Cost of Healthcare Transparency Is Trust in the American System
As Americans learn just how vigilant they must be, and become wary, the entire system suffers
Jessie Gruman is president of the Center for the Advancement of Health.
Trust is the glue that holds an open, democratic society together. A successful democracy depends on our confidence that professionals and institutions are competent, that both private institutions and government at all levels operate within the bounds of the laws, that an independent judiciary enforces those laws, and that a free press shines a light on any of these guarantors when they fall short.
And so, of course, trust has always been central to healthcare. We must trust doctors and hospitals if we are to benefit from the care they offer. Without trust, who would allow a surgeon to cut open his chest and fiddle with his heart? Without trust, who would take noxious medicines or suffer radiation burns to cure a disease whose symptoms she cannot detect? We patients don't know how these things work, but we are willing to place our lives in the hands of those who say they do and have licenses affirming it.
Unfortunately our trust in healthcare is also eroding.
Why? Advances in information technology make increasingly transparent our idealized vision of healthcare. For example, new evidence about what treatments work has led to documentation of how infrequently they are delivered appropriately. The ability of researchers to examine the data underlying new and competing claims also allows us to view flawed findings and scientists' conflicts of interest. Reports rating the quality of care offered by different hospitals, health plans, and physicians provide statistics to inform our choices but vary widely in reliability and relevance. Combine these with an active press, a 24-hour news cycle, the proliferation of watchdog groups, and commercial interests that manipulate scientific claims to support their aims. The result is a media environment infused with messages that tell us that our every action increases our health risks, that science is uncertain, and that healthcare professionals and institutions are not living up to their obligations.
This loss of trust is deeply disruptive. It leads us to devalue professional opinions of our doctors, nurses, and pharmacists and become skeptical about their recommendations. We begin to regard all information as equal; scientific claims bear the same weight as commercial claims and are regarded with suspicion or naive enthusiasm, depending on what suits our fancy. We can no longer sort the wheat from the chaff.
"But this is reality," one may say. "Doesn't such evidence point to the need for all of us to act as vigilant consumers of information and services? The responsibility is ours: we have to be careful; we have to become experts; we have to question everything."
Indeed, this new transparency reveals a more realistic picture of what is now required for each of us to benefit from healthcare. The lengthening of Americans' lifespan and improvement in quality of life made possible by impressive advances in scientific knowledge and technology can be realized only if we make informed decisions about our healthcare, modify lifelong habits, and manage complicated medical regimens—often while ill. We must learn how to test what we're told and when to challenge our care. Thus, the new transparency imposes new obligations on us as patients while at the same time making it more difficult to satisfy these obligations.
Such demands represent a radical change from the passive patient role that has been characteristic of Americans' traditional approach to healthcare. Acquiring the knowledge, skills, and motivation and finding the time to become effectively involved in our care is not simply a matter of picking the right information off one of the 1.3 billion health-related sites now online. It requires broad recognition of our role in the success of care and a commitment on our part and the part of all those with a role in healthcare to ensure that all who seek care have the opportunity to participate in it effectively.
In the meantime, however, many of us have become uncertain whether our doctors know enough to ease our suffering, whether the medications they prescribe will hurt us or heal us, or if our hospital is a safe place to be cared for when we are ill. And we aren't sure where to find reliable counsel on these questions. Over time we will adapt to this new reality: we will forge a more accurate understanding of what healthcare can do and what we must do. And with this knowledge, we will recover our trust, but that trust will necessarily be more measured, tempered by the newly visible promises, limitations, and demands of American healthcare in the 21st century.
Reader Comments
What?
An underlining problem is we are fighting against our own ignorance. The United States of America cannot be "A successful democracy" because it is a Federal Republic.
The attempts to opporate a democracy under the stipulations of our constitution creates a tangle of conflicting activities that will not be resolved unless we collectively learn and practice constitutional realities.
Freedom is not an avoidance of responsibility - Freedom is because of responsibility.
Give it a Rest
We have excellent facilities, mainly excellent care (if we have good insurance), and generally well trained doctors and caregivers.
When dealing with life and death matters, things don't always turn out rosey, and sometimes errors occur. This is not grounds for massive "mistrust". The inefficiencies and financial nightmares associated with healthcare are what need to be fixed.
I just went through a major health event ultimately requiring surgery. I filled out too many forms, saw too many doctors, took too many tests, sat in too many waiting rooms, paid too many deductibles, argued too often with billing departments wanting to collect overbilling that should have been written off, recieved statements from doctors, statements from the insurance company, statements before insurance paid, statements after insurance paid, statements after remaining balances are written down, statements showing the balanced cleared in full. I had duplicate blood tests, multiple forms, and received invoices from doctors I never met but somewhere along the line they looked at one of my sonograms. I received invoices from companies I never heard of in Arkansas for procedures done in South Carolina. I paid thousands of dollars out of pocket because I couldn't have the surgery in December because the doctors were all booked up or were out on holiday.
Bottom line - HUGE waste of my time, paper, paperwork, employee hours to process it all, no central records database, major expense to me (and I can afford it), over $20,000 paid by my insurance company, and if I had another health event, it would all be repeated again.
We have to get universal health care. I have lived overseas and had it before and it was great. I went to the MD, showed my ID card, and saw no invoices, deductible payments or increases in my premiums. I did not wait for service. the doctors were excellent, the hospitals immaculate.
I had no worries about limits for certain services. People did not go bankrupt when they became ill. Old people were not trading pill expense for food. Those who do not think the standard coverage is adequate could purchase additional insurance that gave them more private rooms and exotic treatment options. But everyone has the basic service. Employers do not have to pay insurance for employees, so their costs are way lower.
The cost to you and I? The same amount we pay now for health insurance if employed. The difference? No one is turned away, totally portable if you change jobs, available anywhere you live or vacation. This is possible due to the efficiencies of having everyone in one pool - purchasing supplies, medications, centralized patient information, no more outdated walls of paper files, no more piles of paperwork to insurance companies for reimbursement claims, no more separate doctor bills to generate and collect. The doctors make very good money, so they are not suffering either.
It is time. Let's fix this instead.
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