Healthcare Pricing Transparency: An Ethical Debate

Graphic by Nancy Chen

Healthcare pricing has long been a subject of confusion and frustration for Americans. Despite being one of the most significant financial burdens on families, healthcare pricing remains notoriously obscure, leaving consumers at a disadvantage when it comes to understanding and navigating costs. In an effort to address this issue, President Donald Trump issued an executive order on February 25, 2025 mandating that hospitals and insurance companies disclose more detailed pricing information to patients; this executive order represents progress towards a more transparent and patient-friendly system. However, it has sparked debate about its effectiveness in lowering healthcare costs and empowering patients.

The hidden nature of pricing contributes directly to the financial anxiety many Americans experience. Health insurance companies, hospitals, and physicians traditionally negotiate rates behind closed doors, making it nearly impossible for patients to compare prices and make informed decisions about their care. Nearly 20% of American patients undergoing in-network elective surgery or giving birth report receiving surprise bills. [1] This lack of transparency has led to significant financial strain for many individuals, especially when faced with unexpected medical bills for services they did not anticipate or understand the cost of in advance. According to KFF polling, approximately half of U.S. adults claim it is challenging to afford health care costs. Additionally, one in four report that they or a family member in their household have faced difficulties paying for health care in the past 12 months. [2]

President Trump’s executive order, “Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information,” seeks to prioritize patients by providing them with more meaningful and accessible price information. It requires hospitals and health plans to maintain consumer-friendly displays of pricing details, including negotiated rates with providers, out-of-network payments, and the actual prices paid by them or their pharmacy benefit managers for prescription drugs. [3]

Price transparency is a cornerstone of patient welfare and health equity. By knowing the accurate costs of their treatment, patients gain the ability to make informed decisions about their healthcare while considering their financial circumstances. This transparency fosters competition among providers, driving down costs and benefiting consumers who might otherwise face limited or costly options. Additionally, clear pricing information helps reduce the occurrence of surprise medical bills, enabling patients to anticipate expenses and avoid unexpected charges. Greater transparency also holds hospitals and insurance companies accountable for their pricing practices, promoting fairness and equity across the healthcare system.

A significant concern regarding transparency in healthcare is its potential to reduce competition. Public disclosure of pricing information might lead hospitals to engage in price collusion, aligning rates with each other rather than competing to lower costs. This issue has been observed in Denmark, where concrete price postings resulted in unintended negative outcomes. [4] Such practices could undermine the competition that transparency advocates aim to promote, ultimately inflating costs for consumers.

Another ethical concern is the risk of prioritizing price transparency over more critical healthcare reforms. While transparency may address certain financial aspects, it fails to tackle deeper systemic challenges, such as improving access to care, expanding insurance coverage, or enhancing the overall efficiency of the healthcare system.

While increasing transparency holds great promise by empowering patients, fostering competition, and mitigating surprise medical bills, it also comes with ethical concerns, such as the risk of price collusion and overshadowing more urgent systemic reforms. Transparency is undeniably a vital component of healthcare reform; however, it is only one piece of the puzzle. Achieving a truly affordable and equitable healthcare system will require a multifaceted approach that addresses the deeper, structural challenges faced by all Americans.

Reviewed by Abby Winslow

Resources

[1] Lopes, L., Montero, A., Presiado, M., & Hamel, L. (2024, March 1). Americans’ Challenges with Health Care Costs. Kaiser Family Foundation. https://www.kff.org/health-costs/issue-brief/americans-challenges-with-health-care-costs/

[2] Pollack, H. A. (2022). Necessity for and Limitations of Price Transparency in American Health Care. AMA Journal of Ethics, 24(11), E1069-1074. https://doi.org/10.1001/amajethics.2022.1069 

[3] The White House. (2025b, February 25). Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information. The White House. https://www.whitehouse.gov/presidential-actions/2025/02/making-america-healthy-again-by-empowering-patients-with-clear-accurate-and-actionable-healthcare-pricing-information/ 

[4] Albaek, S., Mollgaard, P., & Overgaard, P. B. (1997). Government-Assisted Oligopoly Coordination? A Concrete Case. Journal of Industrial Economics, 45(4), 429–443. https://doi.org/10.1111/1467-6451.00057 

A Changing Scene for the CDC: Regulation that Shapes Public Health Transparency

Graphic by Jackie No

Changing policies on regulation and communication for independent healthcare organizations may have serious implications for the public health sector, as the Center for Disease Control and Prevention (CDC), who are at the forefront of a rapidly changing healthcare industry. Communication with the public and data availability are recent developments that have brought public health concerns and controversies in the public eye.

