NY’s Alternative Price Transparency

I recently attended a panel discussion about the future of healthcare reform and specifically the American Health Care Act that the Republicans unveiled (review coming up soon). When I asked the panelists about the importance of price transparency for the effective functioning of a free market, I was told that New York State passed a law requiring the top providers in the state to post prices for their procedures. This surprised me because I had never heard of this law, what great news!

A quick search of “New York price transparency law” reveals several unrelated articles about price transparency in general, a few links about a new pharmaceutical price transparency effort being pushed and then finally a link to New York Senate Bill S77 which seeks to “enact the transparency in health care fees act”. That sounds great so far, what does this thing do?

  S 2999-L. HEALTH CARE BILLS.  1. FOR PURPOSES OF  THIS  TITL  "HEALTH
CARE  PROVIDER"  SHALL  MEAN  A  PRACTITIONER IN AN INDIVIDUAL PRACTICE,
GROUP PRACTICE, PARTNERSHIP, PROFESSIONAL CORPORATION OR  OTHER  AUTHOR-
IZED  FORM  OF  ASSOCIATION, A HOSPITAL OR OTHER HEALTH CARE INSTITUTION
ISSUED AN OPERATING CERTIFICATE PURSUANT TO THIS CHAPTER OR  THE  MENTAL
HYGIENE  LAW,  A  CERTIFIED  HOME  HEALTH AGENCY OR A LICENSED HOME CARE
SERVICES AGENCY, AND ANY OTHER PURVEYOR  OF  HEALTH  OR  HEALTH  RELATED
ITEMS  OR SERVICES INCLUDING BUT NOT LIMITED TO A CLINICAL LABORATORY, A
PHYSIOLOGICAL LABORATORY, A PHARMACY, A PURVEYOR  OF  X-RAY  OR  IMAGING
SERVICES,  A PURVEYOR OF PHYSICAL THERAPY SERVICES, A PURVEYOR OF HEALTH
OR HEALTH RELATED SUPPLIES, APPLIANCES OR  EQUIPMENT,  OR  AN  AMBULANCE
SERVICE.
  2.  PRIOR  TO  PERFORMING  ANY  HEALTH  CARE SERVICES, ALL HEALTH CARE
PROVIDERS SHALL ADVISE PATIENTS IN WRITING OF THE FEE TO BE  CHARGED  TO
THE PATIENT FOR THE SERVICES TO BE RENDERED IN THE EVENT SUCH FEE IS NOT
PAID FOR BY INSURANCE.
  S 3. This act shall take effect immediately.

Beautiful! This is exactly the bill that our healthcare system needs. When does this go live?

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Oh…it hasn’t passed into law yet, it’s still a proposal. That must be why I never heard of this bill. But it’s in the health committee, so that’s good news, right? It’s a good cost control mechanism that also has the benefit of protecting consumers from surprise billing, surely it will pass, right?

 LEGISLATIVE HISTORY :

S.344 of 2015-2016 (Hoylman): Died in Health
A.250 of 2015-2016 (Rozic): Died in Health
S.7124 of 2014 (Hoylman): Died in Health
A.3518 of 2013-2014 (Rozic): Died in Health

Of course it won’t pass. This is yet another incarnation of a bill that gets brought up every year (thank you state senators Hoylman and Rozic), gets sent to the health committee, and dies there. Well, I wonder why it keeps dying there? It’s most likely not so different from what happened to the price transparency law that was passed in Ohio:

The hubris of the healthcare lobby, as displayed by its actions after the law passed unanimously in June, 2015, is unfortunately telling.  The lobbyists who are ostensibly representing Ohio providers failed to even inform their members that this legislation passed, leaving the vast majority in the dark and unprepared to comply with the law.  This failure to inform provider members of legislation that would affect their practices is not surprising given the confidence of the lobby in its ability to reverse the will of the people.  According to the healthcare lobby, it “had the votes” (meaning had enough “friends” in the legislature) to repeal the law.

So if we don’t get to have true price transparency, as I was misinformed by the panelist, what do we have instead? In 2015 New York State passed a bill establishing FAIR Health as a benchmark pricing tool to protect consumers. FAIR Health claims that law offered “comprehensive healthcare cost transparency”, which is a very loose definition of comprehensive, since it does no such thing. What FAIR Health does do is provide an award winning consumer website that tells me that in my area my estimated out of pocket cost for a hemodialysis procedure with one physician evaluation is $85.50…

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… which means absolutely nothing! What theoretical provider matches this estimate? What theoretical plan matches this coverage setup? What if the provider is out of my network? Of course they don’t even provide a recommendation of a provider that most matches this estimate.  And as a consumer that magical word “estimate” is really unsettling, because if I walk into the wrong facility, that cost could easily be much higher. So do I feel like I am protected from surprise fees? Am I able to shop around for a hemodialysis at the price best for me? Absolutely not, because we don’t have “comprehensive price transparency,” we have alternative price transparency.

And as long as we allow lobbies to hijack the legislative process to protect entrenched monopolies, that’s the price transparency we deserve.

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If Air Travel Worked Like Healthcare

This is an older video from 2010, but all if it is still true. It speaks volumes to how the ACA does nothing to address the real problems in the healthcare market.

Healthcare reform has repeatedly failed because Washington continues to misdiagnose an over-regulated noncompetitive provider market as a health insurance coverage problem. We don’t need Obamacare. We need Southwest General Hospital. Healthcare is too important not to be left to the free market.