The Best Thing That Almost Happened to Healthcare

April 6, 2020

Lawmakers should support what 91 percent of Americans want, despite how much money they get paid to vote otherwise.

The tweet from President Trump came shortly after 3 pm, on a Tuesday in late March, detonating a chain of cheers from members of a nationwide coalition of patient and physician advocates that I belong to, a group fighting hard for price transparency in health care.

The POTUS Tweet triggering the reaction read: Price transparency is so important for the people of our Country. In many ways, it will prove to be as important as healthcare itself. A great issue for both Republicans and Democrats. Hopefully it will be approved!

We scored! Or, we almost did. For six years, as the executive director of the Association of Independent Doctors, a national nonpartisan, nonprofit trade organization, I have been working with a dozen or so advocacy groups, who collectively have been working with lawyers, journalists, lawmakers, employers, and government agencies to bring health-care prices down, to stop consolidation in health care, and to restore the patient-doctor relationship. One certain way to do all that is to achieve complete price transparency in health care.

In a government survey, 91 percent of Americans said they would like to be able to see and compare the price of health care before they buy it and get blindsided by a bill they can’t afford. Why is that so much to ask?

Because those who profit from keeping patients in the dark – namely health systems, insurance companies and big pharma -- spend hundreds of millions of dollars lobbying Congress to make sure their secret negotiated prices stay hidden.

Who wouldn’t love that business model? Deliver the nonrefundable product, then disclose the price.

That Tuesday afternoon tweet wasn’t the first time President Trump had signaled that health-care price transparency was as a signature goal of his Administration, a move “as important as healthcare itself.” Last June, he signed an executive order to improve price and quality transparency in health care. He mentioned price transparency in February in his State of the Union Address. Now all he needed – all we needed -- was a law to enforce it. And that was why the tweet’s timing was so fortuitous.

Notably, the tweet came out as Congress was hammering out the $2.2 trillion CARES Act, the phase III stimulus package was being fast-tracked to bring economic relief to a nation shutting down in response to the coronavirus pandemic.

Fueling our hopes came rumors that a price transparency measure was on the table and may be added to the bill. That night, The Hill confirmed in an article titled “White House pushing to include health price transparency in coronavirus package” that the Administration was advancing regulations that would require hospitals and insurers to disclose health-care prices in the massive stimulus package. 

“The Trump administration is trying to codify regulations it issued in November that would require hospitals to post their prices online, while mandating insurers allow patients to compare costs and different providers,” the story said.

The hopes among those in the coalition soared, and our imaginations took flight.

If health-care prices were transparent …

·       … Americans could shop for health care the way we shop for cars, refrigerators, big screens and houses, and everything else we buy.

·       … patients could know the cost of care before they received it, and before they got a bill they could neither foresee nor afford.

·       … hospitals and doctors would have to compete based on price and quality, creating a free market that would drive prices down and quality up.

·       … patients would see that independent doctors, those who aren’t owned by hospitals or private equity groups, cost a lot less than their employed colleagues, because they don’t layer in large, and valueless facility fees; they would also see that non-hospital-owned imaging and outpatient surgery centers were far less expensive. 

·       … we could eliminate the waste in our health-care system, starting with our administrator-heavy hospitals and the middle players in the supply chain, who never touch a patient, but who prosper excessively from our price-opaque system. 

·       … competition would cause health-care prices to tumble down, and employers could put that savings toward more jobs and higher wages, while workers and taxpayers could stop spending one out of every five dollars they earn on health care, and start putting more money into retirement or savings, or just to pay their bills.

All if prices were transparent.

In those heady hours before the stimulus bill was finalized, we dreamed this could be. And then, as the sausage was made in the night, it wasn’t. The transparency measure did not make it into the 880-page bill.

By 9 a.m. Wednesday a story came out in Modern Healthcare offering a glimpse into how special interests quashed the dream. The story carried this sad explainer:

The White House had pushed for a surprise billing ban and for price transparency language that was ultimately left out. The Greater New York Hospital Association, a powerful force in (U.S. Sen. Chuck) Schumer's state, told members that the group "advocated strongly against" the policies.

"We are also pleased that extraneous measures supported by the Trump Administration, such as surprise billing and price transparency provisions, were not included in the final legislation," GNYHA said in an email to members.

And that is the story about the best thing that almost happened to health care.

But my association and the rest of the coalition are not giving up. Trump knows what to do, but Congress needs to budge. I may be disappointed often, but I still believe that our lawmakers should support what 91 percent of Americans want, despite how much money they get paid to vote otherwise. 

A Phase IV stimulus package is in the works. Maybe this time Congress will listen to Americans, and we’ll win.

Marni Jameson Carey is the executive director of the Association of Independent Doctors, a national nonprofit trade association that works to help stop the consolidation in health care, promote price transparency and market competition, and keep American’s doctors independent.