Consumer-Driven Health Plans Fueled Spread of Medical Disinformation

I was moved when I listened to the recent podcast series from the NYTimes, We Were Three[i]. The story was horrifying, touching, and eye-opening at the same time as it revealed some truths about the harm that distrust in the medical system can cause, especially in the midst of a dangerous and deadly pandemic. And, to be honest, it resonated with me due to how it paralleled some issues I have had with close relatives who live in a distant state.

The story is told by the older sister who learns from her brother that her father has died of Covid. It isn’t until her younger brother, who lived with her father, also dies from Covid that she learns of the extent that distrust of doctors and hospitals led her family away from medical care and toward alternative remedies (although “quackery” is a more appropriate term in this case).

Much of the story is heartbreaking—and almost unbelievable, yet as someone who has written about medical disinformation for a long time, not much of the bizarre behavior reported in the story is new to me. Still, it is upsetting to hear how people can act so irrationally and cruelly when they are susceptible to disinformation spread by people who directly or indirectly benefit by purveying snake oil remedies to vulnerable people.

The eye-opening aspect to me was the genesis of the brother’s distrust of the healthcare system. He had dealt with some previous medical care that led to high bills that caused financial distress. So, he and his father, along with others in their community, had grown skeptical of the motives of doctors who led them to expensive treatments without any warning that the costs may not be fully covered by insurance and that just the amount of their co-pays could lead to severe financial problems.

It isn’t difficult to understand how conspiracy theories about the motives of mainstream medicine found fertile ground among populations that faced disastrous consequences from unaffordable medical bills. It only takes a “germ” of truth for conspiracy theories to grow once they are pollinated and spread by social media influencers, as well as community influencers from religious and social groups.

One of the seeds of truth that fed vaccine hesitancy, as described in the We Were Three podcast, was the fact that doctors and pharmacists receive payment for every vaccine they administer. Under normal conditions, I don’t think most people would object to such a reimbursement program, especially if they knew the reimbursement amount for administering a Covid19 vaccine (approximately $40[ii]). However, for people who had been burned previously by co-pays for drugs administered by doctors or hospitals (under the 340B program), it was easy for them to make the logical leap that doctors would steer patients toward treatments, even if not appropriate, if they profited from administering those treatments.

Shortly after listening to the podcast series, there was a Kaiser Health News/NPR Bill of the Month[iii] story about a man who was billed approximately $7,000 for in-office infusions when an alternative in pill form, which he ultimately chose and preferred, cost him $216.

Unintended Consequences

Consumer-driven health plans were envisioned as a means to give patients “skin in the game” in choosing medical treatments by including co-pays for visits and some treatments[iv]. Policymakers believed that healthcare costs were rising, in part, because consumers didn’t have any responsibility for paying for their treatments beyond their insurance premiums and therefore had no incentive to select a lower-cost treatment or test if insurance was going to pay the bill. The flaw in this assumption rests in the fact that consumers don’t know the price they will have to pay in advance and, for the most part, physicians and healthcare practices have rejected the notion that it’s their responsibility to help patients figure out the patient’s cost of treatment.

In the case of policies intended to influence consumer healthcare decisions, the devil is in the details. It may seem sensible to require patients to pay 20% or more for some treatments, but as the KHN story illustrates, requiring patients to pay 20% or more for in-hospital infusions can lead to bills of upwards of $7,000 and can have serious repercussions for the majority of US citizens who cannot afford an unexpected expense of $400.

When hospitals send unpaid bills to collection agencies, it can ruin a person’s future and almost certainly will lead to mistrust of the clinicians who recommended the treatment. Once that trust is breached, can we really be surprised that so many people doubt the intentions of medical professionals and look elsewhere for help?

It would take a much longer article to map out all the ways high and unpredictable medical bills have led to so much distrust in the traditional healthcare system. In this post, my objective is to suggest a link between non-transparent unaffordable medical costs, the rise of distrust in the healthcare system, and increased belief in untrustworthy sources of health information, including sources that espouse conspiracy theories about vaccines. With this link between costs and belief in conspiracy theories on your radar, I can almost guarantee that you’ll start noticing additional stories and news items about the spread of medical misinformation and disinformation that can be traced back to a previous encounter with our non-transparent and often unaffordable medical system.

It is important to acknowledge that there have been policy reforms that attempt to correct for the lack of price transparency (e.g., the Sunshine Act, the No Surprises Act, as well as some attention to the skewed incentives of the 340B program)[v]. Still, we have a long way to go before patients have sufficient pricing information, value information, and ability to choose providers to become smart shoppers.

To underscore my point above about the likelihood of noticing additional stories about the ill-effects of high medical fees and subsequent consumer medical debt, I highly recommend this recent episode of Dan Gorenstein’s Tradeoffs podcast: https://tradeoffs.org/2022/11/03/medical-debt/ ‘A Shocking Amount of Misery’: Medical Debt in America[vi]. Dan and his guests offer a succinct and convincing description of the state of medical debt in the US and how it drives so many away from our traditional healthcare system.

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[i] https://www.nytimes.com/2022/10/11/podcasts/we-were-three.html

[ii] https://www.cms.gov/medicare/covid-19/medicare-covid-19-vaccine-shot-payment

[iii] https://khn.org/news/article/bill-of-the-month-shot-prostate-cancer-drug-testosterone/

[iv] https://www.hfma.org/topics/hfm/2019/november/evolution-of-the-consumer-focus-in-healthcare.html

[v] E.g., https://www.commonwealthfund.org/publications/explainer/2022/sep/federal-340b-drug-pricing-program-what-it-is-why-its-facing-legal-challenges

https://communityoncology.org/featured/examining-hospital-price-transparency-drug-profits-and-the-340b-program-2022/

 [vi] Tradeoffs podcast: https://tradeoffs.org/2022/11/03/medical-debt/ ‘A Shocking Amount of Misery’: Medical Debt in America.