U.S. agency proposes rule to eliminate medical debt from most credit reports, saying it's an unreliable predictor of payment

Third Way graphic

Kentucky Health News

The federal Consumer Finance Protection Bureau is proposing to eliminate medical debt from most credit reports, stop companies from sharing debt information and bar lenders from making decisions based on medical data.

About 12 percent of Kentucky adults, more than 400,000 people, are estimated to have medical debt.

The proposed rule brought "immediate cheers from consumer advocacy groups that have long pushed for change," Amy Lotven reports for Inside Health Policy. "CFPB believes the rule . . .would remove as much as $49 billion in debt from 15 million Americans and increase credit scores by an average 20 points."

The agency's research has found that medical debt "is not a good predictor of loan repayments," so it thinks the regulation would "improve underwriting, stop denials of loans to consumers who would repay, and lead to about 22,000 additional safe mortgages a year," Lotven writes.

CFPB Director Rohit Chopra said the credit-reporting system is often inaccurate, yet is used "to coerce patients into paying medical bills that they do not owe."

In 2003, Congress restricted lenders from using medical information about debts, but "agencies created a regulatory loophole that let creditors use such information in their decisions," Lotven reports. The proposed rule "would close the regulatory loophole from 2003 by establishing guardrails for credit-reporting companies and banning lenders from taking medical devices as collateral for a loan as well as from repossessing a device if the loan is not repaid."

Vice President Kamala Harris and Lisa Lacasse, president of the American Cancer Society Cancer Action Network, said states should take similar action. David Kendall, senior fellow for health policy at Third Way, a centrist group that has produced several reports on debt, said the proposed regulation is the latest in a series of federal and state actions “to fight the scourge of medical debt. They have been preventing medical debt by expanding coverage, funding medical debt abolishment, and ending junk insurance that can lead to medical debt.”

UPDATE, June 12: "Tuesday's announcement builds on a 2022 effort by the big credit bureaus TransUnion, Equifax and Experian to keep debt off consumers' reports until it's at least a year old," Axios reports. "The two major credit scoring companies, FICO and VantageScore, have also reduced how much medical debts can factor into consumers' scores at that time."

Attorney general issues alert about scam sales of infant formula

Image from WKDQ.com

Attorney General Daniel Cameron issued a consumer alert Wednesday warning Kentuckians of scams related to the nationwide shortage of infant formula. 

“Scammers often attempt to take advantage of those in stressful situations, and right now that can include Kentuckians who are desperately trying to find formula for their babies," Cameron said in a news release. "We encourage parents to report suspected baby formula scams to our office immediately at ag.ky.gov/scams.”

The release notes that baby-formula scammers may use ploys similar to those used by online-purchase scammers who pose as legitimate sellers and claim to have scarce products. Often, these items are sold at prices that are too high or too good to be true.

"The items are often sold on social media platforms, independent websites, or online vendors like Facebook Marketplace or Craigslist," the release says. "Sellers often require upfront payment for the product or shipping. Payment is usually required through gift cards or online payment platforms. Consumers who are victims of these scams never receive the promised product."

To avoid such scams, Cameron's office offers these tips: 

• Purchase baby formula from known, reputable sources and, when possible, use a credit card to make the purchase.
• Avoid paying for infant formula up front, if purchasing from an unknown source.
• Be suspicious of sources advertising infant formula at prices that are too good to be true. If it seems too good to be true, it is likely a scam.

To report baby formula or other scams, contact the Attorney General’s Consumer Protection Hotline at 1-888-432-9257, or complete the online scam complaint form at ag.ky.gov/scams.

Price transparency in health care is thwarted by providers and others who want to keep deals secret; crowdsourcing may help

Trudy Lieberman

People seeking information on costs of health procedures are frustrated by the lack of clarity from medical providers. Things are not looking up for Americans seeking health-care price transparency, writes Trudy Lieberman in her latest column for the Rural Health News Service.