On February 18, 2025, the White House issued The Ensuring Accountability for All Agencies Executive Order, which mandates that independent regulatory agencies must submit major regulatory actions for federal approval before public release [1]. The communication and dissemination of phases of public health policy are crucial to informing the public of growing health concerns and successful community health efforts [2]. For example, during a healthcare crisis such as an outbreak of a disease, the CDC works to develop mitigation efforts and prevention strategies in order to minimize transmission [3]. With the new executive order, the process of relaying information to the public regarding these efforts is severely delayed because the CDC must get federal approval before communicating with the public about infection control strategies. without the crucial information about how to prevent transmission during an outbreak of other public health concerns, the public is unable to protect themselves in advance. This can lead to a more severe outbreak than if the public had earlier access to information about how to prevent transmission, which places the well-being and lives of the public in jeopardy.

The work of the CDC is also being impacted by the organized effort to purge the Department of Health and Human Services of datasets and webpages with specific terms. Approximately 8,000 CDC datasets and webpages with terms such as “gender ideology”, “reproductive rights”, and “diversity, equity, and inclusion” have been taken down. Other data sets with information about vaccines, veterans’ health, and adolescent health have also been removed]. Several public health officials believe that this effort to remove data from the CDC harms public health by “eliminating access to crucial health information used by clinicians and patients” [4]. This closure of CDC information presents an issue of health equity because these data sets support our understanding of population health. For example, webpages for the CDC’s Division of Adolescent and School Health are no longer available [5]. This includes the Youth Risk Behavior Surveillance System, which is used to measure physical activity, tobacco/drug use, and other behaviors of adolescents. Without such data, it is difficult to understand adolescent health and design prevention measures to support the health of the population.

We have historically relied on evidence-based decision-making in order to support the health of our nation, and efforts to prioritize transparency in data and communication from the CDC must be the focus of future policy interventions. Amidst a changing public health sector, the CDC remains foundational to the ideals of its mission: to protect America from health, safety, and security threats. 

Reviewed by Sanjana Anand

References

[1] “Ensuring Accountability for All Agencies.” The White House, The United States Government, 19 Feb. 2025, www.whitehouse.gov/presidential-actions/2025/02/ensuring-accountability-for-all-agencies/.

[2] “Phase 6: Communication and Dissemination.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, www.cdc.gov/disability-and-health-partners/php/healthy-communities/phase-6-communication-and-dissemination.html. Accessed 21 Mar. 2025.

[3] “Fundamental Elements Needed to Prevent Transmission of Infectious Agents in Healthcare Settings.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, www.cdc.gov/infection-control/hcp/isolation-precautions/prevention.html. Accessed 21 Mar. 2025. 

[4] Feldscher, Karen. “As Health Data Disappear from Government Websites, Experts Push Back.” Harvard T.H. Chan School of Public Health, 5 Feb. 2025, hsph.harvard.edu/news/as-health-data-disappear-from-government-websites-experts-push-back/.

[5] Stone, Will, and Selena Simmons-Duffin. “Trump Administration Purges Websites across Federal Health Agencies.” NPR, NPR, 31 Jan. 2025, www.npr.org/sections/shots-health-news/2025/01/31/nx-s1-5282274/trump-administration-purges-health-websites.

Legal and Ethical Implications of HHS Investigation of DEI in Healthcare

Graphic by Alej Gonzalez-Acosta

Diversity, Equity, and Inclusion (DEI) have become central to the conversation of improving medical education and healthcare. Medical schools and healthcare institutions have adopted DEI initiatives to address racial and socioeconomic disparities, aiming to create a more representative workforce. However, these programs have sparked many controversies and the current presidential administration has taken a hard stance against these policies, arguing that they prioritize identity over merit and lead to discrimination. This tension embodies a core question: Is DEI an essential tool for equitable healthcare, or does it amount to unfair discrimination?

