My family had a health emergency recently. In the first 72 hours, we didn’t have a chance to check the price lists. Even if we had, I don’t think the paramedics or the ER docs or the ICU team were going to pause in their ministrations to ask if we wanted to order out for IV solution or drive across town to the other shop for the EKG. As NPR noted this afternoon, health care doesn’t work like a normal market.
Donald Trump’s latest signature-show-off, ordering the Department of Health and Human Services to write some price transparency rules, won’t “fundamentally chang[e]” the non-market nature of the healthcare marketplace. It’s certainly not “bigger than anything else we’ve done in this particular realm.” Prices will not “come down by numbers that you won’t even believe” (good grief—does the mindless extemporizing never end? Trump had an actual economist in the room who could give him a number; could the President of the United States not read a simple brief and give actual data instead of gratuitous hyperbole?); it’s possible that, absent bigger reforms acknowledging the non-market nature of healthcare, Trump’s order, if turned into actual action (and given his poor batting average, transformation of this healthcare theater into actual price-transparency policy is a longshot) will raise prices:
The Federation of American Hospitals, the American Hospital Association and America’s Health Insurance Plans have argued that disclosing contracted prices won’t help consumers know what they’d actually be on the hook to pay.
The trade groups also have said that revealing the process could reduce competition, because no doctor or hospital would want to be paid the lowest rate and would ask for the higher payments neighboring facilities receive.
“We also agree that patients should have accurate, real-time information about costs so they can make the best, most informed decisions about their care,” Matt Eyles, AHIP president and CEO, said in a statement. “But publicly disclosing competitively negotiated, proprietary rates will reduce competition and push prices higher — not lower— for consumers, patients and taxpayers” [Rachel Roubein, “Trump Aims at Health Cost Transparency with Executive Order,” Politico, 2019.06.24].
But maybe Trump figures he’s got to make it look like he’s doing something on healthcare, since his numbers on that issue offer Democrats a foothold for 2020 gains:
American Bridge polled voters in small towns and rural areas, screening out self-identified liberal Democrats, to find out what they thought of the president. The group gave Trump a positive job approval rating overall, and it backed a generic Republican for Congress by 29 points over a generic Democrat. But the Republican-leaning pool of voters also gave Trump unfavorable ratings on several key issues, highlighting potential avenues of attack for American Bridge: 50 percent rated Trump negatively on “cutting taxes for people like me.”
Several health care questions were worse for the president. Just 25 percent of respondents gave Trump a positive rating for “reducing health care costs,” compared to 67 percent who rated him negatively, while they split against Trump 39-51 on “taking on the drug and pharmaceutical companies” [Scott Bland, “Democratic Group’s Poll Shows Trump Vulnerable with His Base on Health Care,” Politico, 2019.06.24].
Trump’s promised price list might not move those low ratings much in rural America. After all, what good is a hospital price list here in Aberdeen when the Avera doctor (Dr. Armstrong, who led his team with clear-eyed confidence and saved a life) tells you you’re going to Sanford because Sanford is the only shop in the state with the machine we need to have the best chance of going home happy and whole someday?