True price transparency would allow consumers to evaluate costs and plan for elective procedures or services that aren't covered by their insurance, in order to make informed decisions. Unfortunately, it's not that simple, Lieberman writes. Prices are negotiated, often in secret, between insurance companies, hospitals and doctors. One provider can charge different fees for services according to the type of patient and payment method.

Powerful lobbying interests have prevented health-care price transparency. Ohio passed a law last year to require doctors, hospitals and other health-care providers to disclose prices for their services, "but Gov. John Kasich, the Ohio Hospital Association and other health groups that oppose transparency have stymied implementation," Lieberman reports. "The governor’s budget for next year calls for repealing the law."

Lieberman interviewed patients in Nebraska, South Dakota and California who are “downright angry” and demanding information, she reports. They expressed concerns about hospitals intentionally keeping patients in the dark. A California woman made more than 10 phone calls trying to plan for an outpatient procedure, only to find an expected additional $5,706 on her bill.

Lieberman also spoke with Jeanne Pinder, founder and CEO of ClearHealthCosts. The organization with journalism-based roots seeks to empower people looking for information on medical costs. It gathers from people from all over the U.S. insurance companies' explanations of benefits. Their crowd-sourcing approach to price transparency reveals an inexplicable variety in costs, from hundreds to thousands, and codes for procedures. They use the information to maintain a searchable database that generates price reports by ZIP code and region.

Such information sharing via the internet, with a community approach, could be the key to price transparency, Lieberman ventures. Pinder says the “fix” for public frustration and anger is transparency.

But some caution that knowing prices will not necessarily cut health-care costs. Cost does not always equate with quality, but Americans want more price transparency. One in five have compared costs before seeking treatment, according to a Public Agenda report. And most people think that comparing prices has saved them money.

Public Agenda chart

Drug prices keep rising, with no end in sight

By Trudy Lieberman
Rural Health News Service

Recently a tweet from Lauren Sausser, a fine health reporter I know in South Carolina, caught my eye. “Crazy drug prices became personal. My dad will start Keytruda regimen on Friday, $15,000 per infusion, once every three weeks indefinitely.” The high cost of pharmaceuticals had hit home!

Her 61-year-old father, Jim McCallister, who lives in Spartanburg, S.C., had been diagnosed with a melanoma discovered during a routine skin exam a few weeks earlier. It had spread to his lungs. Doctors recommended the drug, which uses the body’s immune system to attack cancer cells and has showed promise in treating aggressive melanomas.

McCallister’s employer-provided insurance is paying for most of his treatment, and the family is looking into Merck’s co-pay program. In the meantime, McCallister faces several thousand dollars of out-of-pocket costs.

McCallister may be lucky cost-wise. But the fact remains: Somebody is paying for the high cost of Keytruda and other new drugs coming on the market. Sausser said her dad asked if insurance would cover the drug. “The doctor told him they would find some way.”

That’s the nub of the dilemma. For many like McCallister, there may be help, often from the drug companies themselves in the form of patient assistance plans. Remember drug company AstraZeneca’s ads for some of its costly drugs: “AstraZeneca may be able to help”? Sometimes state or local government programs, private charities, nonprofit agencies, or coupon programs help patients pay for their drugs. Patients who can’t get help from any of those sources often go without.

None of the assistance programs, however, attack the underlying prices for the drugs, which pharmaceutical makers can set according to what the market will bear. They can pretty much do whatever they want with little push back from those who end up paying the bills – governments, insurers and patients. The U.S. has no cost controls, and government doesn’t negotiate drug prices the way many other countries do.

So the price of commonly prescribed drugs like the EpiPen, a shot that stops life-threatening allergic reactions, has risen to more than $600 for two pens. In 2009 two pens cost $100. The price for Abilify, an antipsychotic, has risen 113 percent between 2007 and 2014, and the cholesterol-lowering drug Crestor has climbed 103 percent over the same time period, according to The Campaign for Sustainable Rx Pricing, a group of employers, insurers, and unions that are trying to raise public awareness of high drug prices.

