My heart ablation came with a bill. Then another. Then another—facility, anesthesiologist, cardiology, each on its own schedule, none of them adding up to anything I could follow. The total may have been hundreds of thousands of dollars. I still don’t actually know.
If a hotel did this, I’d never book there again. If a restaurant did this, I’d write a nasty review on Yelp (don’t tempt me). If an airline did this, I’d tell everyone I knew never to fly them again. In healthcare, I just… paid.
We’ve lowered our standards for healthcare further than for anything else we buy, and nobody’s healthier for it.
I think that’s going to change as more health brands compete for our business. And as they do, we should demand what we already expect from basically every other company we pay. Tell us what it costs. Make it easy to access care. Respect our time.
To get us going, I drafted us a Health Consumer’s Bill of Rights—ten amendments, written in the original style. And where there’s something you can do about it today, I’ve included it.
Amendment I: Treat us like humans
Healthcare shall make no law respecting an establishment of jargon, or prohibiting the free exercise of humor; or abridging the right of the people to be spoken to like humans, and to petition for a redress of grievances without a fax machine.
Reasonable follow-ups. A nice waiting room. Instructions a normal person can follow. Clear communication in a language you understand. And a little personality—Ro’s ads, CrowdHealth’s videos, and even General Medicine TJ Parker’s tweets prove healthcare can talk to us like adults, even make us laugh, without being any less serious about the care. We should expect clinics to compete on patient experience.
Exercise your right: Before booking, read the clinic’s Google reviews. They’re the closest thing to a source of truth on experience—and yes, it’s embarrassing how bad most are. Shop around.
Amendment II. Medical records
A well-organized Medical Record, being necessary to the health of a free Person, the right of the people to keep and bear their own Data, shall not be infringed.
Are my gut issues connected to my anxiety? Are these night sweats normal? What should I actually be doing at my age with my family history? These used to be questions you’d ask your doctor friends. Now millions are asking ChatGPT/Claude. Imagine how much easier it would be to engage with your health if you could actually see the full picture. Imagine all of this living in your own personal health OS, with all the context on your health to date, so it can flag adverse drug-drug reactions, share patterns across specialties, proactively suggest lab tests or scans your family history suggests are necessary, etc.
Exercise your right: Get your medical records in one place. Ask Muse/Instinct/Duet/whatever to pull records from your providers into one central, cloud-based place your LLMs can pull from. Before connecting anything, review its privacy policy, how it uses your data, and whether you can export or delete it. I plan to share a step-by-step on this in a future edition.
Amendment III. Know the price beforehand
No Charge shall, in time of health, be quartered in any household without the consent of the Owner, nor in time of emergency, but in a manner prescribed by the No Surprises Act.
It’s absurd for any consumer to accept, “We don’t really know what this will cost. We’ll bill you later.” I mean, imagine a restaurant sending the bill three weeks after dinner, and it’s different from your friend’s bill for the same pasta 😵💫. That literally happens in healthcare. Knowing the price doesn’t mean I’m hunting for the cheapest care, either. I just want to know what I’m buying—like looks around literally everything else I pay for.
It’s especially infuriating that the law currently mandates every hospital makes its pricing transparent… most still don’t comply! Come on, even Cheesecake Factory displays calories for all their dishes. If they can share their exorbitant (and oh-so-delicious) counts, so can healthcare.
Exercise your right: For anything non-urgent, ask for two estimates: 1) what you’ll owe using your insurance and 2) what you’d pay in cash. Sometimes the cash price wins 💸. The same goes for prescriptions; compare your insurance co-pay with pharmacy cash prices and services like GoodRx. There are also marketplaces for cash-pay services, including Sesame.
Amendment IV. Understand your bills
The right of the people to be secure in their persons, houses, and wallets, against unreasonable bills and collections, shall not be violated; and no Bill shall issue but upon an Explanation of Benefits, supported by an itemization, particularly describing the services rendered and the persons who rendered them.
Most of us have stared at an explanation of benefits that says, “This is not a bill,” and then gotten a bill 🙄. Seriously, what is the deal with that? Why is it “not a bill,” exactly? Why does an actual bill always follow? Why is our health insurance paying to send us extra mail, and can we have them cut that out and take the cost off our premiums?
What I wanted after my ablation was a Monarch-style dashboard that includes what you spent, what you owe, and where you stand on your deductible. I imagine this would help all stakeholders get paid more. Because when bills pile up and are hard to track, people just give up 🤷.
Exercise your right: Ask for an itemized bill and compare it with your explanation of benefits. If they don’t match, ask the provider to resolve the discrepancy before paying, and confirm the payment deadline. And if they deny coverage outright, appeal. One four-state study found nearly half (!) of coverage denials that reached an independent reviewer were overturned. That’s how wrong these can be 🫠. (One startup I’ve got a crush on that helps you manage this is called Sheer Health.)
Also, you can try calling your provider and push back on any bills. Ask whether they can put you on a no-cost, no-fee payment plan for large bills over a long period. (I was allowed to pay back one heart ablation bill over 48 months without any fee, which I think means I made money? 😆) You won’t know unless you ask.
Amendment V. Put your healthcare dollars to work
No person shall be deprived of life, liberty, or pre-tax dollars without due process of law; nor shall private health savings sit idle, without just compensation.
