Why we need an economic informed consent

The next time I receive medical care, I want to know how much it will cost before I agree that it will be done — and that includes no matter who pays the bill.

And, doctor, I want you to know and I want you to care how much what you prescribe is going to cost me or somebody.

You say it is beyond your control to know? I say, insist.

Rise up, as one, and demand to know.

If I go into a department store, or a restaurant, or a bar, or a supermarket, or online for theater, or a football game, or airplane tickets, or a hotel room, I will know how much I will have to pay to obtain whatever it is I want before I close the deal.

Why have we as a society allowed medical care of all sorts to be so different? Are we just a bunch of ninnies?

Not knowing, or sometimes even caring about the price of a surgical procedure, a diagnostic test, a biopsy, an MRI, a hospitalization, an emergency room, or urgent care, or primary care, or specialist office visit is routine.

Recently, some politicians in — of all places — Florida tried to change at least a little bit of that nonsense.

But some elements of the Florida medical industrial complex rose up to smite those silly legislators. Didn’t they understand who is in charge?

I believe that we patients should, if mentally competent, and in a non-emergency, non-OR, and -ICU situation, be provided an opportunity for an “economic informed consent.”

Medical decisions are increasingly shared decisions. However, a frank discussion about the comparative costs and charges for the options, whether the payment will be by the insurance company, Medicare, Medicaid, or out-of-pocket for the patient, or shared, is usually missing.

Of course the medical marketplace does not behave like other markets; it is rigged by so many factors and groups.

Consumer-driven healthcare truly cannot grow in importance and frequency unless costs, including costs for referral, are knowable.

The attitude that “if insurance will cover it, do it” lies at the root of our problem of healthcare cost inflation. No one is held accountable.

If we as a country could widely apply the “economic informed consent,” physicians and patients would become educated together to become wiser shoppers.

Most of us in healthcare laud “transparency” — let that include economic transparency.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

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