Large unexpected expenses are never welcome. No one likes a costly surprise. That may explain why Congress is talking about government imposing a “fix” to “protect” patients from surprise medical bills.
That may sound good, but healthy skepticism is warranted. One only needs to remember how the Obama-Biden administration repeatedly promised to save us all thousands of dollars every year and allow us to keep our health insurance and our doctor. None of that turned out to be true.
We need a solution to surprise medical bills that rescues consumers from being caught in between the doctor’s or hospital’s bill and the insurance company’s refusal to pay it. But we also need a solution that empowers consumers, not government bureaucrats, and that promotes innovation and harnesses the power of the marketplace to ensure high quality care at the lowest prices.
We must be 100% sure that we avoid government mandated procedures that effectively impose price controls because they also reduce the likelihood of future healthcare innovations and slow the development of promising medicines and procedures. Government mandates almost invariably shift power to government bureaucrats and health insurance companies, rather than giving consumers more control over their own healthcare.
The most common cause of a surprise medical bill is when a person uses a healthcare provider that is not in their insurance plan’s network of providers. While it doesn’t happen often, it is a real challenge for consumers when it does happen. Insurance companies have contracts with healthcare providers to provide medical services at discounted rates. That makes them “in-network.” The “out-of-network” providers charge a price without any pre-negotiated discounted rates. The problem arises when consumers get stuck between the insurance company that doesn’t want to pay and the doctor who should be paid.
The best way to solve the nation’s surprise medical bill problem is to implement a fair and open independent dispute resolution (IDR) process. A fair IDR process simply means that both sides of the out-of-network bill dispute, the physician and the health insurer, are allowed to submit all relevant information to make their case. Then the arbitrator or decision-maker can weigh the evidence and provide a fact specific resolution to what the insurance company should pay and what the doctor should accept.
This would relieve the patient of worrying about the bill, and it would make sure that difficult or complex medical procedures and treatments don’t become devalued or more difficult to find.
Sens. Lamar Alexander and Bill Cassidy are rumored to be working on a “compromise” that purports to use a form of IDR. But we should be on high alert because all indications are that the “compromise” will include a rigged or sham IDR process that puts the heavy hand of government on one side of the scales of fairness and justice. There is no reason to use a process that from the start tips the scales in favor of either the doctor or the insurance company.
This “compromise” will favor insurance companies over doctors. If the government-imposed process ends up being a price control system, it will simply be a step toward socialized medicine and will make finding doctors to treat you more difficult. What we should all want is a fair and balanced process.
A fair and impartial IDR process that resolves the pricing dispute would prevent the consumer from getting caught in the middle. It would also empower consumers, not government.
Additionally, it would harness the power of the marketplace to keep quality up and prices down. It is important to remember that government regulations don’t have a track record of reducing costs. Moreover, government mandates will do nothing to reward innovation, or to empower consumers.
Regardless of what their true motives were or are, the results we have witnessed in the last 50 years from politicians promising “fixes” has been that things end up costing a lot more than promised, and government gets more and more control. Those who can afford lobbying efforts may escape the costly impact of these government mandates. But rarely do these promised fixes on balance help the average citizen.
Instead of continuing to empower government, insurance companies, and those who can afford lobbyists to protect their interests, let’s try reforms that put economic power back in the hands of healthcare consumers. Let’s trust the marketplace to do what it does so well — boost quality and keep prices comparatively low. We trust the marketplace to provide us with food, housing, technology, and thousands of other very important things. Why not our healthcare, as well?
We can do all of this with a fair and balanced IDR process that allows both sides of the out-of-network bill dispute to submit all relevant information to make their case. If this happens, we protect consumers from surprise medical bills and we keep burdensome government mandates out of our healthcare choices. That’s a win-win!
By The Hill•
Americans are anxious to get back to work and to send their children to school. The science backs them up. We have learned a lot over the past months, and we are putting that knowledge to use. We are capitalizing on the advanced capabilities that we have developed, as we redouble our efforts to protect vulnerable populations and deliver new and effective treatments in record time.
Here’s what we now know:
We know who is at risk. Only 0.2 percent of U.S. deaths have been people younger than 25, and 80 percent have been in people over 65; the average fatality age is 78. A JAMA Pediatrics study of North American pediatric hospitals flatly stated that “our data indicate that children are at far greater risk of critical illness from influenza than from COVID-19.”
We may see more cases as social interactions pick up, because this is a contagious disease. However, the overwhelming majority of cases are now occurring in younger, low-risk people — decades younger, on average, than seen in the spring. And the vast majority of these people deal with the infection without consequence; many don’t even know they have it.
While we saw more cases in July and August, we are not seeing the explosion of deaths we saw early on. An analysis of CDC data shows that the case fatality rate has declined by approximately 85 percent from its peak.
That is partly because we are much better now at protecting our most vulnerable, including our senior citizens. States have learned from those that experienced outbreaks before them, and they have implemented thoughtful policies as a result.
