Health Care's Endless Loops

Last week the Federal Trade Commission (FTC) issued its final “click-to-cancel” rule, making it easier for consumers to cancel various kinds of subscriptions, such as gym memberships or streaming services. It will require enrollments to be as easy to cancel as they were to enroll.

Gym membership cancellations aren't the only "endless loop. Credit: FTC

“Too often, businesses make people jump through endless hoops just to cancel a subscription,” said Commission Chair Lina M. Khan. “The FTC’s rule will end these tricks and traps, saving Americans time and money. Nobody should be stuck paying for a service they no longer want.”

Oh, boy, Chairperson Khan: if you want to talk about jumping through endless loops, let’s talk about health care.

The FTC rule was part of its effort to modernize its 1973 Negative Option Rule. It had issued a preliminary rule in March 2023, which drew some 16,000 comments. Laura Brett, vice president of the National Advertising Division of BBB National Programs, explained the need for the rule to CNN: “(Consumers) had to jump through hoops online to find out where to cancel. Other times they might’ve been able to sign up online, but in order to cancel they had to call and talk to a representative. Other kinds of memberships required them to actually show up in person to cancel their subscription,”

Credit: FTC

The new rule is also part of a broader Biden Administration Time Is Money initiative, “a new governmentwide effort to crack down on all the ways that corporations—through excessive paperwork, hold times, and general aggravation—add unnecessary headaches and hassles to people’s days and degrade their quality of life.”

Predictably, not everyone agrees. The U.S. Chamber of Commerce called the whole Time is Money initiative a heavy-handed effort to micromanage business practices and pricing, and warned it would lead to “fewer choices, higher prices, and more headaches.”

But of course they do; I mean, if you asked an AI to create a Chamber of Commerce response to virtually any regulation, it would probably sound much like that.

Critics see politics behind the rule. In her dissent, Melissa Holyoak, one of the FTC’s two Republican commissioners, wrote: “Why the rush? There is a simple explanation. Less than a month from election day, the Chair is hurrying to finish a rule that follows through on a campaign pledge made by the Chair’s favored presidential candidate.” The same could be said of the Biden Administration’s new proposed rules to make over-the-counter birth control to be covered by insurers at no cost to patients.

Be that as it may, we all have more subscriptions than we probably really want, the gym membership scam has been going on so long that there was a Friends episode about it almost 30 years ago, and who among us hasn’t gotten caught in endless loops with supposed customer service representatives – if you can ever reach a live person – about some problem with a company?

Which leads me to health care.

Providing health care has always been complex, as physicians like to remind us, but just trying to receive health care has grown more and more complex over the past several decades (while growing drastically more expensive). Time is Money, the Biden Administration tells us, but in health care, the only people whose time is valued are the people billing us. We are, after all, patients, so we are supposed to be patient.

The FTC, and the Biden Administration more generally, has this right: Time is Money, and that’s our time and our money. The initiative specifically included healthcare – “…the unnecessary complications of dealing with health insurance companies…” – but I don’t think that goes far enough, fast enough.

We've all been there. Credit: Bing Image Creator

I like the precept that things should be as easy to get out of as they were to get into, although I want to use that more as a parameter than a restriction in expanding the discussion to healthcare.

For example, many of us have been complaining for years about lack of health information interoperability. Despite valiant efforts to bring it about, we all fill out too many of the same forms, asking for the same information, in too many different medical offices, and too many of us find that crucial parts of our health information do not make their way to subsequent health care practitioners, unless we make it happen. E.g., ever have to photocopy a medical record or obtain a CD of imaging results so that a new physician can see them?  You shouldn’t have to.

It should be easy – or, at the very least, easier.

Other examples, in no particular order:

• It should be harder for health care organizations to send patients to collections (or to sue them) than it would be to meet with them in person to try to negotiate a settlement.
• Claim denials should be as easy to appeal as the claim was easy to deny.
• Preauthorizations should be as easy to obtain as they are to deny.
• It shouldn’t be any easier to disenroll insurance members as it is to enroll them (I’m thinking of you, Medicaid disenrollments!).
• It should be as easy for patients to find new in-network providers as it is for their existing provider to become out-of-network.  
• It should be as easy for a patient’s appointment to start on time as it was to make the appointment. And late or cancelled appointments should result in financial considerations to the patient.
• It should be as easy for patients to find information on physicians’ actual expertise/experience as it is for them to find their marketing promises.
• It should be as easy for patients to obtain second opinions/referrals as it would be to make appointments with their current physicians.

I’m sure many of you have your own ideas/suggestions – feel free to note them in the comments below, or as responses to posts about this on Twitter or LinkedIn.

------------

I admit that I don’t think that subscription cancellations is one of the more important things the FTC could be working on, or that the above suggestions are the top things they should focus on in health care. I’d rather, for example, that they expand their work on assuring health care competition or the role of private equity in health care.

Still, our time is money, and sometimes that time is our health too, so anything they can do to help reduce the endless loops, in healthcare and elsewhere, I’m all for.