Monique Yohanan is a doctor and senior fellow for health policy at the nonprofit Independent Women.
Six weeks ago, my shoulder started hurting. I took it easy. I cut back on Pilates and stopped paddling out to surf. I’m a physician, so I followed the conservative playbook: gentle range of motion, avoiding heavy weights, taking ibuprofen and icing it. The pain got worse. Within two weeks, I could barely move my arm.
I checked for in-network options, since I have insurance. My primary care appointment would have taken a week. A quality physical therapist in my area, another two weeks. Scheduling an initial imaging study? Several more days. A referral to an orthopedic surgeon would have taken months. But because I knew the system, I also knew the likely end result: The insurance-guided recommendation for what ultimately was my diagnosis, frozen shoulder — a swelling around the shoulder joint that effectively glues it into place and makes it painful to move — would be nine to 12 months of conservative management because the condition usually resolves on its own.
My medical training gave me an advantage most patients don’t have. I knew the short list of likely diagnoses. I knew I didn’t have red-flag symptoms requiring emergency evaluation. That understanding saved me some worry, but it also revealed a deeper problem: Most patients have no way to judge what is urgent, what is routine and which delays are medically necessary and reflect best care (sometimes a stepwise approach is appropriate) versus administratively imposed. They are left navigating a system designed around opacity. This lack of transparency is a long-standing feature of how care is delivered and paid for.
But my medical knowledge only got me halfway there. The real acceleration came from something most patients simply don’t have: I could call in a favor. I reached out to a colleague — an experienced physical therapist — and the next day he examined me. Within minutes, he could tell my shoulder was beginning to freeze up and said I needed to see an orthopedic surgeon as soon as possible. That one courtesy collapsed what would have been weeks or months of waiting on the insurance system into a Monday phone call and a Wednesday appointment. That is not a system working well. It is a work-around available only to insiders.
When I called to schedule, the transparency continued: My colleague had told me that this doctor didn’t take insurance and let me know exactly what the visit would cost. There were no surprise fees, no prior authorizations, no guessing about what might or might not be covered. Paying out of pocket wasn’t my preference, but it was the only way to get timely care rather than wait months in pain for the condition to resolve. Most people don’t have that option.
The orthopedic visit showed what transparent medicine looks like. I knew the price before I walked in. In a single appointment, the surgeon performed a thoughtful exam, did an ultrasound, confirmed I didn’t have a rotator cuff tear and told me I had a frozen shoulder. Then he offered a treatment — a steroid injection. He described the risks and benefits. I agreed, and he performed the procedure immediately. Within minutes, my pain was cut in half.
The default insurance pathway offers endurance, not intervention — long stretches of conservative management with no clear timeline for improvement and no acknowledgment that earlier relief is possible. For millions of patients, it isn’t just that using insurance-covered care is the only affordable option; it’s that coverage rules determine which treatments are made available and whether relief is even offered. The existence of faster, evidence-supported options isn’t a secret; the system’s refusal to make them visible is. Then there is the financial side. Private-pay care has a clear price. The insured pathway has dozens of hidden ones: co-pays, percentages of total cost, imaging fees, facility charges, serial appointments, time off work and months of lost function. Transparent medicine shouldn’t depend on who you know.
Real transparency levels the field. The good news is that Congress is trying to make headway to deliver long overdue transparency to patients. The Patients Deserve Price Tags Act, introduced by Sens. John Hickenlooper (D-Colorado) and Roger Marshall (R-Kansas), doesn’t just force hospitals and insurers to reveal negotiated rates. It requires every part of the care chain — imaging centers, labs, outpatient facilities, surgical practices — to post real prices up front. Patients can then make rational decisions, and policymakers can finally see where the dysfunction lies. The bill has been introduced in the Senate but has not yet advanced to a floor vote.
The Marshall-Hickenlooper Act won’t fix everything overnight, but it makes the pathway visible. A health care system that works for everyone — not just insiders — starts with price transparency.
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