Crowdsourcing is engaging a lot of news organizations today. While some journalists are nervous about crowdsourcing — “Yikes, we’d rather talk than listen, and what if they tell us something we don’t want to hear? Or something that we know isn’t true?” — we here at clearhealthcosts.com love crowdsourcing. We find, as journalists, that our communities are smart, energized, truthful and engaged, and happy to join hands in thinking, reporting and helping us make something that’s bigger than the sum of its parts. We learn great things by listening, so … now we’re going to to an experiment crowdsourcing coverage for our blog.
Our current project crowdsourcing health care prices in California, with KQED public radio in San Francisco and KPCC/Southern California public radio in Los Angeles, has been a great success, as was our previous project with WNYC public radio, and we’re looking forward to launching similar projects with other partners.
Our community members have a lot to say. Some of what they say about health care prices we knew (people are upset, and they feel like they’re paying too much, and they have a hard time understanding their bills) — but some of what they say is totally radical: They’re out there negotiating over prices regularly. They’re putting away their insurance cards, choosing to pay cash and saving hundreds and hundreds of dollars.
They want to show us their bills. They want to talk about it.
1. Almost overnight, we have seen an explosion in the number of doctors contacting us to offer support of pricing transparency. Our theory: most docs got into this profession to help people, and they’re appalled by the epidemic of money medicine, and by the simple fact that their treatment decisions are increasingly governed by money — what the insurance company will pay, what the patient can afford, what’s on the formulary. Yes, there are some bad apples in the bunch. But that is the exception, not the rule. (Hospital bills, on the other hand, are full of errors and overcharges.)
2. There’s a similar explosion in the number of people who want to talk about “all on Medicare.” The idea of single-payer is still unpalatable to much of the nation, and the term “single-payer” has itself been tainted in the political discourse. But we are hearing from people on the left and the right and in the middle who are saying variations of this: “All on Medicare” to us means something like “Enough is enough. Single payer is the way to go.”
3. The shocking rise in generic drug prices: what happened, and will the congressional investigation that Bernie Sanders is mounting have any effect? Nearly 70 percent of Americans use some prescription drugs, and the skyrocketing prices affect millions of people. Should we blame it all on Big Pharma? What about pharmacy benefit managers?
4. Mergers and acquisitions in health care hit an all-time high. Lists of providers with office addresses, phone numbers and billing contacts are out of date before they are even printed, let alone posted on the web. Will we wind up with one big hospital health care system, named Blue Partners Aetna Cigna Cedars Mayo Cleveland Optum Sutter HCA Tenet Continuum? And how will that differ from “all on Medicare” or single-payer or whatever you want to call it? Oh, right: Blue Partners Aetna Cigna etc. will be a for-profit, with an eye on Wall Street.
5. People are paying cash for health care, as they increasingly realize that putting away their insurance card is good under certain circumstances. A $4 generic at a big-box store rather than a $15 co-pay for a generic under their insurance plan? A $580 charge for a cash MRI rather than an $1850 charge under their insurance plan because they haven’t met their deductible? We may be seeing the beginning of the end of employer-sponsored high-premium insurance. And wait until the Cadillac tax hits fully in 2018; people are already positioning themselves for that, and it’s looking ugly for those who want to preserve a system in which employees pay no premiums and no co-pays or co-insurance or deductibles.
6. Price transparency is huge. Those who embrace it will be rewarded, and laggards may be punished. You may have a great insurance plan, few health problems and low out of pockets. But you’re an exception, rather than the rule. Listen to our community members:
“Thanks for what you’re doing to make healthcare reasonable and fraud-free!”
“From Rapid City South Dakota. I think your effort to establish a list of prices for various medical procedures is great. ”
“I just want to say that your website is amazing. Please don’t stop because you are helping people everyday, many of whom are struggling to make ends meet while others are just looking for a some transparency in a market where there has traditionally been very little.”
7. Insurance plan design is totally not sexy, but it is the next big frontier. Narrow networks? What does your plan allow, and what does it prohibit? Can you get the kind of insulin you need under your plan’s formulary, or are you only covered for insulin you’re allergic to? Do you have to travel 300 miles for behavioral health coverage? Did your insurance deny treatment that made your illness, injury or condition worse?
8. Medicaid expansion reduces everybody’s private premiums in states where it’s been embraced. This makes sense, but who thought about it in this way? It will be interesting to see how many more states decide to refuse Medicaid expansion, and how many embrace it.
9. Healthcare.gov will not work perfectly during open enrollment. Neither will the states’ individual exchanges. We will probably hear a lot about this, and we’ll probably have to write about it, but this is a sideshow, and the complaints about failed software should be remarked upon and then ignored. Software doesn’t always work; we happen to know. The administration is trying to fix it, but it’s still complicated.
10. Patient engagement is indeed the blockbuster drug. Yes, it’s hard; yes, it’s often unreimbursed. Yes, it can go awry. But it is the future of medicine: let me introduce you to patients and providers joining hands to make a better future: e-Patient Dave deBronkart, Casey Quinlan, Danny Sands, Leslie Kernisan, Gilles Frydman, the Society for Participatory Medicine, and the people at the heart of the Patient-family Engagement Roadmap, prepared by the American Institutes for Research under a grant from the Gordon and Betty Moore Foundation. Even the Institute of Medicine has weighed in on shared decision-making.
11. I am not planning to write about this, but I add it here for the sake of adding it: The ACA didn’t totally fail. The ACA didn’t totally succeed.
So that’s a start on what we’re thinking about. What do you want us to cover?
Tell us your thoughts, either in the comments, by Twitter @chcosts, or by email to info (at) clearhealthcosts (dot) com.
With such success in those two projects, we decided to try crowdsourcing our coverage: what health cost topics should we cover? We’re looking back and looking forward — and we’re coming to you, our community, to help guide us. Here are some subjects we plan to write about.
Our ask for you: Please tell us what surprises you. What you want us to cover?
Let us know, in the comments, by Twitter @chcosts, or by email to info (at) clearhealthcosts (dot) com. Or by snailmail to P.O. Box 8124, Pelham, N.Y. 10803. Or by Pony Express…