Lifting the Shroud of Secrecy in Health Care

Over the next several weeks, representatives from various care-delivery systems, insurers and other members of the health care ecosystem will gather before cameras, Congress and other public outlets to speak to the institutional end times that will occur if the White House’s finalized health care price transparency rule and the proposed transparency in coverage rule come into effect. They will be wrong.

The administration’s efforts to introduce transparency into the cost of health care should be lauded by consumers and all who care about improving health care in America.

I’ve been the chief executive officer of a 14-hospital academic medical center for the last six years, and I’ve been in the medical field for far longer. Over that time, the procedures and practices for how we deliver care to those who need it have advanced at incredible rates. 

Unfortunately, the costs have grown astronomically, as well. This bloating is a symptom of a system that has spurned the interests of its patients — the only party to whom it owes any loyalty.

These transparency rules are not being created out of spite. These new policies are the first step toward breaking a system that has for too long relied on the use of other people’s money, to pay expenses that are often poorly explained and insufficiently justified by the insurer. 

No reasonable person would believe that the economics of health care are best carried out in private; or that a patient would prefer to receive a bill not from the caregiver, but from an insurer who has paid the provider in accordance with a byzantine contract that has been worked out between the two, without regard for the nuanced needs of the patient.

For too long, those of us who work in the health care field have defended an inefficient system that has led to the levels of frustration and suffering necessary for politicians to create entire campaigns on “Medicare for All” platforms. Unfortunately, the consensus among most economists and employers is clear: The disruption and rancor that would be created from efforts to pass this type of legislation would inevitably lead to a maintenance of the status quo.

A similar, well-intentioned idealism led to the Affordable Care Act; by giving millions of people access to health care, we funneled them into an already fundamentally broken system. We then hoped that the institutions delivering care would transform, but they didn’t. That failure was in no small part because we didn’t create the disruptions necessary to force our economic interests into alignment with those of our consumers: our patients.

Existing legislation has failed to protect patients – which is all of us — because it has failed to create an understanding between the care providers, the recipients and the intermediaries between them. The transparency policies are a significant step for us to create that understanding. 

The American health care system is broken because it is paid to be inefficient; our ecosystem has slowly become crowded with new intermediaries and sources of red tape. This has led to the systemic quagmire that characterizes our health care system. But the patients that we serve are smart.

They know better than anyone what their abilities are to fund their treatments. Most dangerously for the health care system, they don’t care what means or mechanism through which that treatment is delivered, provided the product is delivered at the price and at the time at which they demand it.  Ultimately, by giving patients the tools to be as informed as possible about the real costs of services and treatments that their providers offer, we in the medical space give them back some of the control of their lives and welfare that they should have had all along.

The vigor with which the traditional health care system is protesting the administration’s attempts to regulate transparency is powerful evidence for its necessity.

Transparency will not end with forcing hospitals to put their charge master on their website. True transparency will be created when the employer-insurer-provider-patient gauntlet has been obliterated and replaced with a streamlined system in which the patients can assess the costs of their care, the means through which they will receive their care, and the assistance they’ll need to pay for it. True transparency will only exist when the patients can see the end results of their care before they go into the facility.

If we are to move together, on a national level, toward a rational, affordable, transparent and quality-assured health care system, the first steps won’t be made from a “Medicare-For-All” platform — nor will they be made by making minor tweaks to a system that has failed so many people. Instead, we need to begin by peeling back the shrouds surrounding the providers of medical care, the pharmaceutical interests and the insurers, so we can fully diagnose the problem.


Stephen K. Klasko, MD, MBA, is president of Thomas Jefferson University and CEO of Jefferson Health.

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