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Wednesday, August 24, 2011

Fair Care: Alex Fair's Jacket

I worked at Barstons Child’s Play, a toy store in Washington, DC for 12 years.  My late husband Fred worked there for a year and a half.  We had very different jobs in the store.  I helped a lot of customers and Fred priced a lot of products.  He was amazingly fast with a pricing gun.  I was so proud of Fred, and he rarely made a mistake that beginners often made.  He never priced the product on the back.  Steven, the store manager, was very clear about his pricing expectations.  The price should be crisp and clear and on the front of the package.  Customers should never have a doubt about what was the price of a product. 

This upfront pricing was so helpful.  It helped the customers browse the store free of worry.  I can’t tell you how many times I have seen concerned tourists pass by local restaurants in DC when the menu items are listed without prices.  The couples walk by those eateries and the old quote often attributed to J.P. Morgan seems to apply, “If you have to ask how much it costs, you can’t afford it.”

I am very glad we worked for many years at a store with clear and transparent pricing.  Occasionally, folks would come by with circulars from discount stores showing us deeply discounted prices on certain items that were loss leaders, but we supported a pricing structure that was reasonable and based on margin with excellent and knowledgeable customer service.

I was very disturbed by this lack of transparency when I began to delve into the world of medicine.  I also was dismayed by the different pricing structures based on insurance payments or lack of insurance.  For many years I was insured at my place of work, but we could not afford a policy for the entire family.  So, we paid out of pocket for every pediatric visit and every ER visit.  We would pay 100% of the bill for each appointment.  Pediatric sick visits would cost $125.00, check-ups with immunization would run close to $400.00 and an ER trip would be well over $1,000.  But as we would not know these prices until after we got the bill, each encounter was filled with the nervous worry: “How much will this cost us?”

When our entire family was insured with Fred’s job at American University, I began comparing the old rates we paid compared to the new ones with insurance.  Insurance paid at only 80% and the rest was written off.  As an uninsured family we had always paid 100% of the bill.  How is that possible?

I was further dismayed, in the spring of 2010 after hearing a presentation by a FICO group about fraud management.  They explained what a great service they were to insurance companies as they would track a hospital or physician practice for fraudulent coding that resulted in higher reimbursement then required.  This tracking could help insurers recoup funds or at least stop fraud.  I questioned the speakers, “Who is watching out for fraud against the uninsured or underinsured patient who is often paying at 100%.”  They looked at me quizzically first saying, “No one. Or if anyone was checking I would I guess it would be the DEA?”

I wondered who is out there representing consumers?  Who is demanding pricing transparency in Medicine?  Which practitioners are giving great service at good prices?  How do I even find out what prices are reasonable?  Then I met Alex Fair. 

This is Fair Care: Alex Fair’s Jacket.
Fair Care: Alex Fair's Jacket
I met Alex at Health 2.0 Goes to Washington in 2010.  He walked purposely through the room.  Alex bristled with anger at a system so stacked against consumers so he designed  It is an online resource that helps patients compare service options; they can negotiate and see which providers want to be part of a process of true transparency and access.  Alex created this vital service after trying to get pediatric wellness checks for his children, and finding out he was charged five times the price that he had been charged while insured.

Alex’s jacket depicts much of the anguish the uninsured, under-insured and those with a high-deductable plan feel while trying to get services.  I am sure you have heard of the phrase drowning in debt, but it most applies to those who have lost everything in an attempt to get medical care.  When I testified in March of 2010 about the great need for reform in our medical system, I met a very sick people who had sold all they had in an attempt to pay for medical care.  One of the saddest examples was a family in which both parents were sick and so was one of their children.  The father spoke to us from his wheel chair as he described selling their home and most of their possessions in an attempt first to pay for care and then to qualify for Medicaid.  The family was uprooted and had to move into a basement of a relative just to survive. 

So within this painting a hand reaches out of the depths and clutched within his fingers are a few bills.  These bills are burning.  I have seen many pictures of money “burning” or “going down the drain.”  But those bills are usually $10’s, $20’s and $100 dollar bills.  This hand clasps a few ones and a five.  This is all he has and it is being destroyed.  When you live on the edge every dollar is so important.  Many times in my adult life money was so tight, that the only money left for groceries was contained within the spare change box on my kitchen counter.  I would sit at the table creating rolls of coins to pay for milk and bread, as Fred’s shoulders would slump in defeat at our economic status. 
Burning Money
This is the reality of many of us in this nation.  Every dollar is important and 73 cents can be the straw that broke the camel’s back.

Upon this hand, a couple of figures climb.  Half in and out of the water a women tries to gain purchase.  Her hospital gown is falling off and her face is distraught.  Her husband grasps her arm.  He is naked, having literally  “lost the shirt off his back” in the pursuit of her care.
Drowning in Debt
A doctor grasps the husband’s arm as he mounts the pinnacle of the hand place a battle pennant of FairCare.  Holding the flagstaff is a small girl.  She is our hope for the future.  Her face is lit with a small smile of joy.  She represents a future in which price structure is transparent, services are accessible, doctors are not hampered by excessive office paperwork and we all benefit by being healthier and unafraid to schedule appointments.
Fair Care
And that is FAIR.  

1 comment:

  1. Wow Regina! Thanks for listening and retelling our story and what we are doing, on "canvas" and in words. I bristle less with the anger now that the site works for thousands of Americans. People every day are saving up to 75% on needed or wanted medical and dental services and the needle is starting to move. Physicians, Dentists, Chiropractors, Surgical Centers, Hospital Systems, National Laboratories, Radiology Centers, Diagnostics, and pharmaceutical suppliers are signing themselves up and going direct, listing prices and being fair.

    Check it out at

    Is the cure for all healthcare? No, but it certainly is improving affordability and access for everyone.

    Thank you Regina for including us in your Gallery. We are honored.

    I too remember that long walk when we met. Your story hit me hard and made me know we were doing the right thing. We have just launched the site that morning and didn't know how people would react. Your enthusiasm was important in those early days, as it is now.

    So many people go far too long, not being in charge of their care, being given the run around like you were. If they were the ones in charge, starting with arranging for the services they wanted and the fees they would pay, how much better would the resultant care be? Without tying payment to accountability to the person getting the services, there is a disconnect, handicapping the natural partnership between care givers and care getters. When we pay ourselves, we tend to make sure we get what we paid for.

    Care is not a free gift, but a contracted service that, in truth, does not need to cost anyone the "charges" that services are set at in most cases. On FairCareMD people are asking for and getting up to 75% off list prices. This changes the dynamic and gives people a greater feeling of control, not taking "no" for an answer. Instead of being answerable to an insurance company that rewards doctors for not overspending on their services, doctors on FairCareMD are rewarded for giving great service to patients. Great FairCareMDs (and DDSs, DOs, DCs, PAs, Psy.D.s, Ph.D.s, RNs, LMSWs,...) are rewarded with referrals and reviews that make them proud and happy to be doctors again as opposed to hamsters on the insurance company's wheels. Paying fair fees directly is a win-win for doctors and patients.

    Regina has led us all in this respect and is an inspirational example for everyone, as well as a great friend of FairCareMD!

    Once again, thank you! I will wear my jacket proudly.

    Best Regards,
    Alex Fair
    Founder & CEO, FairCareMD