Carly Got it Backwards

November 18, 2015

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Presidential candidate Carly Fiorina, had great things to say about free markets in health care at the recent November GOP debate, until this:

“And, we ‘ought to have the government ensure that you must -- and I don’t use that term often, that government ‘ought to do something, but every healthcare provider ‘ought to publish its costs, its prices, its outcomes, because as patients we don’t know what we’re buying.”
Posting of prices in a free market is as natural as getting up in the morning.
A government mandate to post prices and outcomes will not a free market make.  
Ms. Fiorina does not know the price of her medical care because she, like millions of Americans, does not pay her own medical bills. She probably has third-party payer (e.g. employer, health plan, government) to do it for her.
Doctors are pretty clueless too. How should “price” be defined? Due to contract stipulations, payment withholds, “performance” bonuses, penalties for failure to comply with intrusive federal reporting requirements, and Medicare “clawbacks,” payment rates are all over the map.
Outcome reporting is murkier still…and potentially deadly. An outcomes scorecard for PCI (Percutaneous Coronary Interventions) cardiac surgery in New York led to this:
“Some surveys of surgeons and cardiologists in the state indicate that they believe that avoidance of high-risk patients is a problem.” One study “reported the 67% of New York Surgeons claimed they had refused to treat at least 1 patient in the previous year, and 18% refused to treat ≥5 patients.” Another study “found that 83% of interventional cardiologists in New York ‘agreed’ or ‘strongly agreed’ that the publication of statewide PCI report cards decreased the chance that patients needing PCI actually received it.”
Furthermore, what part of your outcome has nothing to do with your physician? How much of your outcome is affected by you and your unique physiology, personal choices, lifestyle, DNA, behavior or compliance to doctor’s orders?
If a free market is the goal, candidates and policymakers should start by advocating for first-party payment and a repeal of the Obamacare prohibition on traditional indemnity health insurance. If individuals start paying their own doctor’s bills (making cost-benefit decisions and negotiating prices), owning their own true  (non-managed care) insurance policies, and submitting their claims to their insurer for payment back to themselves, a free-market will re-emerge, costs will dramatically drop (both medical and administrative) and outside interference in medical decisions will be minimized.
First-party payment is how we buy cars and food and phones and houses. Why not health care?
For freedom,
Twila Brase, RN, PHN
President and Co-founder