Menus Subscribe Search

Follow us


Dicker With Your Doc? Not So Fast…

• January 25, 2011 • 4:39 PM

While it’s not a bad idea to pay attention to the various costs of your medical care, the president of the Center for Advancing Health argues that haggling over costs is not a long-term solution to spiraling expenses.

“How to Haggle With Your Doctor” was the title of a recent Business section column in The New York Times. This is one of many similar directives to the public (as seen here, here, here and here) urging us to lower the high price of our health care by going mano a mano with our physicians about the price of tests they recommend and the drugs they prescribe. Such articles provide simple, common-sense recommendations about how to respond to the urgency many of us feel — insured or uninsured — to reduce our health care expenses.

With unemployment at 9.4 percent and more than 50 million Americans lacking any or adequate health insurance, I understand the impulse of editors to assign this story. Plus, “of all the providers of medical care, physicians are most important in determining how much will be spent,” notes Arnold Relman in the New York Review of Books, since they make all the allocation decisions that “call on the facilities and services of all the other providers of care — hospitals, imaging centers, diagnostic laboratories, manufacturers of drugs and equipment.” The prices charged by these institutions vary widely, and therein lies the opportunity to find some savings.

But coming off a wave of big-buck spending related to my recent diagnosis of stomach cancer, I am acutely aware that haggling with my doctor about the costs of my care is neither simple nor is it a matter of common sense. Rather, it is a matter of 1) understanding in detail both the opportunities and limitations related to my health insurance; 2) being persistent in seeking information, since price lists are often difficult to track down and comparisons of quality (accuracy) of laboratories and testing facilities are nonexistent; 3) using available information and my judgment to weigh options; 4) the willingness to risk the rejection of my request by my provider and perhaps antagonize her; and 5) overcoming my pride and asking to be treated well while seeking the best value for my money.

The fact that health care is not a real “market” for patients is old news, although perhaps not to those journalists who blithely recommend that we set off to haggle our way to cheaper care. And it is irrelevant news to the vast majority of the public for whom discussing cost with their doctor is anathema. Many people would not consider doing so, first, because they may not know that the prices of drugs and tests vary so much by provider/source; second, because they may feel uncomfortable mentioning money concerns; and third, because the public has long held the view that more expensive care is better care and in seeking to pay less, one may be tacitly agreeing to accept less effective care.

Objectively, none of these factors should influence a person’s ability to ask straightforwardly: “I wonder if there is a way you could help me reduce the price of my care?” But our relationship with our providers is rarely objective. We come to them when we are sick and vulnerable. We put our lives in their hands. We trust them to do the best for us. And we value deeply their efforts. Haggle about the price of this commitment? Many of us will not, even if the alternatives are bankruptcy or going without care.

So what should we make of this rash of recommendations to enlist our providers in reducing the price of care?

I, for one, want to know whether similar imprecations are aimed at doctors and other providers so that if we must ask for help to pay less, they are able to respond with useful strategies and without hostility. All health plans remind doctors of policies that aim to constrain costs by providing incentives to physicians who deliver care that is evidence-based, for example, or dictating the priorities of drugs prescribed for certain treatments. But our requests are not policy-based. They relate to the use of specific facilities, dosages and frequencies. Other than providers in federally qualified health centers, many of whom have well-honed skills in squeezing the most care for from each dollar, most providers are largely unfamiliar with the prices of the services, tests and drugs they recommend.

Will this advice to ask for a break on the price of care exert demand that results in more transparency about cost and quality? Perhaps, but only if many more people cast off their traditional passivity with regard to their care, overcome their reluctance to discuss money, and invest the time required to tracking down the elusive price and quality information that is required.

The frequency of the recommendation to haggle with one’s doctor may reassure the public that discussing the price of care will apply pressure to meaningfully reduce what we pay. But saying, “This drug/that test is too expensive for me. Can you do me a favor and spend time with me to find lower-price solutions without compromising quality?” is not an approach that will lead to a widespread and enduring solution.

While we are waiting for the enactment of federal and state policies that would ensure that each of us can afford the care we need, what private policies and public regulations about transparency and price would help us out here? What would ensure that those of us who are willing to take on the tasks of trying to cut a better deal for our care with our providers have the information and guidance to do so?

Subscribe to Miller-McCune

Jessie Gruman
Jessie Gruman, PhD, is the founder and president of the Washington, D.C.-based Center for Advancing Health. She is the author of "Aftershock: What to Do When You or Someone you Love is Diagnosed with a Devastating Diagnosis."

More From Jessie Gruman

A weekly roundup of the best of Pacific Standard and PSmag.com, delivered straight to your inbox.

Recent Posts

December 22 • 2:00 PM

The Paradox of Women’s Sexuality in Breastfeeding Advocacy and Breast Cancer Campaigns

We capitalize on the sexualization of the breast to raise awareness about breast cancer, yet we cringe at the idea of a woman nursing her child.


December 22 • 1:00 PM

Keep That E-Reader Out of Bed and You’ll Feel Better in the Morning

New research finds e-readers, like other light-emitting electronic devices, can disrupt normal sleep patterns.


