The next time I receive medical care, I want to know how much it will cost before I agree that it will be done — and that includes no matter who pays the bill.
And, doctor, I want you to know and I want you to care how much what you prescribe is going to cost me or somebody.
You say it is beyond your control to know? I say, insist.
Rise up, as one, and demand to know.
If I go into a department store, or a restaurant, or a bar, or a supermarket, or online for theater, or a football game, or airplane tickets, or a hotel room, I will know how much I will have to pay to obtain whatever it is I want before I close the deal.
Why have we as a society allowed medical care of all sorts to be so different? Are we just a bunch of ninnies?
Not knowing, or sometimes even caring about the price of a surgical procedure, a diagnostic test, a biopsy, an MRI, a hospitalization, an emergency room, or urgent care, or primary care, or specialist office visit is routine.
Recently, some politicians in — of all places — Florida tried to change at least a little bit of that nonsense.
But some elements of the Florida medical industrial complex rose up to smite those silly legislators. Didn’t they understand who is in charge?
I believe that we patients should, if mentally competent, and in a non-emergency, non-OR, and -ICU situation, be provided an opportunity for an “economic informed consent.”
Medical decisions are increasingly shared decisions. However, a frank discussion about the comparative costs and charges for the options, whether the payment will be by the insurance company, Medicare, Medicaid, or out-of-pocket for the patient, or shared, is usually missing.
Of course the medical marketplace does not behave like other markets; it is rigged by so many factors and groups.
Consumer-driven healthcare truly cannot grow in importance and frequency unless costs, including costs for referral, are knowable.
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The attitude that “if insurance will cover it, do it” lies at the root of our problem of healthcare cost inflation. No one is held accountable.
If we as a country could widely apply the “economic informed consent,” physicians and patients would become educated together to become wiser shoppers.
Most of us in healthcare laud “transparency” — let that include economic transparency.
George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.
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