I have an early-onset type of cataract, and my vision has gotten so bad I’m ready for surgery. As a patient, I’m not too happy about being in this situation, but as a health-care-policy wonk, this seems like the perfect opportunity to test one of the central tenets of conservative health-care-reform plans: comparison shopping. Conservatives think one of the reasons health care costs so much is that patients are for the most part completely unaware of the price of medical services. Their solution? Give patients more “skin in the game.”
That’s the idea behind GOP plans to ban Medigap insurance, supplemental insurance for Medicare beneficiaries that pays for the portion of health care bills that Medicare doesn’t cover. It’s also the rationale for health-savings accounts and high-deductible, high co-pay insurance plans, which more and more employers are switching to as health care costs go up.
In theory, giving patients clear price information and a financial stake in their choices should give them an incentive to get treatments that are really worth it and reduce the tendency to overconsume medical care because it’s “free.” But have you ever actually tried to find out the price of your health care? Your pharmacist can usually tell you the cost of a prescription drug vs. that of the generic one, but just try to do a little comparison shopping when it comes to getting a CT scan or back surgery, or in my case, the lens used to replace cataracts.
Numerous researchers and commentators have pointed out that prices for essentially identical health care services can vary wildly, even within a small geographic area. The price of an MRI, for example, can range from $350 to $2,300 at a facility just a few miles away. Different patients can also pay radically different prices for the same service, even within the same hospital, depending upon the price their insurer has negotiated. If you’re uninsured, you may be charged the highest price of all.
Back to my cataracts: my insurance will cover the basic procedure and the most common type of lens implant. When I saw an ophthalmologist, though, he offered me a choice between three different lenses: the regular lens, which is fully covered; a lens designed to correct astigmatism; and a “multifocal” lens, which according to the promotional brochure, will “correct vision near, far, and in between, for [my] best chance at freedom from glasses!”
I’ve never considered glasses quite so limiting as the lensmaker seems to think I do, but the prospect was intriguing nonetheless. Then I saw the price tag. I would have to pay nearly $3,000 out of pocket for the multifocal lens. Per eye. That’s $6,000 our family could spend on a new car or a vacation or sending our son to college.
So, which lens should I pick? And could I find the lens I prefer for less somewhere else? I called around a few local ophthalmologists. It turned out that I could find out the cost of cataract surgery pretty easily, and the price for the fancy lens was almost identical at all four places. Chalk one up for price transparency: I know what my choices are, I know what they cost, and I have a $6,000 incentive not to choose something expensive unless I really want it.
So why do I still have no idea which lens to choose? Because I still need more information. All I know about this lens is what the slick brochure from the manufacturer is telling me. But how safe is the more expensive lens? What are the long-term effects? Can I get a new lens put in if it goes bad? That kind of information just doesn’t exist — as it doesn’t for many medical procedures.
My experience suggests that conservative ideas about skin in the game are only partly right. Having a financial stake in the decision did make me more conscious of the price of my health care, and in this case I was able to get information about price, though it was a lot harder than shopping for a car or a TV. But price transparency alone isn’t enough. Until there’s the same amount of transparency on safety and efficacy, patients will still be left in the dark.