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Should Pricing for Medical Services be Regulated to be Transparent?

Congressman Paul Ryan agrees that not knowing the price for procedures reduces consumers' ability to comparison shop and make educated decisions.

Congressman Paul Ryan made his last two stops for his 19-city tour of the First District today in Sturtevant and Racine.

In Sturtevant, a woman stood up and thanked Ryan for his service and then asked him if his plan would provide consumers a way to comparison shop. This resident explained that as an employee in the healthcare system, she sees the inequities of pricing structure, but as a consumer who comparison shops for other goods and services her family needs, she's frustrated by not being able to do the same for healthcare.

Ryan agreed that the pricing structures are flawed, and explained why they're flawed.

And while the Path to Prosperity doesn't address this issue, he said he is helping author new legislation tackling the need for healthcare transparency that he will introduce that bill down the road a bit.

Watch the video and tell me what you think. Does healthcare pricing need to be as transparent as reading a menu at a restaurant? Should government regulate to get transparency? How will such transparency help us control the way healthcare costs rise?

TammyM April 30, 2011 at 08:45 PM
Websites for this exist already. Why don't all doctors sign up for them? If all doctors listed their services on a site like FairCareMD the cost of care would go down significantly. Why not legislate something like this? As it is they mostly only have doctors in New York. The founder, Alex Fair actually went to school at the Medical College of Wisconsin too, right in Milwaukee! Let's support transparency and tell Ryan to get behind that effort and encourage docs to sign up!
Heather in Caledonia May 01, 2011 at 01:11 PM
What about when you go for a lab test? Why isn't the price given to you right away? When I go to the dentist, they can tell me exactly how much it's going to cost and what my insurance will cover. Why can't Wheaton figure something out that would do that for people BEFORE they agree to a procedure or test?
Heather Rayne Geyer May 01, 2011 at 08:23 PM
I have had experience with health care, insurance and as a patient (bill payer). When I worked as a Surgical Tech Assistant, part of my job was to clear all insurance costs, copays, yadayada. I basically had to make sure everything being done was getting covered. This was a ridiculously insane part of my job. They make it nearly impossible and will never tell you anything "for sure". It is ALWAYS an estimate. Because at any moment, things can change. Insurance companies make things VERY difficult. I have to call them almost every time I receive a bill due to a problem, or a form that wasn't filed or some stupid mistake either on their end or WF's. When my husband had his wisdom teeth removed we got a number from the dental office as to what would be paid and what we had to pay. We were not told this was an estimate. We wanted to make sure because we may have gone somewhere else. After the surgery we were told we owed an amount triple than what was told to us. It took months to fight it through the BBB - but we won. I guess my point it - this would be a very difficult thing to do. There are so many components to treatments, care, labs, etc. Sometimes Drs. don't KNOW what needs to be done until you are naked on the table. It isn't always black or white - not an exact science. I say regulate the insurance companies. Talk about needing transparency!!
Heather Asiyanbi (Editor) May 01, 2011 at 10:05 PM
While it's true that doctors don't always know the end result (surgery), office visits, lab tests, MRIs, mammograms, and even x-rays can have a simple cost. Even the cost of a hospital room has a base cost. Why is an MRI $2800 at one location but $3200 at another? But just knowing that, can certainly make a big difference on where you go for the test; more so when you are responsible for a percentage of that cost. I think it should be that easy. Office visit is so much. Routine lab tests for cholesterol and CBC is this much. X-rays are so much for 5 angles and this much for 10. We should be informed consumers and not just think, "oh, my insurance will take care of it." That kind of thinking is what got us here in the first place. But yes, something needs to be done with the insurance industry as well. Not sure what, exactly, but definitely needs to change.
Heather Rayne Geyer May 01, 2011 at 10:14 PM
With many insurances you can't even chose one place over another anyway. Its all so confusing. A "menu" would make things much easier. I dont know that it is so much apathy that did us in, but also I think we have been conditioned to feel as though we do not have a choice in anything.
Heather Rayne Geyer May 01, 2011 at 10:14 PM
I do think this would be an easier plan to administer if there were universial healthcare. :)
Heather Asiyanbi (Editor) May 01, 2011 at 10:17 PM
I don't think insurance companies should be able to limit you to where you go. I know that's pie-in-the-sky thinking, but you pay for their services, right? Why should they tell you that Dr. A is okay, but Dr. B is not, especially if you already have a relationship with Dr. B and then ... what if Dr. B is also less expensive?! Insurance is the only service in America we pay for and then hope to God we never need for anything more than routine stuff like annual physicals. Don't even get me started on car insurance.
Heather Asiyanbi (Editor) May 01, 2011 at 10:20 PM
Insurance is meant to spread the "pain" over a larger pool of people, right? So ... if that's the case ... paying into a universal system would be better as long as you retain the ability to choose your provider(s) AND patients are required to pay a percentage of their bills above annual physicals. I think that's key ... preventative medicine like annual physicals, mammograms, well baby, etc., should be covered 100% (with the aforementioned blood work), but anything else should be shared cost at a 90/10 split, for example. That forces people to be more informed consumers, perhaps could even spur folks into taking better care of themselves? I dunno ... it's complicated, I know. But does it need to be?
mona lori May 02, 2011 at 04:11 PM
Consumers need to know what health care services will cost them out-of-pocket --- before they visit a provider. If consumers have access to tools that provide meaningful prices, consumers will be empowered to shop around for the best value and make their health care dollars go further. Several initiatives and websites focus on providing consumers with tools to look up prices, but the health care industry still has a long way to go to bring meaningful price data to consumers. Be sure the check out www.outofpocket.com, a free search tool that allows consumers to search for health care prices. Regards, Mona Lori Founder Outofpocket.com

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