Announcement of Public Workshop, "Examining Health Care Competition" ("Health Care Workshop") Project No. P13-1207 #00003

Submission Number:
Jitendra Thacker
Initiative Name:
Announcement of Public Workshop, "Examining Health Care Competition" ("Health Care Workshop") Project No. P13-1207
As I have had an HSA for several years and closely tracked spending, it is clear that the opaque system of insurance paid healthcare prevents a free market in healthcare. Most providers do not make it easy to obtain costs. It appears that very few people ask for costs because they are on plans where the insurer pays. And when one asks the insurance company, in my case Aetna, I have routinely received incorrect information on expected costs. In the worst cases, some facilities in the same area are charging 5 times more than other facilities for routine procedures and tests. In one case, Aetna confirmed the costs of a particular facility to be near the average, and the actual bill turned out to be 5 times the average. If the modus operandi is to disclose pricing information after a procedure, how is that like any other competitive market that we have? In a more recent case, Aetna disallowed a test that they would have paid out to Quest Diagnostics at the Aetna rate for $24. Since they disallowed it, they paid out from my HSA at the billed rate. The billed rate is $300! How can a medical provider morally or ethically provide services for which they are willing to accept $24, but then charge individuals $300? How can insurance companies justify paying out $300 of somebody elses money when they would only pay $24 for the same procedure? For some reason, the normal competitive marketplace conditions don't seem to apply in healthcare. A large organization might receive hotels at 30%-40% discounts over rack rate, but consumers in almost any market are able to buy services at full price if they want convenience or discounted prices if they look for bargains. Only in healthcare are there markups on 5x at one facility vs another or in this other case, a rate of 12x more for billing direct to an indivdual vs billing to an insurer. The bottom line is that transparent pricing is a key and necessary part of a competitive market. The ideal scenario is that prior to any procedure, the patient should be presented with the estimated cost of the procedures they are likely to undergo and at the same time presented with a local average of a meaningful number of facilities, a state average and a national average. Additonally, individually billed rates vs insurance rates should also be disclosed. This would put an end to the shameful profiteering that goes on. My email address, should it be needed is [redacted]