Price transparency in healthcare. On the surface this sounds like a wonderful and logical idea. After all, if capitalism has taught us anything it's the more information a consumer has the more efficient economic system we will have (think price that truly reflects market conditions). Much in the same way psychology teaches us the people will seek pleasure and avoid pain, the market will seek pleasure by producing the best product at the least possible price while avoiding pain by not rewarding high prices or fraud. Did you just let a sarcastic laugh too??

While studying political science at Boise State University, one of the hardest classes I ever took was called American Political Economy (at least that’s the title of the class that’s stuck in my head right at this moment). In simply turns, it was supposed to be the use of economics in order to explain politics, seems pretty simple and straightforward right. Wrong, as I recall, despite a ton of work and sweat on my part a win for that class was accepting that C’s get degree’s. Why am I going down memory lane you ask? Well, its because I believe that the price transparency argument is very similar to my American Political Economy class experience. On the surface its pretty straightforward, price transparency is using economics in order to help patients like me receive better healthcare and thus a higher quality of life (think accurate price that reflects quality care). In reality, pice transparency is much, much more complicated and requires a deep dive into the weeds of healthcare, economics, politics, and the differences between a checkbook and human right.

Before going forward I should admit to something. My mind is completely made up on this topic and probably won’t change. In my humble opinion, price transparency in healthcare is the new “wag the dog”. It is crap, it is the latest and newest way to make patients like me look like extremists because we are against capitalism while at the same time protecting the profit interests of the few. So right now you have 2 choices, either continue reading my argument or go look at my photography. More and more I’m being told that I’m getting good at taking pictures so either choice will reward you.

Back on topic. First, let's discuss some basic assumptions of price transparency that one has to make in order to be a supporter of it. First, one has to accept that our healthcare system operates on the same economic principles and ideas as the same system for big screen HD TVs or the underwear we are wearing (you are wearing underwear right?). Simply put, we want the best quality product for the lowest price possible. In addition, we trust the stores these products are sold in and believe the manufacturing system is developed with our best interests at heart. As a biased person, I’m sure there is probably a cleaner way of stating this that would be more neutral but since this is my post and website, you get Big Al’s brain.

In addition to the assumptions about our healthcare system, one has to assume the both acute and chronic patients, like me, are operating as consumers. We have the same economic goals as someone who is going shopping for a new 60 inch HD TV or a nice new pair of cheeky underwear (sorry, I heard that term on the radio this morning which immediately made me giggle, yes I have the maturity of a 2nd grader). Doctors, nurses, pharmacists would be similar to business owners or CEO’s. Caregivers, love ones, and friends would be the party team that comes over to watch stuff on the new HD TV I guess, sorry I’m not sure of your part in this assumption game.

Time to blow up these stupid assumptions. Yes, I said stupid and here is why.

According to mom, I basically went straight to an MRI machine after birth because there was a worry I was born with water on my brain. Given this argument I feel the need to state the obvious, parental needs in a situation like this are NOT the same as a consumer going to Best Buy to buy a new Sony HD TV. Mom and dad didn’t need an MRI salesman at that point, they needed a doctor to explain what my life would be like if the worst case scenario came true and I did have water on my brain. I’ve had spinal meningitis, countless sprained ankles, 11 plus surgeries, several serious pneumonia episodes, and so much more. However, the night I fell off a cliff while rock climbing is probably the time I needed the healthcare system the most. I needed an emergency room NOW. Although I did not have health insurance at the time, and was only making peanuts as a local delivery driver, I was not going to tell my friend that was driving me the ER to pull over because I needed to call all 3 hospitals in the Treasure Valley in order to comparison shop x-rays and cat scans. I wasn’t going to call St. Al’s and ask if I bought one day in their facility if they would offer a second at half price. There was no time to schedule interviews with surgeons or ask if they had any Groupon’s available. Under NO circumstance was I consumer of healthcare at that moment in time, I was a broken human who was bleeding out of the top of my head and whose left arm was sticking up 3 inches in the wrong direction who required immediate help. I needed care, compassion, and someone with the intellectual curiosity to put me back together, not a salesperson for a HD TV.

I have another story proving patients are not consumers. My dad was a retired one star general, easily one of the toughest humans I’ve ever meet. At 4;30pm, on the 3rd Friday of August 2017, I received a call from him even though I was at work. I mentioned this because 10 years earlier dad had drove himself to the hospital in the middle of a stroke because he knew my brother and I were at school/work (like I said, he was one tough dude). Dad knew I left work at 5pm so him calling during work hours was unusual. However, dad had finally relaxed from his military discipline so I assumed he was calling to say he wanted a steak dinner and that he was buying and wanted to know if I would like a steak dinner too. Now, I had just turned into my boss my final product of the week and was about ready to do my daily check of the Ada County Sheriff’s arrest report website, its fun to see if I knew anyone or in one case, to see a girl I had dated in high school. Since I was just running out the reminder of the work day, I took his call instead of letting it to go to voicemail and calling back after I was off (which he normally would have advocated and almost demanded I do, work comes first). Turns out I had made the right choice to answer, it was the Boise Fire Department calling to tell me someone had found dad sleeping in his driveway, bloody, and not making sense. Yeah, dad’s one star general Maverick fly boy swagger wasn’t going to get him out of this situation, at that moment dad needed others to make even the most basic of medical decisions for him at that point. Price was not a factor, ensuring a father and retired brigadier general received the best care possible was the only thing on everyones mind.

