Why Not Really Let People Shop For Health Care Services?

Christina Rexode's Associated Press article 'Physician, heal thy bills' was published today by the Miami Herald, wherein she urges people to shop wisely for medical services; for example, by asking providers to quote fees for certain services then consulting the Health Care Blue Book website to see if the quote is reasonable.

I have been advocating the mandatory publication of all fees charged by medical providers since the early 80s due to my experience in Hawaii with the Hawaii Medical Service Association, a non-profit Blue Cross Shield provider. Hawaii was subject to the state's Prepaid Health Care Act. HMSA was governed of course by doctors who had a hand in crafting the Act.

I was racked with a considerable co-payment, which led me to question HMSA policies, and, to become, in several respects, an "activist" for a brief period of time, with the result that the state ombudsman sent me a letter stating that HMSA had revised its contracts and promotional material, which he expected would help "hundreds of thousands of people."

The central issue I took up was the Usual, Customary, and Reasonable (UCR) method for calculating insurance coverage; Usual being what a provider usually charges for a particular service; Customary being what providers on the whole customarily charge for that service; and Reasonable being a a Formula for calculating the result in a particular insurance case.

When I asked to see the Reasonable Formula, I was informed by HMSA's litigation liaison that it was secret, i.e. "proprietary." I then asserted a novel "stakeholder's right to examine" that information as a member of the non-profit association. My request was denied and I was advised the only way I would ever see the Formula was by court order.

Now that was the background for my proposition that all providers of medical services independently and via insurance companies be required by law to publish the fees charged for all services via a national database searchable by the public.

My proposal naturally fell on deaf ears, despite the fact that the mouths associated with those ears spoke eloquently about "free market" principles, and "rational markets" whereby all consumers make "rational decisions."

I speak not only of Republican and Democratic politicians, but of economists who falsely claim they are not motivated by political prejudices. Hillary Clinton's notorious committee on health care refused to even receive my suggestion, which I urged as an important step in dampening rampantly rising medical costs.

Wait a minute. Is not this a free country? Why not let people shop?

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South Beach Anecdote: I was at Dr. Mereos dental office on Alton Road. I asked the assistant at the desk to quote me the price for root canals. After she gave me the quote, an elderly lady in the waiting room tugged at my shirt and confided that, if I went to a dentist on Arthur Godfrey Road, then I would save a great deal of money on a root canal. She slipped me the dentist's name and address before I left.