That helps explain why Medicare recently reported its spending on prescription drugs increased more than 17 percent in 2014 even though the number of claims from the program’s 38 million beneficiaries rose only 3 percent.

Medicare’s prescription drug law was never meant to pay all a person’s drug expenses. This year once a beneficiary and her drug plan have paid $3,310 for medicines, she reaches the coverage gap where she must pay the cost of most of her drugs. If she spends, out of her own pocket, another $4,850 for drugs this calendar year, she qualifies for catastrophic coverage and pays only 5 percent of all her remaining drugs for the year.

The trouble is that with prices so high, it’s easy to end up in the coverage gap paying out-of-pocket. Even protection offered by catastrophic coverage may not be enough. That’s especially true for people taking high-priced specialty drugs.

In 2013, about 3 million people were in this predicament. “Not a lot of people pay above the threshold, but those who do can pay through the nose,” says Tricia Neuman, senior vice president of the Kaiser Family Foundation.

Escalating drug prices affect everyone – even those not taking expensive drugs or not on Medicare. High drug prices affect all insurance premiums sooner or later.

Not long ago I spotted a letter to the editor in USA Today from Heather Block, age 53, who has Stage 4 breast cancer. She was calling for patients to organize and build a network to help craft solutions for the problem of skyrocketing drug prices.

I talked to Block about this. Her zeal and interest in organizing patients reminded me of the early days of the consumer movement in the 1960s when citizens organized to pass legislation to make the marketplace safer and more fair. With drugs, Block says, it’s hard to organize people because of drug assistance programs that take the sting out of prices and make patients less willing to work against the companies, the presence of disease advocacy groups funded by the pharmaceutical industry, and a general reluctance to speak up for fear of jeopardizing their own health and survival.

She’s asking for consumers to share their stories at this email: h3ath3rblock@gmail.com.

What problems are you having paying for prescription drugs? Write to Trudy at trudy.lieberman@gmail.com.

FTC warns online marketers about claims of Zika protection

"It appears that some online marketers may be trying to take advantage of consumer concerns" about the Zika virus, so the Federal Trade Commission has sent letters to 10 of them warning that "Zika protection claims must be supported by competent and reliable scientific evidence in the form of well-controlled human clinical testing," the FTC said in a news release this month.

Some mosquito species carry Zika better than others.

"The products of concern include wristbands, patches, and stickers that purportedly can repel the mosquitoes that carry Zika or otherwise protect users from the virus," the FTC said. "The letters also point out that the testing supporting claims of protection from the Zika virus must use the mosquito species that are able to carry the virus, and must be able to demonstrate that the repellent effects last as long as advertised."

The agency "is concerned that some products don't work as advertised," FTC consumer education specialist Aditi Jhaveri wrote on the agency's Consumer Information blog. "To prevent mosquito bites, the Centers for Disease Control and Prevention recommends using skin-applied insect repellents registered with the Environmental Protection Agency with certain active ingredients. The EPA also has registered products to treat clothing and gear. These registered products have been evaluated by the EPA for safety and effectiveness."

The EPA registry is searchable by type of insect, active ingredient, company name and the length of time protection is needed.

"If you’re considering an all-natural repellent — or a wristband or sticker — not registered with the EPA, know that the CDC and EPA don’t speak to their effectiveness," Jhaveri wrote. "And if you’re a parent, know that certain ingredients aren’t safe for children under 3 — even if they’re advertised as all-natural. Here’s more from the EPA on using repellents safely and effectively.

Health-care consumers get little help resolving complaints, columnist says, citing some horrific examples

By Trudy Lieberman
Rural Health News Service

Who protects consumers of health care?

Two recent emails from readers got me thinking about that question. I don’t mean consumers in their role as patients whose medical well-being is looked after by state medical boards and health departments that police doctors and hospitals. Those organizations don’t always do a perfect job protecting patients from harm, but at least they are in place.

