving services, anyone with the presence of mind to take a step back and examine things in context will see this is just. another. tired. gimmick.
The beginning of a real solution to the healthcare cost problem requires the following steps, in order:
1. Recognize every single person’s fundamental vulnerability to disease and death.
THEN
2. Affirm healthcare as a human right, NOT a commodity that is only available to those that can afford it.
THEN
3. Change the system into an “Ultimate Public Utility” model – because it’s something that we ALL benefit from, and are (mostly) unable to predict when we will require.
THEN
4. Realize that a publicly funded, Single Payer model – improved Medicare for everyone – is the NECESSARY BUT NOT SUFFICIENT next step.
I’ve noticed some Single Payer advocates start to falter when they present Single Payer as the ipso facto solution for every healthcare-related problem. It will not be like that. Very little will change for the average person if we just decide tomorrow to extend Medicare to cover everyone. A Single Payer system’s REAL power is providing the ONLY framework that will allow us to collate our bloated, fragmented system into one that can be examined and systematically changed in response to population needs. More fundamentally, it is the only one in which population needs can be accurately assessed in the absence of profiteering. It will be a quicker, more centralized, more responsive system because it is structured to be resistant to conflicts of interest. The goal of a Single Payer system is to provide necessary healthcare to everyone, NOT quibble about piecemeal, temporary gimmicks like price-posting.
Victoria Powell, a 3rd-year med student at Virginia Commonwealth University in Richmond, Va. Her blog, Short White Coat, Inc., is a collection of thoughts, experiences and opinions on the complex relationship between medical industry and medical practice. You can follow her commentaries here.