Health Care Cost Should Be Clear In Advance [Courant Opinion]

April 28, 2015

Op-ed by Stephen Smith as it appeared in the Hartford Courant
Many readers may be familiar with the story last year about a patient who received a bill for $117,000 from a doctor who had assisted in his surgery. This assistant surgeon — totally unknown to the patient — was not in the network of providers recognized by the patient’s insurer, so the patient got stuck with the bill.

Horror stories like this abound in the Byzantine system of health care that we have in the United States. But a series of bipartisan bills making their way through the General Assembly may improve things for those of us living in Connecticut.

State Senate Minority Leader Len Fasano, R-North Haven, and Senate President Pro Tem Martin Looney, D-New Haven, have joined to co-sponsor a series of bills to make health care better in Connecticut. One bill will make it easier for patients to know ahead of time what their health care will cost. Patients will be able to go to a website run by Access Health CT that will allow them to comparison-shop in terms of price and quality.

Knowing the price ahead of time is becoming ever more important as high-deductible health plans are being foisted on the public. New York Times columnist Elizabeth Rosenthal reported in her series “Paying Till It Hurts” that the price of a colonoscopy ranged from $6,385 in Long Island to $19,438 in Durham, N.C. The Looney-Fasano bill would at least allow patients to know ahead of time what the price will be.

And patients aren’t the only ones in the dark about the price of medical treatments. It took me more than a year and a half to extract a price list from the commercial laboratory I use for tests on my patients at the Community Health Center in New London.

The reason given by the laboratory for its reluctance to provide me with a price list was that the cost varies depending on who’s paying. It’s not unusual for an uninsured patient to pay 10 times as much as Medicaid pays for the same service. Commercial insurance companies negotiate prices for themselves that vary from one insurance company to another.

You may still be in for a surprise — even if you can find out how much the doctor is going to charge you — when a separate bill for a “facility fee” arrives from the hospital. The bill for a colonoscopy performed by the same doctor in a hospital-owned outpatient center can cost thousands of dollars more than the same procedure performed in the doctor’s office. Another of the Looney-Fasano bills would greatly restrict the use of these facility fees.

The two Senate leaders also propose the creation of an independent 14-member Commission on Health Care Policy and Cost Containment, whose mission would be to reduce health care costs in the state while improving quality. The commission will be able to systematically collect and analyze data and make recommendations on policy changes that would achieve the dual goals of better health and lower costs.

The way health care is delivered pleases neither health care providers nor consumers. Much of the blame for this sorry state of affairs is due to the way our health care system evolved — largely without thoughtful planning. The result is a fragmented, expensive, wasteful and too often unsafe industry focused too much on disease and not enough on health.

The proposed commission has the potential to envision the kind of health care system that we need in Connecticut. To be successful, the commission will need to coordinate closely with other agencies responsible for different parts of the health care enterprise.

The Looney-Fasano bills represent a long-overdue initiative to begin to reshape the health care system in Connecticut into one that is fairer, more accountable and more efficient. Their bipartisan efforts deserve our bipartisan support.

Stephen R. Smith, M.D., is professor emeritus of family medicine at the Warren Alpert Medical School of Brown University and practices as a family physician in New London, where he lives.