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If only there was more transparency in healthcare, the arguments goes, we could take a big step to reducing costs.  OK, let’s have a show of hands.  How many people actually believe that?

Open doorsTransparency requires a free exchange of information – patients asking questions, being responsible for the care they need, and paying for it.  So imagine the surprise of a patient who pressed the doctor’s front office manager to explain their pricing because she was concerned with out-of-pocket costs only to be told by the doctor, during the appointment, that he no longer wanted her in his practice.  “I will not tolerate patients who do not trust what we are telling them about what is best for them, about our fees, or who upsets my staff trying to negotiate.”

Humiliated, she left the office feeling like a villain, not the victim, which was most assuredly the case.  This woman, who lived on a fixed budget, had been seeing the physician for five years.  She always paid her bill at the time of service but recently had experienced an unexpected surge of spending on healthcare.

Another woman, who was away from home on business when she began to feel ill and was concerned that a recurring E-coli infection was raising its painful and ugly head again, tried to call her doctor after hours only to learn, courtesy of a convoluted phone tree answering system, that there would be a fee to complete the connection.  In this case, they were at least honest that it was really about the money.

Running a medical practice, like a hospital, is a business.  About that there is no dispute.  But I always thought that healthcare was an industry that had a conscience and that the patients were supposed to come first.  To be fair the vast majority of physicians, most who are struggling with the challenges of healthcare economics, do care about their patients and would not abandon them in the name of a dollar. 

The thing that concerns me is that we are only now beginning to feel the effects of sequestration.  Changes from the Affordable Care Act and additional deficit reduction are still to come our way.  What will happen to patients who want more information on costs – transparency — or those on limited incomes who need to contact their physician after hours in hopes of avoiding a more costly visit to a hospital emergency department?

These two examples are not isolated.  Across America, patients are running into these types of economic hurdles.  To some physicians and hospitals, transparency may be important, but not at the expense of profit.  

Are we doomed to a three-tiered system for the haves, those who have to scrutinize every dollar they spend, and the have not’s?