The scariest question in American medicine 👀

Last week I promised you a question scarier than almost any diagnosis. Four words long. The one you've dreaded in a waiting room. Here it is:

You're in the cold, sterile exam room. The long, nerve-wracking visit went perfectly fine. Then comes the part that actually keeps you up at night… the bill. You won't see it for weeks. When it lands, it'll be a number you never agreed to, wrapped in a word — "covered" — that has caused more anxiety than most diagnoses.

You just purchased a service without ever seeing the price.

Imagine ordering a coffee without knowing what it costs, or walking into a restaurant and only learning the fare three weeks after dinner. In any other industry, we'd call that absurd. In healthcare, we call it Tuesday afternoon.

So let me start with the most underrated act of care there is: just telling people the price.

Did you know that in Direct Primary Care this is the default?

You scroll their website at 11pm. There it is. A blood panel: a real number. No 'starting at.' No asterisk. You read it twice because you're not used to being trusted with it.

A flat monthly membership. Visits included. Common labs printed right there — often a fraction of what they'd "cost" elsewhere. No surprise envelope three weeks later.

It sounds too simple to count as innovation. But notice what it tells a patient:

The rest of American life sprinted toward the price tag.

Every coffee comes with a tip screen, every ride with an upfront fare, every checkout with a number you approve before you pay. Healthcare ran the other way.

We needed an act of Congress to ban the surprise bill, and a federal rule just to make hospitals publish prices at all.

We passed actual laws to make doctors show you a price. Sit with that.

In 2021, the federal government ordered hospitals to post their prices. Five years later, a KFF Health News investigation co-published with NPR found the data mostly buried in spreadsheets full of billing codes nobody understands — used almost entirely by health systems and insurers as "fodder for negotiations," not by patients making decisions.

"There's no evidence that patients use this information," said Zack Cooper, health economist at Yale University.

Nothing revolutionary here. Just letting people know what they're paying for.

While the federal government was still fighting hospitals to publish prices, a nurse-practitioner-led clinic in Cedar Park, Texas — Impact Family Wellness — was busy doing the opposite: telling people, out loud, what a test costs.

A complete blood count, self-pay: $15 to $40. A thyroid check: $30 to $70. Cash price, no insurance, no guessing.

The same tests can run $200 to $500 in a hospital or insurance-billed setting — depending on the plan, the day, and how the billing code was entered. Their words, not ours: "patients without insurance are often billed the highest rates."

No law required them to say any of that. It was a decision made by people who believe patients deserve to know the price before the test — not three weeks after.

The DPC clinic down the street didn't wait for Washington to figure it out.

📉 Fewer than 1% of patients ever used a price transparency tool before getting care, Yale researchers found. Not 1 in 10. Fewer than 1 in 100. We built the whole "let patients shop" theory on a behavior almost nobody has.

🧭 And the ones who could shop, didn't. A Yale and Harvard study found the typical patient drives past six lower-priced MRI providers on the way to their scan — paying 27% higher co-pays — because they go where their doctor sends them. Turns out a price list only helps if care worked like shopping. It doesn't. It works like trust.

If you run a clinic and you've ever hesitated to post your prices publicly — try it.

Watch what it does to the room. The patients who find you because of that number aren't shopping for cheap care. They're looking for someone they can trust.

That's a different kind of patient. And a different kind of practice.

👉 Forward this to someone who's still afraid to open a medical envelope.