But who protects patients when things go wrong on health care’s financial side? What happens when you receive a bill you didn’t expect and can’t afford to pay? What happens when insurers send unintelligible explanations of benefits you can’t understand? What about questionable loan arrangements to avoid medical bankruptcy? Consumers of health care are pretty much on their own.

From the 1960s though the 1980s when people complained, they got action from consumer organizations, government and even businesses that set up departments to handle complaints. That consumer movement is now but a flicker.

“We don’t have as many public-interest minded regulators, and officials who try to grab these issues by the horns and deal with them,” says Chuck Bell, director of programs for Consumers Union.

The emails I received show that although it’s an uphill battle to get redress, fighting back as an individual can get attention and may ultimately lead to better protections for everyone.

John Rutledge, a retiree, got snared in Medicare’s three-day rule by a hospital near his hometown Wheaton, Ill. At the end of March he took his wife, who was having breathing problems, to the hospital where she was held for three nights of “observation.” Patients must be in a hospital for three days as an in-patient before they are entitled to Medicare benefits for 100 days of skilled nursing home care, as I noted in a recent column.

Thousands of families have been caught when hospitals decide their loved ones are admitted for “observation,” a tactic that allows them to avoid repaying Medicare if government auditors find patients should not have been classified as “in-patients.” Playing the “observational” game is worth millions to hospitals but costs families tens of thousands of dollars when someone doesn’t qualify for Medicare-covered skilled nursing care.

Rutledge knew about the three-day rule. Both his doctor and a pulmonologist at the same medical practice recommended an in-patient stay, and Rutledge refused to sign a hospital document saying his wife was admitted for observation. Still, the hospital prevailed, claiming a consultant made the decision to keep her for “observation.”

Rutledge was stuck with a bill that, so far, totals over $15,000 for the skilled nursing care his wife did need. He said he had been a “significant donor” to the hospital foundation, and “I have told the foundation that what I spend as a result of “observation” will come out of what I planned to give them, starting with the annual gift.”

The second email came from Kathryn Green, a college history professor who lives in Greenwood, Miss. Green is fighting an air-ambulance company, which transported her late husband to a Jackson hospital after he suffered a fatal fall in their home. This “nightmare,” as she calls it, is a bill from the transport company that claims it’s outside her insurance network, and says she owes them $50,950.

“I am 63 and will have a devastated retirement if this is upheld,” Green told me.

Blue Cross & Blue Shield of Mississippi, the administrator for her insurance carrier the State and School Employees’ Health Insurance Plan, paid $7,192 of the $58,142 the transport company billed. Blue Cross has told Green that she should be held harmless and should not be charged for the “balance after payment of the Allowable Charge has been made directly to that provider.”

Green is raising a ruckus and has taken her case to state and national media, members of Congress, the state attorney general, and the Mississippi Health Advocacy Program. The company has told her it will begin collection efforts.

In both cases there’s a legislative solution. The three-day rule can be fixed by counting all the time a patient spends in the hospital whether they’re classified as an “in” or as an “observational” patient. The ambulance problem can be fixed by changing the 1978 airline deregulation law that prevents states from interfering with fares, services, and routes. But money and politics block the federal changes that would help people like Rutledge and Green.

“It’s like playing a game of health-insurance roulette,” Bell says. “Your coverage exposes you to these gaps that have been normalized. It’s become the way of doing business.” A resurgent consumer movement could change all that.

What consumer problems have you had with balance billing? Write to trudy.lieberman@gmail.com.

Peanut butter can be a healthy choice, but you have to read the labels; gimmicks to improve taste not the best for nutrition

Peanut butter has long been considered a healthy food choice, and for the most part it still is, but with the advent of low-fat brands, flavored peanut butters and companies adding preservatives to lengthen shelf life, not all peanut butters are equally nutritious, Jose Aguayo and Ryan Canavan report for the Environmental Working Group.

