When we were fighting for price transparency inside the White House, I heard one argument constantly: patients aren’t going to shop for health care.
They were right.
They were just wrong about why it mattered.
Patients were never the audience. Employers were.
Troy Reichert and Dr. Jonathan Bushman host Patients Win for the people who buy health care: CHROs, CFOs, brokers, and physicians. They gave me the chance to tell the story of how we got here.
It starts with my old boss, Senator Tom Coburn.
Jonathan knew him too. In 2007, as a medical student, he invited Coburn to speak about physicians in politics. Coburn pulled a card out of his wallet, preloaded to buy health care, and said everyone needs one.
Nineteen years later, we’re still building the system where that idea works.
Many years after that visit, Cynthia Fisher, who runs PatientRightsAdvocate.org, the powerhouse funding the fight for transparent prices, figured out that the only way to get a meeting with me in the White House was to bring Tom Coburn.
Well, it worked.
I sat there planning how to say no, and halfway through I caught myself thinking:
This is the right thing to do. Figure out how to say yes.
And so it began. What followed was the real fight.
White House economists argued that price competition wouldn’t lower prices, so we held a journal club to walk them through the literature. A little guerrilla warfare got it into the State of the Union. The hospitals sued us twice and got laughed out of court twice.
Now vendors are turning that data into something employers can use to pick a network or check whether a direct contract is fair.
The next fight is cash pay at scale.
Jonathan is already living a version of it. His direct primary care practice grew during COVID while everyone else was suffering, because patients could reach him. He walked one woman through a colorectal cancer diagnosis, a surgical consult, and a hospital admission entirely by phone. Six months later, she introduced herself in his exam room. He recognized her voice.
HSAs won’t get the rest of us there. They sit on top of a high-deductible plan paying the plan’s negotiated rate, and cash you pay doesn’t count toward your deductible. Cash pay scales when employers pay cash, and two things block that. Most TPAs run on dinosaur claims systems, though two or three can handle cash now. And the network contracts make us submit a list of exceptions the network can veto. I’d argue those provisions violate the Sherman Act, and DOJ should take a hard look.
Jonathan asked me what it takes for patients to win consistently.
My answer: Don’t be a patient.
We’ve never been sicker, fatter, sadder, or more medicated. Jonathan knows what I mean. He sees it daily.
The Latin word for doctor means teacher. Doctors could stand to do more of it.
Check it out here.