What if all US health care costs were transparent Jeanne Pinder
So, a little while ago,
members of my family
had three bits of minor surgery,
about a half hour each,
and we got three sets of bills.
For the first one, the anesthesia bill
alone was 2,000 dollars;
the second one, 2,000 dollars;
the third one, 6,000 dollars.
So I’m a journalist.
I’m like, what’s up with that?
I found out that I was actually,
for the expensive one,
being charged 1,419 dollars
for a generic anti-nausea drug
that I could buy online
for two dollars and forty-nine cents.
I had a long and unsatisfactory
argument with the hospital,
the insurer and my employer.
Everybody agreed
that this was totally fine.
But it got me thinking, and the more
I talked to people, the more I realized:
nobody has any idea
what stuff costs in health care.
Not before, during or after
that procedure or test
do you have any idea
what it’s going to cost.
It’s only months later that you get
an “explanation of benefits”
that explains exactly nothing.
So this came back to me
a little while later.
I had volunteered for a buyout
from the New York Times,
where I had worked for more than
20 years as a journalist.
I was looking for my next act.
It turned out that next act
was to build a company
telling people what stuff costs
in health care.
I won a “Shark Tank”-type
pitch contest to do just that.
Health costs ate up almost 18 percent
of our gross domestic product last year,
but nobody has any idea what stuff costs.
But what if we did know?
So we started out small.
We called doctors and hospitals
and asked them what they would accept
as a cash payment for simple procedures.
Some people were helpful.
A lot of people hung up on us.
Some people were just plain rude.
They said, “We don’t know,”
or, “Our lawyers won’t
let us tell you that,”
though we did get a lot of information.
We found, for example,
that here in the New York area,
you could get an echocardiogram
for 200 dollars in Brooklyn
or for 2,150 dollars in Manhattan,
just a few miles away.
New Orleans, the same simple blood test,
19 dollars over here,
522 dollars just a few blocks away.
San Francisco, the same MRI,
475 dollars
or 6,221 dollars just 25 miles away.
These pricing variations existed
for all the procedures
and all the cities that we surveyed.
Then we started to ask people
to tell us their health bills.
In partnership with public radio station
WNYC here in New York,
we asked women to tell us
the prices of their mammograms.
People told us nobody would do that,
that it was too personal.
But in the space of three weeks,
400 women told us about their prices.
Then we started to make it easier
for people to share their data
into our online searchable database.
It’s sort of like a mash-up of Kayak.com
and the Waze traffic app for health care.
(Laughter)
We call it a community-created
guide to health costs.
Our survey and crowdsourcing work
grew into partnerships
with top newsrooms nationwide –
in New Orleans, Philadelphia,
San Francisco, Los Angeles,
Miami and other places.
We used the data to tell stories
about people who were suffering
and how to avoid that suffering,
to avoid that “gotcha” bill.
A woman in New Orleans saved
nearly 4,000 dollars using our data.
A San Francisco contributor
saved nearly 1,300 dollars
by putting away his insurance card
and paying cash.
There are a lot of people
who are going to in-network hospitals
and getting out-of-network bills.
And then there was the hospital
that continued to bill a dead man.
We learned that thousands of people
wanted to tell us their prices.
They want to learn what stuff costs,
find out how to argue a bill,
help us solve this problem that’s hurting
them and their friends and families.
We talked to people who had
to sell a car to pay a health bill,
go into bankruptcy,
skip a treatment because of the cost.
Imagine if you could afford the diagnosis
but not the cure.
We set off a huge conversation about costs
involving doctors and hospitals, yes,
but also their patients,
or as we like to call them, people.
(Laughter)
We changed policy.
A consumer protection bill
that had been stalled
in the Louisiana legislature for 10 years
passed after we launched.
Let’s face it:
this huge, slow-rolling
public health crisis
is a national emergency.
And I don’t think government’s
going to help us out anytime soon.
But what if the answer was really simple:
make all the prices public all the time.
Would our individual bills go down?
Our health premiums?
Be really clear about this:
this is a United States problem.
In most of the rest
of the developed world,
sick people don’t have
to worry about money.
It’s also true that price transparency
will not solve every problem.
There will still be expensive treatments,
huge friction from our insurance system.
There will still be fraud
and a massive problem
with overtreatment and overdiagnosis.
And not everything is shoppable.
Not everybody wants
the cheapest appendectomy
or the cheapest cancer care.
But when we talk
about these clear effects,
we’re looking at a real issue
that’s actually very simple.
When we first started calling for prices,
we actually felt like
we were going to be arrested.
It seemed kind of transgressive
to talk about medicine and health care
in the same breath,
and yet it became liberating,
because we found not only data
but also good and honest people
out there in the system
who want to help folks
get the care they need
at a price they can afford.
And it got easier to ask.
So I’ll leave you with some questions.
What if we all knew what stuff cost
in health care in advance?
What if, every time
you Googled for an MRI,
you got drop-downs telling you
where to buy and for how much,
the way you do when
you Google for a laser printer?
What if all of the time and energy
and money that’s spent hiding prices
was squeezed out of the system?
What if each one of us could pick
the $19 test every time
instead of the $522 one?
Would our individual bills go down?
Our premiums?
I don’t know, but if you don’t ask,
you’ll never know.
And you might save a ton of money.
And I’ve got to think that a lot of us
and the system itself
would be a lot healthier.
Thank you.
(Applause)