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The new budget bill could reduce the lifetime benefits of millions of Americans by tens of thousands if not hundreds of thousands of dollars, Larry Kotlikoff writes. Photo by PeopleImages.com and Getty Images

Column: ‘Maddeningly complex’ health care costs force patients to become detectives

Editor’s note: Yesterday, we published the health care cost nightmare of singer Ivy Austin, “My health insurance nightmare and what I’m doing from now on.” Today, we publish the outraged response of Elisabeth Rosenthal, author of “An American Sickness: How Healthcare Became Big Business and How You Can Take It Back,” featured recently on our Thursday Making Sen$e broadcast segment. She also wrote one of the year’s most popular posts here on Making Sen$e: “6 questions to ask at every doctor’s appointment.”

Please let us know if you’ve had similar experiences to Ivy’s. We plan to publish excerpts from the responses we get.

— Paul Solman, economics correspondent


Ivy is a heroic customer and patient, trying mightily to make this work. As many patients who’ve done so, she’s wasted hours of her time and come away with few answers. We are constantly told we should be better consumers of health care, that we should shop for insurance and high-value care.

Well, how can we be expected to do that if the prices are unknowable and we get contradictory answers from every expert we ask? This system is so maddeningly complex, there is no real price for anything — the price is what the market will bear and what your insurer — or, increasingly, you — can be backed into paying. Frankly, at a personal level, it smells a bit like extortion.

And Ivy is an exceptionally smart, energetic patient-consumer. What happens to the average person who doesn’t ask or is embarrassed to ask about price in advance? They just get stuck with big bills ex post facto.

On financial issues, there’s no informed consent, which is a basic principle of medicine and legal systems and contracts. That’s just wrong. Oh sure, there are transparency web sites where you can get some idea of the price of different medical services in your area — generally through crowdsourcing or by reviewing insurance claims. In my book, I suggest that everyone should look at them to see the huge variation in price and to find lower-cost providers. But I don’t really see why this kind of detective work is even necessary.

In many countries, knowing the cost of your procedure or your medicine in advance is a patient’s right and should be a patient’s right here too. That way you can plan for the financial hit or seek out something cheaper or decide, as many patients do, that the study or procedure just isn’t worth it. As I sometimes say, I don’t have to crowdsource the price of a baguette at Whole Foods, so why can’t I expect a lot more transparency in health care? In France, prices are posted in doctors’ offices. In Australia, a written estimate before hospitalization is a patient’s right — and that idea is supported by doctors.

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