Consumers want and need price transparency in health care, lawmaker says

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Americans spend an enormous amount of money on health care – $4.5 trillion in 2022.

But patients and physicians don’t always know the cost of services before they happen.

Patients, physicians, lawmakers and regulators all are involved in the continuing evolution of price obscurity and price transparency in the American health care system.

Rep. Larry Bucshon, MD (R-Indiana), spent years as a practicing physician and cardiothoracic surgeon before being elected to Congress in 2010. As vice chair of the Health Subcommittee of the House Committee on Energy & Commerce, he has reviewed numerous pending bills that would affect health care and medicine around the nation.

On Feb. 16, Bucshon spoke to Medical Economics about a number of issues dealing with health care, including price transparency and the potential for legislative action during the 2024 presidential election year.

This transcript has been edited for length and clarity.

Rep. Larry Bucshon, MD (R-Indiana)

Medical Economics: There are numerous news reports about price differences for medical services based on location, and sometimes even within the same facility or hospital. What more would you like to see about price transparency in health care?

Rep. Larry Bucshon, MD: The consumer needs to understand what the prices of things are in a way that the consumers can properly assess the value of the service. For example, during the Trump administration, which is has bipartisan support for the most part, they put in a rule that hospitals were going to have to disclose their fees, how much they charge for things. The compliance level, that's been very low and the data that has come out, some places have released their fees with like 30,000 different fees, and in a list that the American consumer has no way of evaluating, and that's not what we need. So what we need is true price transparency where we know what the costs are in a way that the American people can understand. That happens in a lot of other sectors of our economy. If you go to the grocery store, the price is right there. You go down the street to the next grocery store, and if a gallon of milk is 50 cents less or $1 or less, you probably go to the other store and buy your milk. But if you don't have price transparency, you can't assess that in a way that you can make a decision, then it doesn't help. We need broad transparency. I've seen the studies that show, for example, and I'm paraphrasing here, I'm not giving an actual quote, for example, if you have a knee replacement in one state, it might be twice as expensive as the state right next door, depending on who you are. And the other thing is, let me just quickly say I was the president of my medical group, here's how you bill patients for services: You find out what the highest level of payment from the private sector is, in your practice and you bill everybody more than that. So if you take Medicare assignment, because you can't bill people differently, it's not like you can say, oh, Medicare will pay this amount, I'm going to bill that, and UnitedHealthcare is going to pay this, so I'll bill the patient that. You have to bill everybody the same. So, everybody gets billed the same amount. People that have no insurance, of course, they have the entire amount on their backs, whereas, if you have insurance, there's been an agreement about what level, no matter what the charges are, and the patient is not responsible for that. So the whole system away, we pay for and bill in healthcare really needs some substantial changes, and the first step is the American consumer needs to understand the costs in a way that they can use to make good decisions.

Medical Economics: You serve as vice chair of the Health Subcommittee of the House Committee on Energy and Commerce. That committee has a number of pending bills related to health and medicine. What bills are most urgent for you, or what are some things that you would like to highlight?

Rep. Larry Bucshon, MD: Well, the price transparency bill that we passed out of the committee that passed on the House floor, is one that has some of these transparency provisions in there. One of the top priorities that I have right now is trying to find a way to get that through Congress. It has some other changes in there that not everybody in the health care space likes, and I understand that, but that's a priority. We just had a hearing on a number of reauthorizations of health care programs like ones for congestive heart failure, and other things. I think we'll get those across the finish line. We got a whole laundry list of reauthorizations of programs that don't cost money and have broad bipartisan support, that I'm hopeful will get across the finish line. But for me, I think the biggest thing that we have a good chance is this transparency bill that has passed the House and is over in the Senate. Look, I work on the 340B program, which is a drug price program that is absolutely necessary for my rural hospitals and a lot of hospitals to expand services for pharmaceuticals in their area, particularly oncology drugs. We passed a price transparency bill out of the Energy and Commerce Committee to put more transparency in that program for the disproportionate share or dish hospitals consistent with what are called grantees like community health centers and federally qualified health care centers already have to report for transparency purposes. I'm hopeful that we can move that through the house. But those are some of the top things that we need to really get moving.

Medical Economics: The year 2024 is a presidential election year and an election year for the House of Representatives and some senators. Do you believe that will inspire lawmakers to take action on pending bills, especially for bipartisan legislation related to health care?

Rep. Larry Bucshon, MD: I think to a certain extent. I think most legislators, though, try to do what they think is the right thing regardless of whether it's an election year or not, but the reality is, particularly on the Senate side – I'll be honest, because they're up only every six years, so, you know, in the two years that they're preceding their re-election, I think there is room for them to look at more bipartisan legislation and actually try to push things across the finish line, versus the first four years of the Senate term where there's a little less inclination to do things that are not, I would say, lean more partisan, and that's on both sides of the aisle. On the House side, look, we're up every two years, so we're always running. I think that it doesn't really change that much. I think people continue to promote legislation they believe in now. There are people on both sides of the aisle, they're in swing districts, and they particularly really want to have some bipartisan things get across the finish line, but they do that consistently also. So, whether you're in a solid Democrat district, and I'm speaking of the House, or a Republican district or in a swing district, everybody wants to show what they've accomplished, and for the House, a coming election doesn't really change that much, because we're always running for re-election. In the Senate, I firmly believe, and I'm just speaking as a House member, and my senators might disagree, and that's fine, but clearly when you're up for re-election in the Senate, you have more of a propensity to look for bipartisan type legislation to show that you've accomplished some goals.