Spirit of the Law? Hospitals Don’t Give a Fu%$

If you look under the “Categories” archive of this blog you’ll notice that over the years I’ve posted 52 times under “Health Care” and 71 times under “Healthcare.” Ignore the fact that I should have figured out a long time ago which one of those is correct; the point is that I care deeply about health care (healthcare?) and a primary reason for that is how much it has cost me and my family over the years.

I’ve spent my entire career working for very small companies or being self employed, and so I’ve never had access to what you’d call a “Cadillac” health insurance package. I’ve also been responsible for evaluating and choosing an insurance plan every year, whether for my own family when I was self-employed, or for my employer, for the last 25 years. To say that I’m sensitive to how much health care and health insurance cost would be the understatement of the century.

That’s why this story in the Wall Street Journal about hospitals using code to hide the pricing on their website. Here’s an excerpt:

Hospitals that have published their previously confidential prices to comply with a new federal rule have also blocked that information from web searches with special coding embedded on their websites, according to a Wall Street Journal examination.

The information must be disclosed under a federal rule aimed at making the $1 trillion sector more consumer friendly. But hundreds of hospitals embedded code in their websites that prevented Alphabet Inc.’s GOOG -1.24% Google and other search engines from displaying pages with the price lists, according to the Journal examination of more than 3,100 sites.

The code keeps pages from appearing in searches, such as those related to a hospital’s name and prices, computer-science experts said. The prices are often accessible other ways, such as through links that can require clicking through multiple layers of pages.

“It’s technically there, but good luck finding it,” said Chirag Shah, an associate professor at the University of Washington who studies human interactions with computers. “It’s one thing not to optimize your site for searchability, it’s another thing to tag it so it can’t be searched. It’s a clear indication of intentionality.”

Among websites where the Journal found the blocking code were those for some of the biggest U.S. healthcare systems and some of the largest hospitals in cities including New York and Philadelphia…Some regional systems also had such code on their websites, including Michigan’s Beaumont Health and Novant Health in Winston-Salem, N.C.

Lovely to see the system that has a hospital I can walk to, Novant, on the list.

Technically they’re complying with the rules, but in the same way that printing legal disclaimers in 2 point font would be. While that looks and smells bad, I think it would be a mistake to focus on the sliminess of this approach. In my mind it’s far more important to stay focused on how the continued efforts of the health care industrial complex to keep their pricing opaque, and their systems complex and antiquated, prevents any substantive system improvements from developing.

Years ago the insurance program we had was a Health Savings Account (HSA). The way it worked is that we set up an account kind of like an IRA with a bank. We contributed pre-tax dollars to it and it and then used those funds for any health care expenses. It was tied to a catastrophic insurance plan that featured a very high deductible and low premiums, so anything that wasn’t a major health event that would cost over $10,000 in a year we would pay out of pocket via the HSA. Sounds good in theory, but then you have to get an MRI and when you try to find out how much it will cost you find it next to impossible. As a result you pay $1,900 for a scan that took 30 minutes from parking the car to getting back in it, and find out later that you could have had the same procedure done a 10 minute drive away for much less.

That’s a true story, and in full transparency part of the problem was we were used to our old insurance system where we just went to wherever the doctor sent us without question because the insurance was gonna cover everything except our co-pay and deductible. It literally didn’t occur to us that we could ask, although we learned from this experience that we could.

I came away with a valuable insight after our year spent with the HSA and it was this: Our supposedly market-based health care system is lacking an important element – an informed and empowered consumer base. The complexity and opacity of our system virtually guarantees that it will be inefficient and provider-centric, which is great for the providers in the short term, but in the long term will make that bogeyman of “socialized medicine” look more and more appealing by comparison. If that happens they’ll have reaped what they sowed.

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