A Letter to Healthcare Providers from a Consumer

Now that the rules of healthcare delivery have changed so dramatically, we need to be clear about our new relationship. If you thought haggling with insurance companies was rough, just wait until you hear my expectations.

Greetings Providers! By way of introduction, we've met before. I am one of the hundreds of millions of people out there who were once referred to as your patients. Going forward, however, it'd be more accurate if you thought of me as a healthcare consumer. This is a business, after all, and you're selling me a product. So we need to be clear about our new relationship.

Let me assure you, now that the rules of healthcare delivery have changed so dramatically, the idea of the healthcare consumer is not a mere buzzword. This is now a matter of my "skin in the game" and my cold hard cash.

For years healthcare policy wonks have said that the best way to reduce cost growth in healthcare is to educate patients and make them smarter consumers. And the fastest way to educate anybody on anything is to make them pay for it.

And that's where I am now.

For as long as I can remember I was in a traditional health insurance plan where I paid a certain amount in premiums, a certain amount in co-pays, and a certain amount in deductibles. It was a pleasant enough relationship, however insupportable. I didn't understand how it worked because I didn't have to.

I was sorry to see it priced out of existence. My employer and I both saw our health insurance premiums skyrocket over the decades and it was clear that we had to change the way we paid for coverage. So, I bumped into a high-deductible health plan. Now my premiums are lower, but my co-pays and deductibles are higher – a lot higher. All of those various payments and services that you used to haggle over with my insurance company have been dumped into my lap.

Now that I'm the one who will be paying the freight on the first $5,000, or $7,000, or $8,000 and higher of my healthcare costs, here's what you can expect from me.

1. I Want Transparency
Tell me why I need it and what it's going to cost, up front. Make it easy for me compare your costs with the hospital/practice/walk-in clinic down the street. Transparency is highest on my list of priorities because without knowing how you do business, when you do business, how much you charge for your business, we can't do business.

2. I Want it Cheap
Surveys say that healthcare consumers value "quality care." But now that I have to pay more for that quality, I want it cheaper. If your prices are higher you'd better be able to explain why, but I'll still probably go elsewhere.

If you want me to pay $3,000 for an MRI, you'd better be able to explain why I need it. And if the doc-in-the-box down the street can do the MRI for less, I'll have them send you a copy of the images. If it's 2 AM and the emergency department is my only option, you'd better be prepared to provide a detailed list of charges when you present my bill, and you can expect that I will haggle.

I will not pay $100 for an ice pack or $30 for an aspirin. And don't slap me with a "facilities fee." What it costs you to keep your doors open and your lights on is not my concern. Finally, don't expect me to pay additional fees six months or a year down the road when you correct a mistake on my bill.

3. I Want it Now
Don't make me take time off from work to sit in your waiting room for an hour for a harried 15-minute visit with a physician's assistant and a $150 bill. Drug stores are open 24/7. Banks are open later. Even airlines are more consumer friendly than providers!

Extend your office hours later in the day and on weekends to accommodate my schedule. Provide easy Internet access to my personal health account. Improve office scheduling so that I don't have to wait long. Have someone available for telephone consultations. Ensure that your office is easily accessible and close to my home.

I don't see my demands as unreasonable. I am merely asking the healthcare sector – a $2.8 trillion industry that consumes nearly 20% of the gross domestic product – to be as accountable and transparent with it products as any other retail industry.

Here's where I get unreasonable: Even if you deliver on transparency, quality, access and price, I may not pay you.

Maybe I am a deadbeat who never had any intention of paying you. It's more likely that I simply can't afford it. A $5,000 deductible might not seem like a lot of money to docs and healthcare executives with six-figure incomes. However, the median income in the United States in 2012 was about $51,000 and the $5,000 deductible that comes out of my pocket represents at least 10% of my gross pay.

I switched to the high-deductible plan for its lower premiums and as protection against a catastrophic illness or injury. I'm rolling the dice on everything else. So we'd better come to some E-Z credit terms on a payment plan. You've already provided the service, which takes away almost all of your leverage and gives me less incentive to pay. If the haggling gets nasty, you can send bill collectors after me, but they'll probably have to wait in line.

And rest assured that any number of websites and consumer action groups will blossom for people like me who don't really understand how all of this healthcare reform works and what we have to pay for and what the charges cover. We newly informed and suspicious healthcare consumers will be vigilant against perceived rip offs. We will read the stories about price shifting and gouging in healthcare – whether real, fabricated, or exaggerated – and we'll be determined that it won't happen to us.

So, I hope we are clear on what you can expect from our new relationship in the coming years. Most encounters won't devolve into nickel-and-dime haggling over who pays how much for what and why, but a growing number will. If you thought it was rough haggling with insurance companies, wait 'til you get a load of me.