I recently served as president of a Miami hospital and got an insider’s view of the healthcare system. The lack of “legitimate” healthcare pricing has destroyed the system.
Ask the price of any healthcare service and you will always receive the same answer: “What insurance do you have?” Billing is determined by how much can be extracted from each patient on a case by case basis. Because billing rates are not set, the industry is able to prey on patients at their most vulnerable. And if you are out of network or uninsured, you pay the highest rates.
A simple blood test for cholesterol can range from $10 to $400 or more at the same lab. Hospitalization for chest pain can result in a bill from the same hospital for the same services ranging anywhere from $3,000 to $25,000 or more.
Price transparency initiatives are futile when prices may vary by a factor of 100 for the exact same service performed by the same provider.
To stop the bleeding, Congress need only require that healthcare providers publish “legitimate pricing” which means, they can continue to set their own rates, but - a different rate for each patient - must be prohibited.
Rates must be published in a uniform format such as industry standard CPT codes or a percentage of Medicare rates. Every citizen would be empowered to search any medical procedure online and see pricing for all providers within X miles. It would be as easy and familiar as checking the price of any other goods or services.
Legitimate prices mean networks will be obsolete, along with the administrative burdens, tremendous costs, and limitations on patient choice which they impose.
Reducing healthcare costs is the only way to materially lower health insurance premiums. Legitimate pricing will force providers to compete. Costs and therefore insurance premiums will plummet overnight.
But if we keep the status quo, we will continue to see rising prices and outrage over medical bills. We shouldn’t have a system that makes us so powerless.
To reverse our nation’s financial bleeding and end restrictions on patient choice, we petition for the President-Elect's support for Congress to empower citizens by mandating legitimate healthcare pricing.
