TN-01 Republican Congressman Phil Roe is a retired OB-GYN physician who claims to have delivered over 5000 babies and who once creepily quipped that this means he delivered a substantial number of his constituents.
No longer delivering babies, Rep. Roe now delivers a steady stream of half-truths and bad ideas.
In this diary I’d like to focus on one particular half-truth involving what the congressman recently said about the big problem of people being unable to know how much health care is going to cost. There is no question about medical debt being a major cause of family hardship and even bankruptcy, so this is an important issue to get right.
Roe’s view of medical economics requires shifting a significant burden to individuals and families, but doing so in the name of offering them more options and choices. What is typically not discussed is whether the options are worthless.
Roe’s narrow view of healthcare transforms patients from people who are owed a fiduciary duty into self-guided “shoppers” for healthcare services. Extending the shopper metaphor, Roe boasts that he has “long pushed for transparency in the cost of health care” because “patients should have the option to shop for the very best care they can afford, and cost information should be readily available for patients and their families as they decide where to seek care.”
Like all half-truths, Roe’s words sound superficially attractive. But closer inspection shows that Roe merely trades smoke for fun-house mirrors.
Specifically — in a recent online column, Roe praises an administration decision to require hospitals to “publish a list of standard prices on-line, beginning in January 2019.” And then Roe makes this astonishing claim:
I know empowering patients with this kind of pricing data will help families shop for care that makes most sense for them.
For reasons outlined below, Rep. Roe’s words are just ridiculous, absurd, and nonsensical. If he wasn’t talking about such an important topic, I’d call his statement laughable — but when people’s health and well-being are at stake, laughing seems inappropriate.
Moreover, coming from a physician-congressman who should understand healthcare as an expert, it is reasonable to ask whether such words are just plain dishonest.
Here are some key reasons to reject Roe’s claim:
First, the new disclosure rule doesn’t apply to real prices. The prices that will be published are widely recognized as make-believe. These so-called “chargemaster” fees are just the hospital’s grossly inflated list prices. The chargemaster does not show the real prices that are actually paid - prices that are often a small fraction of the chargemaster price. Yet nothing requires a hospital or an insurance company to tell patients about the real prices the hospital actually accepts.
Second, the information to be disclosed under the new rule will be incomprehensible to families. Chargemaster documents are incredibly complicated and challenging to decipher, even for healthcare professionals. Even hospitals themselves must hire specialized experts or teams whose full-time job is to keep track of this information. Chargemaster prices are described in terms of technical jargon and numerical codes that will be unfamiliar to most people. A particular chargemaster may contain as many as 50,000 different prices for various hospital services, equipment, drugs, supplies, and tests. Chargemaster prices can be organized differently from one hospital to another, so direct comparisons can be difficult if not impossible to make.
Third, the information to be disclosed under the new rule will not make it easier for patients to predict or control their health-care expenses. Unless a patient has the good fortune to have access to one of the rare facilities that already advertises flat-fee care (usually for elective surgeries), the specific fees to be charged for a given hospitalization are almost impossible to predict. Access to chargemaster information will not change this situation. Patients can rarely know in advance which specific chargemaster prices will apply to their particular episode of care because they can’t know in advance what care will be provided. The last time I was in hospital, following an accident, clinical staff just came into my room and did things — nobody told me what it would cost, indeed, nobody actually providing my care even could have told me. Does Rep. Roe think a patient is going to be able to look up the chargemaster from their hospital bed when deciding whether to agree to a particular medical service?
Fourth, the information to be disclosed under the new rule will not tell patients anything about what they are getting for their money. Meaningful comparison shopping considers quality as well as price. Yet research shows no particular relationship between chargemaster prices and quality of clinical services. Higher list prices are merely a business negotiating strategy and do not signal better healthcare.
In sum — to use an online chargemaster for comparison shopping would require immense technical knowledge, enormous time, and the ability to predict in advance each separate service, item, and other fee that would be incurred in a hospitalization.
Good luck with that. In a time of need, no family has the ability to wade through the vast complexity of a chargemaster in a comparison shopping exercise. I know that I couldn’t begin do it, even with the help of my physician spouse.
Finally, comparison shopping is only possible when choices actually exist, and Rep. Roe sat by while healthcare choices for his constituents were dramatically reduced. As Congressman Roe knows, a huge hospital merger in his district has left his constituents with extremely limited choice. Almost all the hospitals in a multi-county two-state area are now controlled by one gargantuan corporation. Staff from the Federal Trade Commission strongly criticized the merger as harmful to the interests of the people and Rep. Roe himself admitted that it created a “monopoly.” Yet, despite recognizing the merger as creating a monopoly, the congressman never mustered the courage to actually speak against it and instead appeared to sit on the sidelines as the deal was pushed through.
Apart from Rep. Roe’s really stupid suggestion that families will be able to use chargemaster information for comparison shopping, I do think making chargemaster data public is a good step. It may be useful to teams of researchers and investigative journalists who have the time and skill to spend months figuring out what the data mean. But useful to families for healthcare comparison shopping as Roe claims? Not in a million years. Not on this planet.
A liar cares about the truth and deliberately attempts to hide it. In contrast, as Princeton philosopher Harry Frankfurt explained in his NY Times best-seller, the “bullshitter” doesn't care if what they say is true or false, but instead only cares about being persuasive. To the bullshitter, the most important thing is saying whatever is expected to convince the listener, regardless of whether it is true. Or, apparently in Congressman Roe’s case, saying whatever he thinks it takes to convince the constituent.
In his present position, Rep. Roe has the potential to cause great harm to American healthcare. He can have an outsized influence because he is also co-chair of the GOP “Doctor’s Caucus” and chair of the House Veteran’s Committee, which oversees the huge VA healthcare system. When a person in Roe’s position can’t or won’t speak truthfully to voters about healthcare, or when he takes healthcare positions that appear contrary to basic ethical principles of his own profession, it’s definitely time for someone else to take up the reins.
Roe’s Democratic opponent in the upcoming mid-term is another physician, Dr. Marty Olsen. This unique doctor vs doctor election offers East Tennessee a long-overdue opportunity for change.
I’m ready.