| In any transaction, the fine print matters. That's especially true in health care, where long, impenetrable contracts govern how trillions of dollars get spent. I can sense your eyes glazing over, but stick with me for a minute. These contracts determine how much employers and families pay for health care, and what they get for that money. Your employer has a deal with an insurance company for a medical plan. That insurer has its own contracts with hospitals, doctors and labs. Your company may also use a broker (through another contract) to select the health plan. Yet another contract governs prescription drug benefits. Typically the companies selling the services have standard contracts that the buyer signs, with few if any modifications, especially for small employers. In other words, you're playing by their rules. That can lead to lopsided agreements. For example, employers hire pharmacy benefit managers to help negotiate better prices with drug companies. But I've seen contracts that explicitly say the PBM can profit by taking money from the drug companies it's supposed to be bargaining with. I've also seen contracts that say health insurance companies can pay hospitals more than the amount that the hospital bills in certain cases. Some contracts attempt to keep employers from getting data on how their health plan money is being spent, even though restrictions like that are now supposed to be barred by law. But there's an effort to change these practices. Some people — deep in the wonky details of health benefits — are trying to even the playing field. The first step: publish contracts more favorable to those purchasing health care. The 32BJ Health Fund, which provides benefits to more than 200,000 building service union members and their families, published a template contract this month that it said would help "establish more fair and favorable terms" with insurance providers. "If the contract starts with you, you hold more power," Cora Opsahl, the fund's director, said at a recent conference the group hosted in New York. Similar efforts are underway elsewhere. Mark Cuban, the billionaire who first took aim at the health care status quo with a low-cost mail-order pharmacy, has said companies should publish their health plan contracts to force more transparency in the system. He told me in an email he hopes to make some contracts public at the start of next year. A new nonprofit called Nautilus Health Institute aims to "transform health plan market norms," in part by making better contract language available for buyers of health benefits, free for anyone to adopt. It's "mind numbing stuff, but if you don't sweat these details, you get robbed blind," Dave Chase, one of the founders of Nautilus, told me in a text message. Facing off against deep-pocketed companies with scads of lawyers, "one has to democratize the countermeasures," he said, "or it's not a fair fight." — John Tozzi | 
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