The Problem

Our healthcare system is broken.

We spend more than any other high-income nation on healthcare, by at least 50 percent. Yet, our healthcare outcomes are the worst among economically comparable nations. 

The rising cost of healthcare in America is due solely to an increase in cost and not an increase in utilization. If our healthcare spending continues to rise at historical rates, it will pose a significant threat to our economic stability. Our economy will go into a tailspin and Americans won’t be any healthier.

The U.S. has the
lowest life expectancy and the
highest infant mortality rate
among comparable nations.

Source: OECD

Healthcare's Ailing Economics

The economics of healthcare in America are such that doctors who keep us healthy earn far less than doctors who treat disease. Providers are better compensated when sending patients for expensive tests and scans than when conducting a thorough diagnostic office visit. The patient pays the price in time, money and quality of care. An increasing number of Americans find themselves on high deductible insurance plans, and U.S. businesses are spending more and more money to keep their employees insured.

It’s a vicious cycle. Huge numbers of Americans, even those with insurance, forego medical care because of high prices. And America gets sicker.

  • A lack of transparency results in distrust and a deep sense of insecurity.
    Dalai Lama

The Dysfunctional Healthcare Market 

When it comes to healthcare pricing, patients have no way of knowing how much any healthcare service costs until after they have been treated. Can you imagine buying a car before you find out how much it costs? There is nothing else we buy without knowing prices in advance.

Why are prices kept secret?

  • The system has become so complicated that price calculations are different for each patient.
  • Most price negotiation takes place among insurance companies, healthcare facilities, and “middlemen” negotiating for medical device manufacturers and pharmaceutical companies. 
  • These behind-the-scenes negotiations leave the doctor and patient, the actual consumer, completely out of the loop, and cause prices to be artificially inflated to pay for those negotiators.

Healthcare’s Secret Skewed Pricing 

When we finally receive our medical bills, it is almost impossible to understand what exactly we are paying for or even if we are being billed correctly. According to the Medical Billing Advocates of America (MBAA) 80-90 percent of medical bills contain errors. Doctors, hospitals and insurance companies use coding specialists to create their bills and benefits statements. Many doctors don’t fully understand how those codes are assigned, so how can we as patients hope to decipher our bills? When you consider the fact that coding specialists earn their salaries by making sure medical bills are coded to maximize charges, it is easy to see why unpaid medical bills are a major cause of bankruptcy in the United States.

When you take a closer look at provider pricing strategies, things get even more skewed and complex. Uninsured patients have a price schedule that is higher than baseline prices for insured patients. Many in-network hospitals contract out-of-network doctors in specialties such as anesthesiology or emergency medicine making it difficult or impossible for an insured patient to avoid receiving a surprise bill from an out-of-network provider.

In our blog and through our patient education initiative, we take a closer look at the wide array of inequities and information gaps inherent in the system and offer some short-term strategies to help patients make better healthcare decisions and dispute their medical bills. 

  • Secrecy is the linchpin of abuse of power...its enabling force. Transparency is the only real antidote.
    Glenn Greenwald, writer for the Guardian (UK)

What We Are Doing About the Problem

Patient Education: Bill Dispute Tools and Patient Resources

How You Can Help

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