He asked his wife to call a hospital and find out how much a normal birth costs.
"She just couldn't weasel it out of them," said Reinhardt, who works at Princeton University and this year chaired a high-profile commission that evaluated the financial health of New Jersey's hospitals.
So Reinhardt tried himself. He was able to extract a number from a supervisor, but only after he had explained rather haughtily who he was.
In health-policy circles, there has been a lot of talk in recent years about "consumer-directed health care" and "price transparency," fancy ways of saying Americans might spend a few gazillion less dollars on health care if they could figure out, in advance, how much things cost and had a reason to care. With the number of people with high-deductible insurance plans or no insurance growing, more people have a reason to care.
The Bush administration has strongly endorsed the idea that information about prices will drive Americans toward more cost-effective care. Barack Obama and John McCain are calling for greater price transparency.
Reinhardt agrees that is not too much to ask. "We know what a Chevy costs. We know what a haircut costs," he said.
"It's just simply bizarre. . . . I don't have to hang forever on the phone to get the price of an iPod."
For all the talk, though, many nascent attempts to help consumers compare prices are deeply flawed. "A lot of the price information that's available from public sources is essentially useless," said Paul Ginsburg, president of the Center for Studying Health System Change.
Reinhardt's experiment helps explain why.
The quest for information
Should you attempt to do this experiment on your own, as an Inquirer reporter did with eight hospitals in the region, prepare to hear a lot of canned music and automated voices. And prepare to enter a world so Byzantine that a top Medicare administrator pronounced it impossible for a "human being of average intelligence and limited patience" to understand. The reporter, who is, at least, patient, persisted and will spare you the most painful parts of the odyssey.
When asked anonymously for their prices for either a colonoscopy or an uncomplicated vaginal birth, half the hospitals did what Reinhardt would have expected: nothing. Two - Hahnemann University and Cooper University hospitals - did not return phone messages. After several transfers, Albert Einstein Medical Center eventually sent two separate calls to a voice-mail account that was not working. Abington Memorial Hospital refused to discuss the price of a birth without detailed financial information about the caller's income, a move an official later said was meant to avoid scaring poor, uninsured people away.
But it was the four hospitals that did provide prices - Pennsylvania, Bryn Mawr, Temple University and Virtua West Jersey - that really opened Pandora's box. Their answers shed the most light on how absurdly complicated unearthing cost figures is and how challenging it will be to bring true price competition to health care. They also raise questions about how to treat the uninsured fairly.
The quoted prices for a colonoscopy ranged from $900 to $8,000. Pennsylvania, the only hospital that would price a delivery for the anonymous caller, said it would cost $8,500.
Most callers would not know this, but hospitals typically get less than $600 for a colonoscopy and about $1,300 for a delivery for Medicare patients. Private insurers usually pay a little more than Medicare.
It turns out that, with the exception of Temple, the prices given by the hospitals' billing employees - who were quite helpful and courteous - were what hospitals call "charges." These are nothing like what the grocery store charges you for milk. They are more like the sticker price on a car - if it was two, three or even four times what anyone was actually expected to pay.
In addition, the hospitals could only talk about their bills. So, they pointed out, there might also be bills from a variety of doctors. One - Virtua - it might offer discounts.
This might be a good place to step back, take a deep breath and focus.
Different insurers, different prices
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