Everywhere you look in the health care delivery system, you find players have created obstacles to keep you from finding out what is going on. It is not an accident. Big players know there is truth in the old saying, “Sunlight is the best disinfectant.” The less sunlight that shines on their business practices, the better for them. The less sunlight, the more money they make.

Health care providers, especially the big ones, despise government involvement in health care. They particularly dislike price controls. “Let the free market operate,” they say. And then they do everything they can to frustrate the free market.

As anyone who has ever studied Economics in school knows, prices in a free market are subject to the law of supply and demand. As supply decreases and demand increases, prices go up and vice versa. Essential to the efficient operation of the law of supply and demand is that market participants have access to information about prices and goods. The more information a market participant can hide from a potential competitor, the less likely it is that the potential competitor will present a threat to the participant’s profits.

Let’s take hospitals, for example. A great deal of money flows through the nation’s hospitals. This is especially true in urban areas with their large populations. Hospitals offer many services. How much to they charge for a routine delivery of a baby? Good luck finding out. Although in 2021, the Centers for Medicare and Medicaid Services published a regulation requiring hospitals to disclose their prices to patients, some have yet to do so and many who have made some disclosure, do so in a way that makes it hard for patients to actually find the information.

Hospitals usually have a number of possible prices for a given service. They enter into contracts with the big health insurance companies that set the prices for the hospital’s services to that company’s insureds. The terms of these contracts are a closely guarded secret for the hospitals. They don’t want Cigna knowing how good a deal they gave Aetna. In certain cases, the prices hospital agree to charge customers of health insurance companies bear little relation to reality. Not only is there sometimes no discount, sometimes the charges are higher than what the hospital will agree to take from someone with no insurance. Obviously, if you don’t know which hospital will give you the best price for the service you want, you cannot make an informed decision about where to go.

Doctors are in on it too, but usually in a slightly different way. While doctors’ fees are more transparent, they keep secrets too. For example, most of the cases I file against doctors on behalf of my clients will settle before trial. Unless the doctor is a government employee, they and their malpractice insurer always insist that the fact of payment and its amount be kept secret from the public or pretty much anyone else. Even if they are paying millions to the patient, the settlement agreement always denies that they were at fault and contains large penalties, if the patient tells anyone about the settlement. The reason doctors want to keep these payments a secret is the same reason you want to know about them. Is this a good doctor or is it someone who badly injures patients? If you are never permitted to find out what happened when the doctor got sued, you can’t make an informed decision about whether to go to that doctor or not.

Secrecy is a big deal in another area as well. Doctors and hospitals both play hide the ball when they injure someone. It is a rare day when a doctor or a hospital tells a patient that their bad outcome was actually the result of a mistake by the doctor or nurse and that they are going to make it right with the patient. The patient usually has to figure this out on their own.

As you can see, the patient is always the one being kept in the dark. The secrecy is never for the benefit of the patient. It is always to protect the financial interests of the doctors and hospitals. Clearly, what you don’t know can and does hurt you.

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