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The transparency wars in health care are in full swing. Since the Bush administration launched its initiative for more transparency in government health programs like Medicare, Medicaid or the health plan for federal employees last year, everyone is jumping on the bandwagon. (That is, except the Democratic Party, who see the whole thing as a move to distract us from the real problems in health care: high costs, the uninsured, no single-payer, and the like.)

Party politics aside when we hear about transparency in the media, what are we really talking about? What exactly do we want to be transparent in health care?

Well it appears to be just about everything. Here are some examples of what we (you, me, your mom, the government, your competitor, anyone with a passing interest, the IRS etc.) want to be transparent:

• Physician and hospital costs
• Physician and hospital charges
• Physician and hospital compliance with best medical practices
• Physician and hospital compliance with evidence-based medicine
• Physician and hospital health outcomes
• Physician and hospital medical errors
• Physician and hospital disciplinary actions and lawsuits
• Physician and hospital accreditation, board certifications
• Health plan benefit design and benefit decision making
• Health plan subscribers health demographics, indices
• Health Plan rate-making process, cost of benefits
• Quality of care stats for minorities, gays, immigrants and others
• Everyone’s lobbying activities, dining expenses, airline seat preference
• Health Care CEO’s, and high-priced medical specialists’ outrageous salaries and fees
• Health Care CEOs and their high-priced medical specialists’ outrageous love triangles (why not?)

There are probably a few things I’ve missed. But you get the idea.

And while everyone wants transparency, our most vociferous arguments are usually complaints about why the other guy isn’t more transparent.

But we shouldn’t be too critical. A ton of complicated reasons make it hard to be transparent in health care beyond it being just plain embarrassing. For example, we need measures to compare things like mortality rates. Basic, right? But the measures don’t measure what often needs to be measured. There’s too little data, or too much data, or not the right data, or simply bad data.

Besides, patients won’t use the information correctly anyway. And if they do, well, we aren’t ready, or don’t have the time to go through the stack of contrarian Google research they dump on our desk.

And then there are always those oh-so pesky lawsuits that lurk behind every innocent question or the publication of any real information.

The trump card in all this? It cost too damn much!

So despite all the talk, real transparency in health care is still out there on the horizon. But do not despair, my friends. Despite all this, we are making real progress. Health care may not be transparent but it is becoming translucent:

trans·lu·cent adj

1. allowing light to pass through, but only diffusely, so that objects on the other side cannot be clearly distinguished
2. having a glowing appearance, as if light were coming through

It may be diffuse, but light is starting to get through. Either that, or it’s just glowing as if light were coming through. You be the judge.