"Joe SixPack wants to know the cost. Tell me what the anesthesiologist, the surgeon, the OR, are going to cost. Tell me what it is going to be out of pocket. Don't send me an explanation of benefits 10-30 days after the event and tell me what I am going to owe. That is not rational," he says.
While educating healthcare consumers and providing price transparency have to be a priority Keckley says they're not enough.
"There have to be consequences for those behaviors. Both reinforcing positive behaviors and punishing wrong behaviors. The challenge there is the science. What is the right combination of sticks and carrots in a complex consumer environment?" he says. "It is not a simple environment the way people think. If you have limited resources or a difficult risk profile the sticks and carrots may be quite different than if you are a young healthy strapping flat belly."
"There is an interesting domain emerging in health services research called behavioral economics where we are really trying to map this to individuals with certain characteristics and what is the right blend of sticks and carrots and how do you deliver it and how much is technology and how much is money," Keckley explains.
"So it is the science around sticks and carrots that our policy makers don't have in place now and for a variety of reasons our ideological divides force overly simplistic and sometimes counterproductive results. That is what we ought to have a holy war about. The system has the money but doesn't spend it the right way to get the right results."