Jeanne Pinder: What if All US Health Care Costs Were Transparent? (Transcript)

Jeanne Pinder – TED Residency December 2018 TRANSCRIPT

So, a little while ago, members of my family had three bits of minor surgery, about a half hour each, and we got three sets of bills. For the first one, the anesthesia bill alone was $2,000; the second one, $2,000; the third one, $6,000.

So I’m a journalist, I’m like, what’s up with that? I found out that I was actually, for the expensive one, being charged $1,419 for a generic anti-nausea drug that I could buy online for $2.49.

I had a long and unsatisfactory argument with the hospital, the insurer and my employer. Everybody agreed that this was totally fine. But it got me thinking, and the more I talked to people, the more I realized: nobody has any idea what stuff costs in health care.

Not before, during or after that procedure or test do you have any idea what it’s going to cost? It’s only months later that you get an “explanation of benefits” that explains exactly nothing. So this came back to me a little while later.

I had volunteered for a buyout from the New York Times, where I had worked for more than 20 years as a journalist. I was looking for my next act.

It turned out that next act was to build a company telling people what stuff costs in health care. I won a “Shark Tank”-type pitch contest to do just that. Health costs ate up almost 18% of our gross domestic product last year, but nobody has any idea what stuff costs.

But what if we did know? So we started out small. We called doctors and hospitals and asked them what they would accept as a cash payment for simple procedures. Some people were helpful. A lot of people hung up on us.

Some people were just plain rude. They said, “We don’t know,” or, “Our lawyers won’t let us tell you that,” though we did get a lot of information. We found, for example, that here in the New York area, you could get an echocardiogram for $200 in Brooklyn or for $2,150 in Manhattan, just a few miles away.

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New Orleans, the same simple blood test, $19 dollars over here, $522 just a few blocks away. San Francisco, the same MRI, $475 or $6,221 just 25 miles away. These pricing variations existed for all the procedures and all the cities that we surveyed.

Then we started to ask people to tell us their health bills. In partnership with public radio station WNYC here in New York, we asked women to tell us the prices of their mammograms. People told us nobody would do that, that it was too personal.

But in the space of three weeks, 400 women told us about their prices. Then we started to make it easier for people to share their data into our online searchable database. It’s sort of like a mash-up of and the Waze traffic app for health care. We call it a community-created guide to health costs.

Our survey and crowdsourcing work grew into partnerships with top newsrooms nationwide — in New Orleans, Philadelphia, San Francisco, Los Angeles, Miami and other places. We used the data to tell stories about people who were suffering and how to avoid that suffering, to avoid that “gotcha” bill.

A woman in New Orleans saved nearly $4,000 using our data. A San Francisco contributor saved nearly $1,300 by putting away his insurance card and paying cash.

There are a lot of people who are going to in-network hospitals and getting out-of-network bills. And then there was the hospital that continued to bill a dead man. We learned that thousands of people wanted to tell us their prices. They want to learn what stuff costs, find out how to argue a bill, help us solve this problem that’s hurting them and their friends and families.

We talked to people who had to sell a car to pay a health bill, go into bankruptcy, skip a treatment because of the cost.

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Imagine if you could afford the diagnosis but not the cure. We set off a huge conversation about costs involving doctors and hospitals, yes, but also their patients, or as we like to call them, people.

We changed policy. A consumer protection bill that had been stalled in the Louisiana legislature for 10 years passed after we launched. Let’s face it: this huge, slow-rolling public health crisis is a national emergency.

And I don’t think government’s going to help us out anytime soon. But what if the answer was really simple: make all the prices public all the time, would our individual bills go down? Our health premiums? Be really clear about this: this is a United States problem.

In most of the rest of the developed world, sick people don’t have to worry about money. It’s also true that price transparency will not solve every problem. There will still be expensive treatments, huge friction from our insurance system. There will still be fraud and a massive problem with overtreatment and overdiagnosis. And not everything is shoppable. Not everybody wants the cheapest appendectomy or the cheapest cancer care.

But when we talk about these clear effects, we’re looking at a real issue that’s actually very simple. When we first started calling for prices, we actually felt like we were going to be arrested. It seemed kind of transgressive to talk about medicine and health care in the same breath, and yet it became liberating, because we found not only data but also good and honest people out there in the system who want to help folks get the care they need at a price they can afford. And it got easier to ask.

So I’ll leave you with some questions. What if we all knew what stuff cost in health care in advance? What if, every time you Googled for an MRI, you got drop-downs telling you where to buy and for how much, the way you do when you Google for a laser printer?

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What if all of the time and energy and money that’s spent hiding prices was squeezed out of the system? What if each one of us could pick the $19 test every time instead of the $522 one? Would our individual bills go down? Our premiums? I don’t know, but if you don’t ask, you’ll never know.

And you might save a ton of money. And I’ve got to think that a lot of us and the system itself would be a lot healthier.

Thank you.