Rod Driver

From the Standard Times, June 18, 1993

Public served with posted medical costs


Rhode Island has the fourth highest per-capita medical costs in the country, and the United States has the highest costs in the world.

While general inflation continues at 4 percent, medical costs are rising 12 percent a year. In 1992, the U.S. set another record: medical spending reached 14 percent of our gross domestic product.

Businesses, governments and private individuals struggle to meet the increasing cost of medical insurance; and the federal Medicare program is expected to be bankrupt before the year 2000.

Might out-of-control medical prices be somehow related to the fact that Americans demand every conceivable medical service, but pay little attention to the cost?

The fact is, we have been conditioned not to ask the price of medical services!

Few of us would buy a washing machine, a toaster or even a head of lettuce without first asking the price. Yet, insurance companies tell us not to care about medical costs. One familiar TV commercial concludes cheerfully, "There's nothing more boring than hearing about someone's operation, but at least with Healthmate you won't have to hear how much it costs."

In an effort to raise consumer consciousness of medical expenses, the Rhode Island House of Representatives has passed a bill to require price posting by physicians. Specifically, it would require a physician in private practice to post in his or her office the price of a basic office visit plus the physician's three most common procedures.

Rhode Island requires grocery stores and filling stations to post prices. The state even requires anesthetists to tell their patients about charges before elective surgery. But the Rhode Island Medical Society declares that price posting by physicians would not be appropriate.

The Medical Society says that: (1) A physician would be unduly burdened having to determine his or her three most common procedures. (2) Physicians make different deals with different insurance companies or patients, so there may be several different prices for the same procedure. (3) Posting a sign would be an additional expense.

None of these is a real problem: A physician who can't decide which are his or her three most common procedures can simply post the prices of four or five to be sure. If a physician has different prices depending on who is paying, post the highest price anyone is billed for the procedure. (No one will complain about getting a bill smaller than the posted price.) The cost of posting should be about zero. A price list on the back of an old envelope attached to the wall with a thumbtack would satisfy the proposed law.

There may be additional concerns that the Medical Society prefers not to articulate: (4) Consumers might start comparing prices charged by different physicians (as they do with more worldly purchases). And, worse yet, (5) physicians tend to bill insurance companies much more than they hope to get paid. This pressures the insurance company to raise its payment schedule (and hence to raise the premiums charged subscribers). A physician might rather not display the "prices" sent to insurers.

A price-posting law has actually passed the R.I. House four years in a row. In prior years, its opponents have killed it in the Senate without even a committee hearing. This year -- thanks to a more open General Assembly and to Sen. Myrth York, chairwoman of the Health, Education and Welfare Committee -- bill 93H-5119 had a hearing. And it might even be reported out of committee to let the entire Senate vote on it.

(P.S. The Medical Society continued its oppostion and the bill never came before the full Senate.)