I have been writing a bit lately on the need for healthcare providers to talk with their patients about healthcare costs, if for no other reason than to enable patients to determine whether they can afford to pay for the healthcare that their doctors are recommending them to receive. I have been criticized for this position, on the grounds that I am rationing care from people with less money and connections than I have, a criticism that I have explained as being misguided.
But I have faced another more reasonable criticism too, one I want to write about today. I have been reminded that doctors and other healthcare providers cannot easily discuss healthcare costs with patients because those costs are often unknown. Lisa Rosenbaum made this point in an excellent New Yorker essay:
The first problem with financial disclosure from doctor to patient is a practical one. Doctors rarely know how much their patients actually pay. Patients are covered by a variety of insurers, all of whom offer several plans, for which any individual patient has a different copayment and deductible, which he may or may not have met.
In this post, I will lay out a fuller version of this criticism and then explain why I still think doctors need to hold these conversations, and also why I think these conversations will become much more common in the near future.
This criticism was nicely phrased by Julian Fisher, a neurologist in Boston who wrote a letter to the New York Times. Fisher wrote: “It is doubtful that any physician in the United States knows precisely what a given procedure or treatment costs, how much an insurer might pay with negotiated rates, and how much the patient will ultimately be responsible for.”