Doctors, hospitals, health insurers, and Big Pharma have become so abusive to patients with their billing and pricing that they may have accomplished what many consider a political impossibility ̶ angering Democrats and Republicans in Congress as well as the White House, pushing them all toward bipartisan legislation and executive actions.
Don’t bet on the exact outcome of the latest stirrings. They’re grist for a surge in coverage by the New York Times (click here), Washington Post (here), Wall Street Journal (here), Kaiser Health News (here), Modern Health Care (here), Stat (here), and Pro Publica (here). The stories point out that the partisan divide is too great for Congress and the White House to get near serious work on big health care-related issues like improving the Affordable Care Act.
So, instead, as the articles report, lawmakers are taking varying approaches to attack medical billing, particularly so-called surprise bills (out-of-pocket charges patients get hit with when they get medical services from providers outside their health insurance networks) and balance billing, when medical providers chase patients for charges above what they’ve already recouped from insurers. Health reporters have drilled down on stories about such billing outrages. Drug and hospitals prices also are big targets.
Proposals to address them and more have been put forward by Lamar Alexander of Tennessee and Patty Murray of Washington, the leaders of the Senate Committee on Health, Education, Labor and Pensions (shown above, Murray, left, Alexander, right). They’re pushing a large measure they call the “Lower Health Care Costs Act of 2019.”
There’s also the“STOP Surprise Medical Bills Act”— proposed by Sens. Bill Cassidy (R-La.), Maggie Hassan (D-N.H.), Michael Bennett (D-Co.) and three others.
Or there’s the “No Surprises Act,” from Energy and Commerce Committee Chairman Frank Pallone (D-N.J.) and ranking Republican Greg Walden (Ore.)
Four House Republicans and four House Democrats have gotten behind the“Protecting People from Surprise Medical Bills Act,”which the Washington Post says is just in outline form.
The Journal says the White House, too, is readying an executive order that would use authority across the administration to force greater transparency about medical prices and particularly how hospitals negotiate them in secret with insurers, big employers, and others.
A key obstacle for the politicians in figuring how to help their constituents see lower and more reasonable bills and charges comes down to getting patients out of the middle of disputes among doctors, hospitals, and insurers. Many politicians think it unwise for Congress to set prices for the industry, and they’re unsure how fair and better it would be to have arbitrators determine out-of-network costs for providers. It also may be unworkable, or it might just put too much power in hospitals’ hands, if legal reforms make all providers in a given institution a guaranteed part of patients’ insurer networks. The administration also may want greater disclosure about the work and costs of insurance brokers, middlemen who critics say add unneeded costs (their fees and incentives) to the billing process.
The methods here may not be the key, for now. Instead, it may be most important for doctors, hospitals, insurers, and, yes, Big Pharma to hear the message ─ Americans are sick to death of getting a blizzard of unexpected and indecipherable invoices filled with unexplained and sky high charges that defy reason.
In my practice, I see not only the harms that patients suffer while seeking medical services but also their nightmares in accessing and affording safe, efficient, and excellent medical care. This has become a greater ordeal with the skyrocketing costs, complexity, and uncertainty of treatments and prescription medications, too many of which prove to be dangerous drugs. When they’re sick, injured, and vulnerable, patients also cannot stand to be ground up in a health care system that seems to put its own bloated interests ahead of their chief customers, us.
There are ways to try to cope with crushing medical bills. But medical debt and bankruptcy is a shame of the American health care system, on which we spend more than $3 trillion annually. Doctors, hospitals, insurers, and Big Pharma can expect a reasonable compensation and return for their work and products. But when they are pushing acceptable bounds in markets they dominate to see how high they can get their rates and how poorly they can treat their patients, well, this is unacceptable. We’ve got work to do. Let’s also see in the 2020 elections who deserves political support for improving the nation’s health and health care.