Originally, peanut butter was made from one ingredient: ground roasted peanuts. But now, commercial brands have added sugars, salt, hydrogenated oils and other preservatives, and some are less acceptable than others.

For example, "reduced-fat peanut butters are some of the worst offenders," the authors write. To reduce the fat calories, manufacturers will often take out the healthy monosaturated fats but then add sugar and salt to improve the taste.

Most commercial brands also add hydrogenated oils, as well as preservatives like potassium sorbate, to extend peanut butter's shelf life. The authors note that over 80 percent of peanut-butter brands have hydrogenated oils, which introduce "artery-clogging saturated and trans fats to peanut butter's otherwise-healthy fat profile."

"For a healthy heart, the American Heart Association recommends avoiding foods with hydrogenated oils, including peanut butter," the authors write. So, read the labels when choosing a peanut butter to determine which ones have the least salt, sugar, hydrogenated oils and preservatives, remembering that the healthiest peanut butters are made from just ground roasted peanuts and a pinch of salt.

It should also be noted that while peanut butter can be a healthy choice, it is high in calories and should be eaten in moderation. A standard serving of peanut butter is 2 tablespoons, which is about the size of a golf ball. This amount has about 190 calories.

There's a big difference in hospitals, as various ranking systems show; op-ed analyzes the leading hospitals in Kentucky

Being a responsible health consumer requires some homework, especially when it comes to choosing a hospital, but if you wait until the emergency occurs it is likely too late to do a "thoughtful search," Dr. Kevin Kavanagh of Somerset, chairman of Health Watch USA writes in an opinion piece for the Lexington Herald-Leader.

Kavanagh explained that there are three types of reports available to consumers. U.S. News & World Report ranks mostly on the institutions’ capabilities, while patient safety is the main factor for Consumer Reports, The Leapfrog Group and Medicare’s penalty system for hospital-acquired conditions. Finally, there are patient surveys "which are largely decried by the industry as not truly reflective of quality," although others say "this is the score facilities have to worry about most," Kavanagh writes.

Kavanagh summarizes an analysis that revealed patterns across these ranking systems for high- and low-performing hospitals in Kentucky, along with a chart.

  (4) Centers for Medicare and Medicaid Services readmission penalty, up to 3% penalty on Medicare payments.

  (5) Rates of MRSA bloodstream infections. The national benchmark of 1.00 is the starting point, not the goal, so a value of 1 shows no improvement. Percentage is the penalty or bonus on the facility's Medicare payments.

  (6) CMS patient survey results, on a scale of 1 to 5 stars. This data is from Medicare's Hospital Compare site.

(+) Listed as: St. Elizabeth Healthcare - Edgewood/Grant/Covington

(++) Listed as Norton Hospital, Norton Hospitals, or Norton Healthcare

(+++) Listed as Jewish Hospital, Jewish Hospital & St. Mary's Healthcare or Sts. Mary's & Elizabeth Hospital; Consumer Reports only lists Jewish Hospital. CMS combines the data from Jewish and St. Mary's Healthcare; The Leapfrog Group(sm) surveys the hospitals separately and reports a safety score for both Jewish and Sts. Mary's & Elizabeth Hospital.

Read more here: http://www.kentucky.com/opinion/op-ed/article54997560.html#storylink=cpy

Here are some highlights of Kavanagh's analysis:

• Baptist Health Louisville, Baptist Health Lexington, St. Elizabeth Medical Center and Frankfort Regional Hospital appear to be the top performers.
• St. Joseph Hospital East in Lexington has fallen from a C to an F on the Leapfrog score and is receiving a penalty for hospital-acquired conditions, along with a 2.42 percent penalty for readmission of patients for the same condition within 30 days, more than twice that of other regional institutions.
• University of Louisville Hospital scored a C on the Leapfrog survey, has a high rate of methicillin-resistant staphylococcus areus (MRSA) bloodstream infections and is doing poorly on patient surveys.

