There is no shortage of legal and government sanctioned abuses that are flagrantly displayed in our health care system. One is hard pressed to know what to be more concerned about — the abuses, or the complacency of the average consumer. This article on hospital pricing describes the normative practice of variable fees in health care for the same service, with little logic and no link to quality or efficacy. That payers are willing to tolerate so-called facility fees, where significantly higher charges are paid for a service that is performed in a hospital vs. in a non-hospital location, is difficult to understand or justify. Unfortunately the average patient cares not at all about this sort of abuse. After all, they don’t pay directly. They just expect that insurance should cover whatever charge is leveled for their care. The average patient does not ask about price on services costing thousands, but likely scans the prices on mayonnaise at the grocery store to ensure the best deal. Of course they produce their own hard-earned cash for the latter.

Health care reform does nothing to change consumer behavior with respect to caring about cost. The burden and duty to address these abuses must be assumed by the payers, including employers and government. Be assured that those who benefit from the current regime will politicize efforts to control abuses and excesses, as has already taken place in the partisan attacks against health care reform.

Interestingly, the problem has been largely defined as excessive costs. However as the article references, excessive utilization is of equal importance. An overpriced procedure costs nothing to the patient who not only does not need it, but does not undergo it. Patients should follow the money and be ready to question the need for procedures recommended on their behalf. Will one really learn much from a particular study or test? Is that surgery really necessary and is that drug likely to make a difference? Our health care system is very good at driving utilization and consumption. There is little difference in behaviors between many non-profits and for profit systems when the underlying economic model is fee for service. If one provides the service, one generates a fee. The good deed of restraint and judgment, when it leads to non-consumption, is rewarded with virtue but little else.