Taking control of health care costs: A conversation with Dr. Elisabeth Rosenthal

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Elisabeth Rosenthal was an emergency room doctor before becoming a New York Times health reporter, and both careers prepared her to write ‘An American Sickness: How Healthcare Became Big Business and How You Can Take It Back.’ (Photo courtesy of the author)


Dr. Elisabeth Rosenthal was an emergency room physician and health care reporter before writing New York Times bestseller “An American Sickness: How Healthcare Became Big Business and How You Can Take It Back.” She says health care prices have soared, accessing care is getting more complex, and choices of doctors and health care networks is getting narrower. 

This conversation has been edited for clarity and time. 

Q: People have talked about health care costs rising for a long time. What makes 2018 different than 2008 or 1998?

Well I think some really important issues have come up. First of all, we have more and more people on high deductible, high co-pay plans, so I think the advent of high deductible plans has made people feel their health care costs and be outraged by them. Also, think about the new AIDs drugs in the 1990s, which transformed AIDS overnight from a deadly illness to a chronic, controllable condition — cost $10,000 a year. Now there are just average, ordinary drugs that don’t work very well that cost three times that. So the level of price inflation has gotten so extreme. 

Q: You devote the second half of your book to solutions, including things patients can do. What’s one thing that people could do differently right away that might help them take control of their medical costs?

Get your doctor to send your lab test in-network. Get your doctor to send your x-rays to the cheaper providers. Look at the hospital bills. We know 50 to 80 percent of them contain errors. Do what you do with your restaurant bill.

Q: You’ve also described a lot of hidden costs related to hospital stays. Can you talk about that? 

This is a big ask for patients, but I think there are things you can do. For example, when you first go into a hospital you’re often asked to sign a pile of forms that says “I consent to pay for anything that my insurer doesn’t cover.” I tell everyone to add a clause there saying “so long it is in my insurance network.” I’ve had patients do it who have said that it’s helped them when they say to the hospital, “I’m not going to pay this bill, because I didn’t agree to pay for it.” This is a contract you’re signing, and you can protect yourself in this way.  

Q: I found it interesting what you had to say about the role doctors can play in cutting costs. What should doctors be doing differently?

They need to make price part of their thinking, part of their knowledge base. It’s not taught in medical schools. When I go speak in medical schools or to young doctors or residents, they all say “We want to know the prices. We want prices on order sheets.” Because they know it’s affecting patients. They’re very conscious of it. They’re just not given that information. Older doctors find it uncomfortable to talk price, but becuase of that discomfort they’re frequently in the position now where they’ll write a prescription for a cream or a pill and their patients will call and say, “Hey, doc, do you know that that now costs $1,000?” And they don’t know. So I think price is now making its way into doctors’ mindsets, but it’s an uncomfortable conversation. It doesn’t have to be. 

This conversation is the first in a series of interviews with authors and other experts who write about health care.