HSAs now hold almost $200B across 40–50M accounts, and more than half of it is invested. Since January, bronze and catastrophic marketplace plans count as HSA-eligible, plus HSA dollars can now cover direct primary care memberships. Companies like Truemed and Flex continue to expand what HSAs & FSAs can cover. Meanwhile, ICHRA lets some employers give people a healthcare budget to shop for their own insurance. I believe it’s time for a universal health wallet—or, at the very least, for health-related expenses to be treated differently from regular consumption.
Exercise your right: Take stock of the money options you already have. If you’re HSA-eligible, and your budget allows, consider maxing it. You can also pay qualified expenses out of pocket and save the receipts to reimburse yourself tax-free later—even years later—provided expenses are HSA-eligible. (Read my HSA special edition to catch up.) Also, check whether your employer contributes to an HSA—8% of tax returns in 2022 reported employer contributions. Don’t leave that money on the table!
Amendment VI. Speedy scheduling and coverage directories
In all medical matters, the patient shall enjoy the right to a speedy and convenient appointment, with an in-network clinician, which network shall have been previously ascertained by an accurate directory; and to be informed of the nature and cause of the diagnosis.
Scheduling care should be wayyyy easier. It should not require three phone calls, a voicemail, and a callback offering a slot 6 months out. Finding covered care shouldn’t be a scavenger hunt through a directory last updated when the Yellow Pages were still a thing. Soon, our AI agents will talk to clinicians’ AI agents. Until then, I’m ready for the Resy of healthcare (probably more doctors surfacing their data to LLMs, like ZocDoc recently did).
Amendment VII. Clinician performance
In all procedures where the value in controversy exceeds twenty dollars (so, all of them), the right to know a clinician’s volume, outcomes, and experience with patients like oneself shall be preserved.
Almost every e-commerce site has ratings we can see. Healthcare has, er, a bunch of sparsely populated doctor review sites and completely paid-for “best doctors” lists. It’s time to do better—and do it with nuance beyond “did they have good bedside manner.” I recently heard someone say: “You want the doctor who does the same thing a 1000X times, but shouldn’t doctors be incentivized to do rare things a few times too? Doesn’t that make them cooler, more innovative doctors?” I think there’s some truth to that. I want to know: How often do you perform this procedure? What are your outcomes? How much experience do you have with someone like me? I want to use that information to decide who to go to.
Amendment VIII. Wait times
Excessive waits shall not be required, nor excessive fees imposed, nor cruel and unusual hold music inflicted.
The average wait for new-patient appointments in big U.S. cities is now 31 days, up from 26 in 2022. A typical visit eats about two hours all in—travel, waiting, the clipboard—for maybeeee 20 minutes face-to-face with the doctor, if you’re lucky. Most industries we pay treat our time as the product. Healthcare treats it as free. It’s absurd, and it shouldn’t be this way.
Exercise your right: Before booking, ask whether the visit actually needs a room. Refills, follow-ups, and some “is this weird?” questions may not. You can also use a messaging portal (if your provider has one) or rely on your LLMs for answering some of those questions. And yes, you can also use telehealth solutions to shorten wait times on everything from Doctor’s Notes to neurologist appointments!
Amendment IX. It should just work
The enumeration herein of certain rights shall not be construed to deny or disparage the one beneath them all, retained by the people: that it should just work.
Look back at II, IV, and VI: in every one, the patient is the integrator—chasing records, reconciling bills, cross-checking directories. The companies that win will be the ones that do the assembly for us.
Amendment X. Incentives for long-term outcomes
The years not covered by the current plan, nor by the current employer, are reserved to the people—and someone shall be paid to care how they turn out.
Imo, employer-based health insurance is the original sin of the healthcare system. Because the median worker stays with their current employer for just 3.9 years, insurers aren’t incentivized to invest in preventing someone’s heart disease in year 7 if they’re gone in year 4. I’ve written about this before, but introducing 10-year catastrophic plans could change that because it suddenly makes financial sense to catch disease early and actually care about your long-term outcomes.
Lock-in is a real problem, so add an incentive like life insurance, which literally profits the longer you live. FWIW, John Hancock's Vitality program is the best example I’ve seen (which I also wrote about here). In any case, imagine a system that actually competes for positive health outcomes.
Bottom line: The original Bill of Rights took two years and three-quarters of the states to ratify. This one just requires you.
👭Send these bills to someone in the health space with influence and anyone influenced by their health. (Yes, basically send it to everyone you know 😀.)
📥 Email me at [email protected] with the amendment you’d add, and I may include it here.
🗳️Cast your vote to certify this bill of rights in the poll below.
Should we ratify The Health Consumer’s Bill of Rights?
👋 Who are you again? I’m Derek Flanzraich, and I’m in the business of healthyish. I founded two venture-backed startups–Greatist (👍) and Ness (👎)—and helped dozens of brands you know grow including Ro, GoodRx, Midi, BetterHelp, and LMNT. I now run Healthyish Content, plus a few other healthyish things (like Fixie Dust, launching this fall).
Every Thursday, I share what’s hot, what’s not, and what’s next in consumer health. (Disclosure: I invest in and advise companies in this space—when I cover one, I'll say so.) I sometimes add affiliate links, but they influence my picks zero. Have something to share? Hit reply, I respond to every email.