In addition to dads stroke 10 years earlier, my close friend Justin also had a stroke at that time. Both Justin and dad received treatment at St. Al’s Regional Medical Center. Due to this I knew that St. Al’s had been recognized nationally as one of the best hospitals in the region for stroke treatment. Since I had this knowledge I had no issue, at that time, with the paramedics taking dad to St. Al’s for treatment (I do now, his care at St. Al’s was shit but that’s another story). The point is, I wanted dad at St. Al’s because they had been rated so high for their stroke care and treatment. It was dad, not only did I not give a damn about price I was more than happy to have my inheritance reduced if it meant a higher quality of life for him (dad stated multiple times that he wanted my brother and I to get his money, not healthcare or the government so that is why I’m mentioning money. Dad was highly intelligent and book smart with the soul of a cowboy). As dads primary caregiver due to power of attorney, I wasn’t going to tell Boise Fire to hold on, I wanted to call St. Luke’s quick like to get a price quote on possible stroke care there. I wasn’t going to offer to call Boise Fire back because I wanted to spend hours online researching stroke care in Idaho or the Pacific Northwest. As dad was found of saying, he was upper middle class which meant he probably could have afforded to go to almost any hospital in the country since this country celebrates healthcare as a checkbook right vs human right. All I wanted was dad to get the best possible treatment possible during his time of need, economics be damned. I might be naive here, healthcare decisions should be based on love and not saving $50 on an x-ray.

According to the Google, a consumer is a person who purchases goods and services for personal use. If healthcare were truly an economic system, then the hospital, doctors, pharmacists, radiologists, etc would be offering to pay all patients like dad, me, or Justin for our pain so they could use their good and/or service. Yes, you read that right. If we want or expect healthcare to be in the same market as buying a new HD TV, patients pain (both physical and mental) should be the good and the consumer would be the doctor or hospital. Just imagine how patient centered care would be if the hospital had to pay us for access to our broken bones, dying brains, or cancer cells. We would have treatments for all these issues and more yesterday.

Final thought. On paper capitalism sounds and is a revolutionary idea. I’m currently sharing these thoughts and ideas on a laptop that has more computing power than most rockets, satellites, and spacecraft that have experienced other planets or interstellar space (can you believe the Voyager spacecraft from 50 plus years ago is still sending scientific info back to earth?). Thanks to capitalism and my willingness to work hard, I was able to afford my MacBook Pro. That is very cool. However, there is a risk here that is the main reason I do not want patients group together with consumers.

That risk is simple, capitalism relies on humans being creatures without greed, fraud, or criminal intent for success but can take years or even decades to discover that greed or criminal intent in humans is more common than we care to admit. Based on experience and research I know there is a legitimate chance that my new 13 inch MacBook Pro could last me 5, 7, 9 plus years before I need to replace it which is why I’m willing to pay more vs a different brand that might work just as well but its expected lifespan is measured in months, not years like with Apple products. I also accept the real possibility that somewhere along the manufacturing line a lemon part was used so my MacBook could go belly up in the morning. Regardless if it is greed, fraud, unintentional mistake, or criminal intent, the worst thing that can happen to me is that the money I spent on this laptop is gone forever with no chance of recovery. As dad use to say, “its only money”.

If a human is greedy, fraudulent, or has criminal intent in healthcare, not only am I out money but chances are my life will also be at risk. Greed, fraud, or criminal intent, especially if it takes years to discover, puts peoples lives in danger. We are not talking one or two lives either, we are talking groups and portions of the population since there is so much overlap in healthcare. Contrary to what a conservative will tell you, this does not mean I'm a proponent of socialist healthcare. I will say, at least on paper, I do believe the emphasis of a socialized healthcare system is more on the patient than it is in a capitalist system. What I’m truly a proponent of is creating a healthcare system that does not rely on risk for success. Success is measured in ideas like quality of life, not profits at the end of an income statement.

But wait Alan, the only reason your MacBook Pro is so cool is because Apple took on the risk of starting a computer based business. I admit, this is true. However, thanks to things like social media and the fact we are all now globally connected, I don’t believe humans need things like competition through business with the reward being profit in order to design for the greater good. It is now possible to love discovery, make rent through human centered problem solving, and by the simple desire to end suffering.

Price transparency does nothing towards helping someone end suffering, it doesn’t help someone explore their passion for discovery. It does nothing to help dad when I get a call from Boise Fire informing me that he needs immediate medical attention. When my ego and athletic ability don’t talk so I fall off a cliff rock climbing, price transparency does nothing for me when I’m being rushed to the closest ER. More often than not, healthcare decisions are based on the immediate need of the symptom(s) being witnessed at that particular moment. Healthcare decisions are made based on the individual patients definition of time, not price. All price transparency does is make those with little or no economic resources have to beg for their lives. All price transparency does is prove what we already know, a bandaid should not cost $100 nor should it have 398,283 different prices because a hospital has negotiated a different price for each insurance plan it accepts. That said, if a hospital or Blue Cross/Blue Shield wants to post its prices, I’m all for that even though I did describe it earlier as the new “wag the dog”. I’m guessing someone really good at math will be able to discover some interesting conclusions if they had access to price information. Let’s not kid ourselves, all price transparency proves is healthcare is too expensive for it being a human right and even a $1 copay can prevent access to much needed care.

Stay tuned, I’m thinking about turning this into a multipart series. This post examined price transparency on a high level, I would like to jump into the weeds or numbers. Still working on it but I think if we examine price transparency and housing, we will see how little this tool actually helps keep housing affordable. Like I said, stay tuned.