Choosing an Ambulance Service

Here is the latest pearl of wisdom from a sitting US Senator - Roger Marshall of Kansas - on the Republicans answer to a question they’ve had at least 15 years to solve (since “Obamacare” was passed in March of 2010):

Now don’t get me wrong. Price transparency is a very good thing. And we need more of it in all settings, including healthcare.

AS a former rural hospital COO, I’ll ask and answer my own question. Q: Will price transparency save a trillion dollars a year? A: No.

In 2023, the US Spent about $5 trillion on healthcare in aggregate (incl. private health insurance, Medicare, Medicaid, out-of-pocket spending, and other health care services and programs.

So, no, we are not going to reduce spending by 20% simply by having price transparency.

Why? Because we don’t consume healthcare the same way we buy TVs or gas grills for outdoor barbecues. Here are the fundamental flaws in “consumer choice” when it comes to healthcare:

• Patient A is at home and suddenly feels like they are having a heart attack. They call for an ambulance. Are they going to check around for comparative pricing? They may also need to check to see if a specific ambulance service is “in network” based on their insurance, since out-of-network services cost way more and have worse, if any, insurance coverage.

• What if Patient A is has a stroke and falls unconscious in public, forcing random Good Citizen B to call for an ambulance? Is that third party. How can they compare prices?

• Patient B is on vacation and goes into a diabetic coma. He is taken to the emergency room. Can Patient B ask everyone staff in the ER to hold off on treatment until thy find out if the hospital is in network or if there is an ER at a different hospital across town that charges less?

• Patient C has a type of cancer for which there is only one drug that provides effective treatment. Does price transparency matter in that situation?

• Parent D is visiting family far from their home. Her son Little Johnny breaks his leg playing in the yard. Is Parent D going to compare hospitals and doctors’ offices to decide where to take Little Johnny for emergency and then ongoing care? Maybe, but not likely.

• In the examples above that involve any non-routine care (ambulance service and emergency room service), the patient will be charged for a gazillion other items beyond just the base charge for the ambulance/emergency room: oxygen provision, bandages, syringes, whatever drugs are needed to stabilize the patient, even paper cups (I know - it’s crazy). Will the “consumer" be able to check the pricing and markup on all those services/items? Of course not.

Again, price transparency is a good thing. But price transparency MUST be paired with informed decision-making in order for it to truly have an impact (this is a universal concept - it also applies to buying clothes or food).

I’ve said this before and believe this needs to be repeated ad nauseum, as well as communicated to our elected officials ad nauseum: our patchwork healthcare “system” requires people (not “consumers”) to literally predict the future and guess their future healthcare needs in advance in order to not go bankrupt. THIS IS INSANE!

We are the ONLY developed country that has this “system”. A system that literally bake uncertainty into healthcare decisions - the exact opposite of how a good healthcare system should be structured. Price transparency - while good - won’t change that underlying dynamic.

Want to fix the “system”? Do what other countries do. Have people pay taxes and, in return, provide universal access to basic, quality healthcare at minimal additional cost. Standardize coverage/insurance. Eliminate for-profit healthcare providers and insurers - no other developed country has them.

In fixing our system, I would ask a simple question at every turn: does whatever fix we are considering still require people to guess about the material financial impact of future unknown health needs? If the answer is yes - it’s not a fix.