WASHINGTON – Let’s say you have a sore knee. You visit your doctor, who examines it briefly, then recommends an X-ray. What do you do next?
It’s not just a matter of deciding whether to get the X-ray or not. There’s a good chance you’ll have questions – like, why is your doctor recommending an X-ray? Who’s going to administer said X-ray? What’s the cost? Will insurance cover the cost? Will insurance cover the entire cost?
In an age of 15-minute (or less) doctor appointments, finding a chance to ask all those questions – let alone just one of them – can be challenging. But when a $2,000 bill shows up in the mail months down the road, you’ll probably wish you had asked them.
So why is it so hard?
“Most patients I speak to…feel powerless,” said Elisabeth Rosenthal, editor-in-chief of Kaiser Health News and author of the 2017 book “An American Sickness.” She spoke during a Wednesday panel here on the “Power of the Patient” at the Healthcare Costs Innovation Summit, sponsored by San Diego-based West Health.
Rosenthal was joined by three experts from the health care industry for a discussion that, while light on immediate solutions, did highlight the obstacles patients face managing their health in an expensive and convoluted health care system.
Among the biggest obstacles:
- The patient-physician relationship is weak. Those 15-minute appointments take their toll on both the patient, who often feels deprived of adequate care, and the physician, who often feels deprived of the opportunity to provide adequate care. Lack of time leads to lack of trust between patient and doctor, which leaves them unable to decide together the best line of care for the patient.
- Transparency: Too much or not enough? Some doctors say patients don’t want to think about money. But that’s not true, Rosenthal said. Case in point: When it comes to lab tests – for example, knee X-rays – why is it so difficult to find out what it’s going to cost us, especially when in other parts of the world that information is posted on the doctor’s office wall?
- We want to be fixed. Now. Especially for what we’re paying. A doctor’s visit with no lab work can feel like a rip-off. And if, for example, a person pays $500 for an orthopedist appointment, “I don’t want to be told to come back in six weeks and pay another $500,” said Rosenthal.
Of course, the doctor’s office is only one small piece in a gigantic puzzle. As Rosenthal outlines in her book, health care has some major players. The hospital systems where doctors work are often massive operations, and a trend of consolidation means less choice for both doctors and patients. The same goes for insurance companies (which are now also seeking to provide the care they cover). And on top of that, there are pharmaceutical manufacturers, pharmacy benefit managers, medical supply distributors, equipment manufacturers and any number of medical associations with the power – and the purse strings – to catch lawmakers’ ears.
All this to say: The patient – who arguably has the biggest stake in the system – often seems to have no stake at all.
The panel didn’t end with a clear consensus on what power the patient has right now. The most salient piece of advice on that end was really, simply, to vote: Elect public officials who will give power to patients one day.
Thanks to pressure on lawmakers, 36 states now have some version of the Caregiver Advise, Record, Enable – or CARE – Act, said Carol Raphael, senior adviser at Manatt Health Solutions and former AARP board chair. Among other things, CARE requires hospital staff to train family members caring for their discharged loved ones.
Health care is a “pocketbook issue” for patients, said Rosenthal. She added that she hopes, in the coming midterm elections, “we see a little more front and center talk about voting and health care policy, and the kind of influence patients who are really unhappy and feeling helpless can have.”