Imagine walking into a restaurant, and you’re handed a menu with no prices.
At this hypothetical restaurant, you’re told that the cost of the meal will fluctuate based on where you sit, and who happens to serve you. And you’ll only receive a detailed copy of the bill four weeks later, when it arrives via fax machine.
Welcome to the U.S. health care system.
For physicians like Dr. Pat Basu, analogies like this one are far from perfect. But they are a useful way to describe to people how the U.S. health system really works.
Basu is no ordinary doctor. He works as the chief medical officer at Doctor on Demand, a startup that connects patients to doctors online. Previously, he advised the White House on health care policy and reform. Given his background, he is often invited to speak at medical industry conferences.
But unlike many of his peers, Basu gravitates to consumer-friendly analogies and tries to refrain from using jargon.
We met for coffee this week to chat about the lack of price transparency in health care, and how the average American would react to a restaurant that kept customers in the dark about its prices.
On a whim, I shared the analogy with my Twitter followers late Tuesday evening.
Imagine a restaurant with no prices (u find out only after u order) & a bill that fluctuates based on where you sit — that's healthcare.
— Christina Farr (@chrissyfarr) April 22, 2015
I was floored by the volume and breadth of responses, which ranged from laugh-out-loud funny to downright depressing. I highlighted a few, although I recommend perusing the thread in its entirety.
@chrissyfarr and the person paying won't tell you if they'll pay until after you eat. One wrong bite and you're bankrupt.
— David Bressler (@djbressler) April 22, 2015
— chris matthews (@matthewscd) April 22, 2015
— David States (@statesdj) April 22, 2015
— Shane (@OnerousLetterLi) April 22, 2015
Why the Lack of Price Transparency?
As Dr. Basu explained, it’s long been a struggle for consumers to find out in advance how much their doctor visits and procedures will cost. Unlike restaurants, health care institutions shy away from publishing their prices, as it depends on who’s footing the bill.
Some web-based tools do a decent job of providing cost estimates (KQED launched its own service, PriceCheck, which relies on data aggregated from California-based readers).
But for most patients, price is still a gamble. As one recent study found, the price of a blood test in California can range from $10 to $10,000, depending on the hospital.
— Ryan Flinn (@RS_Flinn) April 22, 2015
Unfortunately, improving price transparency isn’t a simple proposition. The debate has raged for decades among health care policymakers and academics — some have argued that it may not work well in practice.
But for most consumers, who aren’t knee deep in D.C. politics, it is unclear why they can compare prices online for a steak dinner or a new television — but not for a critical medical procedure.
The Trouble With Jargon
The health care industry needs to a better job of reaching people on social media, and helping them understand the status quo.
Much of the available literature on the price transparency topic is confusing and downright boring. And at health care conferences, which I frequently attend in the pursuit of clear answers, speakers spew out incomprehensible medical jargon.
I’ve often wondered: Do these “industry insiders” actually understand each other? Or are they nodding along for appearances sake?
In 2014, I was asked to interview a panel of medical experts at a conference on the topic of “reimbursement.” Half-joking, I suggested that we would have done a better job of filling the room by amending the description to “show me the money.”
“So…What even is reimbursement,?” I asked the panel.
That opening question was met with a minute or so of excruciating silence. Eventually, several of the speakers piped up, each giving me a slightly different answer.
Dr. Jordan Shlain, a physician I bumped into at a recent health-tech conference, had a similar experience when he asked an audience of 400 people if they understood the meaning of the term “patient engagement.” Two hands went up.
I strongly agree with Shlain, who shared this experience in a blog post, that if we want patients to participate in important, ongoing policy discussions about the future of health care, we need to cut down on our use of jargon.
If analogies resonate with people and prompt a discussion about health care, bring ’em on.