COMMENTARY: The real health care crisis isn’t cost, it’s accountability

The government recently put hundreds of hospitals on notice for failing to comply with federal hospital price transparency requirements. It’s a welcome move, but it comes five years after hospitals were first required to post their prices. Evidently, Washington is still struggling to enforce widespread compliance.

This struggle tells us something important. Healthcare’s biggest problem isn’t a shortage of reform proposals; it’s a shortage of accountability.

Every few years, Washington picks a new healthcare villain. Pharmaceutical executives get hauled before Congress and scolded. Then it’s the pharmacy benefit managers’ turn. Insurers get their day over denials and prior authorization.

Now hospitals and health systems are on the hot seat, taking fire for price transparency, 340B profits, facility fees and site-of-care markups.

The hearings follow a familiar script. Executives are dressed down. Headlines are written. Everyone promises reform. Then they go home, and the healthcare crisis continues.

Why does the cycle repeat? Because the major players — providers, insurers, PBMs, manufacturers — are deeply intertwined, each doing things that benefit itself at the expense of others and Americans. Hospitals blame insurers. Insurers blame hospitals. PBMs blame drugmakers, and drugmakers return the favor. Then they play the blame game, pointing fingers at one another while pushing meaningful change down the road. If everyone is the villain, no one is accountable.

The one party with no seat at the table is the consumer. The Department of Health and Human Services is the largest part of the federal government, yet no one represents the people actually seeking care, and ultimately paying the bills. It’s appalling.

Hospital price transparency shouldn’t be controversial. You don’t buy a car, a house or a plane ticket without knowing the price first. Healthcare is the only major purchase Americans are expected to make blindly, and the industry has fought every which way to keep it that way.

Price transparency benefits the consumer. They can comfortably comparison shop for nonurgent care the same way they shop for everything else.

Instead, hospitals litigated the rule, ultimately lost in court, yet largely continued business as usual, shirking transparency requirements for years after the rule took effect. Independent analyses in the early years found that among U.S. hospitals, only a third or fewer fully met the requirements. That’s a shocking level of defiance.

Hospital pricing can be complicated, but that’s no excuse. If developers could count on pricing information, they would build applications that simplify it enough for regular consumers to use. Instead, hospitals have fought transparency requirements and often failed to provide information in required formats, leaving consumers without the tools they need to make informed decisions about their care.

For 30 years, one administration after another has approached healthcare reform the same way: trim reimbursement here, tweak a rule there, push the Medicare trust fund’s insolvency date out a year or two and take a bow. That’s not reform; that’s a Band-Aid.

The system is built to reward behavior that maximizes revenue rather than value. As the vise tightens, professional norms erode, stakeholders watch one another play dirty and everyone becomes more willing to do the same. Organizations that are accustomed to being squeezed learn to rationalize whatever keeps revenue flowing — the 340B spread, the flood of No Surprises Act arbitration claims and rebate arrangements too complicated for anyone to follow.

Meanwhile, premiums climb, hospitals and insurers continue to consolidate, and healthcare grows steadily less affordable. More than anything else, that’s what’s driving public anger.

The administration has shown it’s willing to take on entrenched interests, and the renewed push for price transparency is a good start, but transparency alone won’t fix a system that has spent decades rewarding opacity and cost shifting. Real reform means changing the incentives: data-based quality assessments, outcome-based compensation and rules enforced with real consequences.

We’ve spent decades treating the symptoms. The question is whether Washington finally has the spine to fix the system. The opportunity is here. Let’s hope it takes it.

Michael Abrams is co-founder and managing partner of Numerof &Associates, a healthcare consultancy. He wrote this for InsideSources.com.