December 22 • 12:25 PM

Stop Trying to Be the ‘Next Silicon Valley’

American cities often try to mimic their more economically successful counterparts. A new study suggests that it’s time to stop.


December 22 • 12:00 PM

Pill Mills and the Rise of Controlled Substance Use in Medicare

Despite warnings about abuse, Medicare covered more prescriptions for potent controlled substances in 2012 than it did in 2011. The program’s top prescribers often have faced disciplinary action or criminal charges related to their medical practices.


December 22 • 10:00 AM

Economics at the North Pole: Are Santa’s Elves Slaves?

A pair of economists seek to reconcile two conflicting schools of thought in order to predict what sort of environments increase incentives for labor coercion.


December 22 • 8:00 AM

What Influences Whether Owners Pick Up After Their Dogs?

The presence or absence of suitable receptacles for bags is not the whole picture.


December 22 • 7:04 AM

Coming Soon: This Is How Gangs End


December 22 • 6:00 AM

Politicians Gonna Politic

Is there something to the idea that a politician who no longer faces re-election is free to pursue new policy solutions without needing to kowtow to special interests?


December 20 • 10:28 AM

Flare-Ups

Are my emotions making me ill?


December 19 • 4:00 PM

How a Drug Policy Reform Organization Thinks of the Children

This valuable, newly updated resource for parents is based in the real world.


December 19 • 2:00 PM

Where Did the Ouija Board Come From?

It wasn’t just a toy.


December 19 • 12:00 PM

Social Scientists Can Do More to Eradicate Racial Oppression

Using our knowledge of social systems, all social scientists—black or white, race scholar or not—have an opportunity to challenge white privilege.


December 19 • 10:17 AM

How Scientists Contribute to Bad Science Reporting

By not taking university press officers and research press releases seriously, scientists are often complicit in the media falsehoods they so often deride.


December 19 • 10:00 AM

Pentecostalism in West Africa: A Boon or Barrier to Disease?

How has Ghana stayed Ebola-free despite being at high risk for infection? A look at their American-style Pentecostalism, a religion that threatens to do more harm than good.


December 19 • 8:00 AM

Don’t Text and Drive—Especially If You’re Old

A new study shows that texting while driving becomes even more dangerous with age.


December 19 • 6:12 AM

All That ‘Call of Duty’ With Your Friends Has Not Made You a More Violent Person

But all that solo Call of Duty has.


December 19 • 4:00 AM

Food for Thought: WIC Works

New research finds participation in the federal WIC program, which subsidizes healthy foods for young children, is linked with stronger cognitive development and higher test scores.


December 18 • 4:00 PM

How I Navigated Life as a Newly Sober Mom

Saying “no” to my kids was harder than saying “no” to alcohol. But for their sake and mine, I had to learn to put myself first sometimes.


December 18 • 2:00 PM

Women in Apocalyptic Fiction Shaving Their Armpits

Because our interest in realism apparently only goes so far.


December 18 • 12:00 PM

The Paradox of Choice, 10 Years Later

Paul Hiebert talks to psychologist Barry Schwartz about how modern trends—social media, FOMO, customer review sites—fit in with arguments he made a decade ago in his highly influential book, The Paradox of Choice: Why More Is Less.


December 18 • 10:00 AM

What It’s Like to Spend a Few Hours in the Church of Scientology

Wrestling with thetans, attempting to unlock a memory bank, and a personality test seemingly aimed at people with depression. This is Scientology’s “dissemination drill” for potential new members.


December 18 • 8:00 AM

Gendering #BlackLivesMatter: A Feminist Perspective

Black men are stereotyped as violent, while black women are rendered invisible. Here’s why the gendering of black lives matters.


December 18 • 7:06 AM

Apparently You Can Bring Your Religion to Work

New research says offices that encourage talk of religion actually make for happier workplaces.


December 18 • 6:00 AM

The Very Weak and Complicated Links Between Mental Illness and Gun Violence

Vanderbilt University’s Jonathan Metzl and Kenneth MacLeish address our anxieties and correct our assumptions.


December 18 • 4:00 AM

Should Movies Be Rated RD for Reckless Driving?

A new study finds a link between watching films featuring reckless driving and engaging in similar behavior years later.


Follow us


Stop Trying to Be the ‘Next Silicon Valley’

American cities often try to mimic their more economically successful counterparts. A new study suggests that it's time to stop.

Don’t Text and Drive—Especially If You’re Old

A new study shows that texting while driving becomes even more dangerous with age.

Apparently You Can Bring Your Religion to Work

New research says offices that encourage talk of religion actually make for happier workplaces.

Canadian Kids Have a Serious Smoking Problem

Bootleg cigarette sales could be leading Canadian teens to more serious drugs, a recent study finds.

The Big One

One in two United States senators and two in five House members who left office between 1998 and 2004 became lobbyists. November/December 2014

Copyright © 2014 by Pacific Standard and The Miller-McCune Center for Research, Media, and Public Policy. All Rights Reserved.