Tonight on Twitter, I met Ethan Weiss, a San Francisco cardiologist with a story to tell about a patient. Dr. Weiss is an Associate Professor at UCSF and prolific Tweeter, but his story didn’t fit the format very well.
“I hope you’re sharing this in a better forum,” I said.
“I don’t have one,” he answered, so I asked his permission to post the tweets here and he said sure. Here it is, with my medically unqualified commentary.
The story begins with a patient coming in for an echocardiogram:
In which Dr. Weiss tries to figure out how much of his high deductible this insured and otherwise healthy patient might have to pay for the test:
That turns out to be a hard question. Although the patient was insured, there was no limit on what the hospital could charge him for the test.
As many of us have learned the hard way, there’s no such thing as a sticker price on health care, even when you have insurance.
Price is unhitched from value, and outside the negotiating power of the network, patients pay any price the health care provider names.
No happy ending - just an all-too-familiar outcome of our irrational, broken system.
Christopher Flavelle at Bloomberg News claims that “hospitals price gouge, but it’s not their fault.” Congress is to blame because:
“The Affordable Care Act took some steps to stop hospitals from price-gouging the uninsured, requiring they charge these patients no more than what commercial health plans will pay. But those protections only apply to nonprofit hospitals” which aren’t the problem.
For-profit hospitals are the big gougers, and their promises to offer big discounts to the uninsured are only that: promises, left out of the legislation. Better consumer information would help, but as Dr. Weiss just demonstrated, it can be hard to get, especially when time is a factor - and patients with high deductibles aren’t uninsured, but they may be out of network and out of luck. The solution isn’t to repeal the Affordable Care Act, but to improve it to close loopholes like this that allow hospitals to gouge patients when they’re least able to shop around.