"Bloodstream infections are only the tip of the MRSA iceberg," Kavanagh writes. "Overall, Kentucky has the nation’s second-highest rate of MRSA bloodstream infections, with the University of Kentucky and the University of Louisville being worse than the national benchmark."

He notes that only one hospital, Baptist Health Louisville, was ranked as better than the national benchmark, but writes that the benchmark should not be the goal, going so far as to calling it a failing grade because it is set at an "unacceptably high pre-intervention rate."

Other findings included:

• Baptist Health Lexington, Baptist Health Louisville, St. Joseph Hospital, St. Joseph East and St. Joseph Hospital London were cited in a U.S. Department of Justice settlement for false billing of non-Medicare approved insertions of cardiac devices, although the U.S. attorney "stated the settlements were heavily based on evidence-based medicine."
• St. Joseph London was also involved in a $16.5 million settlement for unnecessary heart procedures in 2014 and one of its staff cardiologists is currently serving a 30-month federal prison sentence.
• Baptist Health Lexington, Baptist Health Louisville, Frankfort Regional and St. Elizabeth Medical Center have achieved the prestigious Magnet designation, given by the American Nurses Credentialing Center. The University of Kentucky lost this designation in 2011 and has applied to regain it.

And while the Joint Commission accredits hospitals, almost all receive its Gold Seal of Approval, he writes, noting that St. Joseph East scored low on several ranking systems but has a Gold Seal. "Not achieving this designation would be a sign of major problems," he writes.

"Substantial quality improvements are needed in our health-care system in Kentucky and nationwide," Kavanagh opines. "Until this takes place, one should preemptively study and evaluate treatment options. As the old saying goes, 'Let the buyer beware,' for in health care, there is little opportunity to return or redo the service."

Online database lets you check on your surgeon; some surgeons say methodology used in analysis of data isn't adequate

A new online database is available to help consumers choose a surgeon, but surgeons are pushing back and asking for a peer-reviewed study of the data.

The searchable database, "Surgeon Scorecard," was created by ProPublica, a nonprofit journalism organization, by using five years of Medicare records to calculate the death and complication rates for nearly 17,000 surgeons performing one of eight elective procedures including knee replacements, the data include knee replacements, hip replacements, cervical spinal fusion, two types of lumbar spinal fusions, gall bladder removal, prostate resection and prostate removal. The website says the scorecard was "guided by experts" and the data were adjusted for differences in patient health, age and hospital quality.

Click here to find data on Kentucky surgeons.

This analysis comes at a time when federal health officials are focusing more attention on these common surgeries, Laura Ungar reports for The Courier-Journal.

"This month, the U.S. Centers for Medicare and Medicaid Services announced a proposal to cut Medicare payments to hospitals with high rates of complications for hip or knee replacements," Ungar reports. "About a quarter of the 400,000 hip and knee replacements Medicare patients undergo each year will be affected by the proposed rule."

ProPublica's report comes with mixed reviews. Health and Human Services Secretary Sylvia M. Burwell told Ungar that this model would "reward providers and doctors for helping patients get and stay healthy."

Leah Binder, president and CEO of the Washington-based Leapfrog Group, a nonprofit organization that rates hospitals, told Ungar that she commended ProPublica for analyzing the data in a way that's useful for consumers. "Complication rates are a strong sign of a certain skill level," she said. "This information is housed by our government, and as taxpayers, we deserve to know how surgeons are doing."

Charles Mick, a spine surgeon in Massachusetts who advised on the project, told Nick Penzenstadler of USA Today that the project is "long overdue. Consider baseball, if you're a batter but never knew if you hit the pitch, how could know you know if you're getting better?" Mick argued that the "uncomfortable public exposure is a small price to pay for better patient care."