On March 7, 2025, the U.S. Department of Health and Human Services (HHS) announced that its Office for Civil Rights (OCR) had initiated four investigations into medical schools and hospitals over allegations that their “medical education, training, or scholarship programs for current or prospective workforce members discriminate on the basis of race, color, national origin, or sex”. [1]  This comes as a response to President Trump’s Executive Order “Ending Illegal Discrimination and Restoring Merit-Based Opportunity”, which aims to end illegal preferences and discrimination, ordering agencies to “enforce our longstanding civil-rights laws and to combat illegal private-sector DEI preferences, mandates, policies, programs, and activities”. [2] 

Proponents for DEI initiatives in healthcare believe it is vital to “address the long-standing and well-documented inequities in our healthcare system”. [3] Diversity in healthcare workers can target the vast racial disparities in health outcomes in the U.S., particularly for Black people. According to a 2023 study published by the JAMA Network, a higher proportion of Black primary care doctors is associated with longer life expectancy and lower mortality rates among Black people. [4] DEI initiatives can help combat implicit biases in healthcare by ensuring that medical students receive training on the unique health challenges faced by different communities. Supporters of DEI argue that these policies do not constitute discrimination but rather correct historical inequities. Therefore, DEI aligns with the medical ethics principles of justice and beneficence, requiring that all individuals have equal opportunities to access and succeed in medical education and work in the best interest of diverse patient populations effectively. Without DEI, medical institutions risk perpetuating a cycle of inequality that leaves underserved communities at a disadvantage.

Critics of DEI in medical education raise ethical concerns about fairness. They argue that DEI policies may lead to reverse discrimination, where qualified candidates from non-minority backgrounds are disadvantaged in admissions and hiring. As evidenced by the recent HHS investigation, critics argue that DEI policies violate the Civil Rights Act, which prohibits racial discrimination in federally funded institutions. Jay Greene, a senior research fellow at the Heritage Foundation, claims that seeing physicians of the same race or increasing the number of doctors from any particular racial group does not improve health outcomes. [5] There are also concerns that DEI efforts could unintentionally lower academic and professional standards. Some worry that medical schools might accept students with lower qualifications, potentially impacting the quality of medical training and patient care, thereby violating the medical ethical principles of justice and beneficence by promoting unqualified students and workers. 

The ethical debate over DEI in healthcare is unlikely to be resolved soon, especially as legal and political battles continue. While DEI advocates see it as a moral imperative to correct systemic inequalities, critics warn against policies that could create new forms of discrimination. The challenge lies in finding a balance between promoting diversity and maintaining fairness in medical education and healthcare.

Reviewed by Anna Chen

Resources

 [1] Department of Health and Human Services. (2025, March 7). HHS’ Civil Rights Office Investigates Alleged Discrimination in Health Care Workforce and Training to Restore Merit-Based Opportunity. HHS.gov. https://www.hhs.gov/about/news/2025/03/07/hhs-civil-rights-office-investigates-alleged-discrimination-health-care-workforce-training-restore-merit-based-opportunity.html 

[2] The White House. (2025, January 21). Ending Illegal Discrimination And Restoring Merit-Based Opportunity – The White House. The White House. https://www.whitehouse.gov/presidential-actions/2025/01/ending-illegal-discrimination-and-restoring-merit-based-opportunity/ 

[3] American Medication Association. (2024, March 26). Statement on improving health through DEI. American Medical Association. https://www.ama-assn.org/press-center/press-releases/statement-improving-health-through-dei  

[4] Snyder, J. E., Upton, R. D., Hassett, T. C., Lee, H., Nouri, Z., & Dill, M. (2023). Black Representation in the Primary Care Physician Workforce and Its Association With Population Life Expectancy and Mortality Rates in the US. JAMA Network Open, 6(4), e236687. https://doi.org/10.1001/jamanetworkopen.2023.6687 

[5] Greene, J., & Kingsbury, I. (2023, December 20). Racial Concordance in Medicine: The Return of Segregation . Do No Harm. https://donoharmmedicine.org/research/2023/racial-concordance-in-medicine-the-return-of-segregation/