But surgeons have taken to the Internet with complaints about the report with editorial headlines like: "ProPublica's Surgeon Score Card: Clickbait? Or Serious Data?" written by Dr. Benjamin Davies for Forbes; "Why the Surgeon Scorecard is a journalistic low point for ProPublica" by Dr. Jeffry Parks on his medical blog; and an open letter titled "ProPublica's Surgeon Scorecard: Call for Peer Review" by Dr. Edward J. Schloss, to name a few.

These physicians argue that there are problems with the methodology, such as overly wide statistical confidence intervals for complication rates, questions about using readmission rates as a measure of complications, considering readmission as equal to death, and not using enough criteria to make these claims.

"ProPublica rightly has high expectations for surgeons and has courageously started a worthwhile process," Davies writes for Forbes. "What they have not done is given pause — or honest reflection — on the obvious harsh limitations of the data they have processed. Instead, we got a clickbait video and a parboiled dataset."

The price for health care could be right, if it's known

By Molly Burchett
Kentucky Health News

People often shop around and compare prices when making a large purchase, and some consumer advocates, employers and health plans are pushing for price transparency in health care so it's easier for consumers to compare prices. However, many questions remain about whether or not price transparency is possible, or if it would even affect health costs and outcomes.

Making it easier for consumers and patients to compare prices encourages them to look around for a better deal, says a study published in the Journal of the American Medical Association. The study focused on the use of Castlight Health's online pricing platform and explored whether there was a reduction in costs to employers and employees for laboratory tests, advanced imaging services and clinician office visits.

Lab tests and imaging saw the biggest savings in the study, dropping 14 percent and 13 percent, and primary care offices visits also dropped by 1 percent, according to the study. Additionally, the study showed that claim payments were lower for all services for employes who used Castlight versus those employees who did not.

But less expensive care doesn't always equal higher quality care. Price transparency’s impact is realized only to the extent that it empowers consumers and influences their behavior, and price is only one of the variables that consumers need to evaluate the value of health services.

"One thing the study can't answer is whether patients are making better decisions or just cheaper ones. They're finding lower-cost options, the study finds, but it doesn't tell us how patients are taking into account things like patient satisfaction, years of clinician experience and other provider characteristics," writes Jason Millman of The Washington Post.

Another important thing the study both can't and wasn't designed to predict is whether transparency will reduce overall health spending, writes Millman. Health-care economist Uwe Reinhardt writes, in a separate JAMA editorial, that early results of research suggest that price transparency in health care can result in less spending.

Other experts have expressed doubts about this "free market" approach. In a Huffington Post article, physician and systems theorist Deane Waldman says that price is not one of the pieces of information consumers need to re-install free market forces into health care because the present health-care market in the U.S. is not free.

"The consumer can have all the information in the world, but without control of his/her own money, and without sellers competing for those dollars, the market will not work. One cannot have the advantages of free market forces if the market is not free," writes Waldman.

Similarly, Reinhardt says that comparing the costs of procedures only works if people have a choice between healthcare providers. That may be a major complication for Kentuckians in rural areas where providers may be scarce or insurance coverage may not be comprehensive.

Massachusetts is the first state to mandate some level of price transparency. However, resistance from both provider and payer communities suggests that large-scale adoption of transparency initiatives will likely be both heavily debated and slow.

Kentuckians talk about health care on new video channel

Featuring stories of Kentuckians telling their stories about their experiences with the health care system, Kentucky Voices for Health has launched a video advocacy channel.

"The mission of Kentucky Voices for Health is to advocate for the needs of the Kentucky health care consumer," Executive Director Jodi Mitchell said. "That means our main priority is helping to ensure that all Kentuckians have access to the quality care they deserve. This new video advocacy effort will ensure that legislators, media and the public can always hear firsthand about the healthcare concerns facing our state."

KVH is a coalition of more than 250 health care organizations, individuals and advocates. The stories will initially focus on stories relating to the move to Medicaid managed care. For more information, click here.