We are doing much better with treating hospitalized patients. Lengths-of-stay are one-third the rate in April; the fatality rate in hospitals is one-half of that in April. Fewer patients need ICUs if hospitalized, and fewer need ventilators when in ICUs.
We are progressing at record speed with vaccine development. This is due to eliminating bureaucracy and working in partnership with America’s world-leading innovators in the private sector.
Despite these gains, our economy has yet to fully reopen. At least 16 states have travel warnings and quarantines in place that are not consistent with Centers for Disease Control and Prevention (CDC) guidelines; in most states, retail stores are limited to pick-up or reduced shopping capacity. Even in states where cases are low, restaurants are often take-out only, and 42 states and territories have seating capacity limited to 25 percent or 50 percent. Fitness centers and gyms have largely reopened, but at reduced capacity.
Beyond those business limits, schools in many cities and states will be opened this fall on a delayed or limited basis. According to the U.S. Department of Education’s tracking, of 5,425 major school districts (about one-third of districts nationwide), almost half plan to operate on hybrid models and another 20 percent plan to operate online-only. That not only harms children, it prevents many parents from working.
A key – but flawed – assumption driving these restrictions is that the number of cases is the most important metric to follow. Yet, whatever effect these restrictions may have on cases, they don’t eliminate the virus. And they impose harms on the country and its citizens, particularly when they require the isolation of large segments of the low-risk and healthy, working populations.
Unlike his critics, who have focused on the wrong goal and engaged in unfounded fear-mongering, President Trump has been implementing a three-pronged, data-driven strategy that is saving lives while safely reopening the economy and society, averting the disastrous calamities of continued lockdown.
First is protecting the high-risk group with an unprecedented focus. This is being done by relying upon highly detailed, real-time monitoring; a smart, prioritized, intensive testing strategy for nursing home staff and residents; deployment of massive extra resources, including point-of-care testing, personal protective equipment (PPE), infection control training and rapid mobilization of CDC strike teams for nursing homes; and extra PPE and point-of-care testing for the environments with elderly individuals outside of nursing homes, like visiting nurse in-home care and senior centers.
Second, we are carefully monitoring hospitals and ICUs in all counties and states with precision to prevent overcrowding, and rapidly increasing capacity in those few hospitals that may need additional personnel, beds, personal protective equipment (PPE) or other supplies.
Third, we are leveraging our resources to guide businesses and schools toward safely reopening with commonsense mitigation measures. We must safely reopen schools as quickly as possible, and keep them open. The harms to children from school closures are too great to accept any other outcome.
While the lockdown may have been justified at the start, when little data was known, we know far more about the virus today. It’s time we use all we have learned and all we have done to reopen our schools and our economy safely and get back to restoring America.
If all you did was listen to the politicians and commentators, you’d think America’s health care system was on the verge of collapse. Nothing could be further from the truth. There are problems, but most of them have been caused by the self-same reformers who’ve been trying for more than two decades to “fix” it.
Much progress has been made since the New York Times and presidential candidate Bill Clinton declared a crisis existed and proposed solving it by increasing the role played by the government in managing the delivery of services and prices. Once the voters learned the potential adverse impacts on the quality of care they received, the debate changed.
Through it all, America has continued providing the best care anywhere. The spirit of invention and innovation that is the hallmark of our civilization exists robustly in the health care sector and, because it does, people are living longer, generally healthier lives. Yet, instead of encouraging that, scholars and policymakers continue to focus on flattening the cost curve through fiat. Price controls and rationing may reduce the perceived costs of medical care but won’t solve the problem.
The real solutions will come from innovations in care. That means continuing the development of radical new treatments that were unthinkable a generation ago and, in a few cases, going back to what was working before the government messed things up.
One place where looking back is already helping us move forward is kidney dialysis. In 1972, thinking they were helping, Congress passed legislation creating a Medicare program to pay for dialysis treatment and patients with end-stage renal disease gravitated to more expensive, center-based care using machines built for use in centers that are large, hard-to-use, and too expensive for home use.
In 1973, 40 percent of dialysis patients received treatment at home. Today, 90 percent receive treatment at dialysis centers and hospitals — at much greater cost and at greater risk to their health because the entire time they are there, checking in, checking out, waiting for and receiving treatment, they’re in the company of others who might be sick with something like COVID-19 that science tells us preys on those whose immune systems are compromised.
We spend more than $110 billion on kidney disease, the ninth leading cause of death in the United States. More than 37 million Americans have some form of this disease and the money paying for their dialysis comes from Uncle Sam through Medicare. That’s not sustainable.
The alternative to spending more is to spend smarter. The Trump Administration, which earlier this year announced a plan to “shake up” the kidney care medical complex is pushing for a return to home-based hemodialysis as a cost-saving measure and one more in line with patient concerns. His executive order on the issue included a direction to the Department of Health and Human Services to develop policies to reduce the number of Americans getting dialysis treatment at dialysis centers.
That’s the right move. The in-home care alternative will have the biggest impact in the shortest amount of time. The current care cycle, where treatment begins when it’s too late to stop disease progression. Must be broken. Instead of throwing more money at dialysis clinics, the priority is being repurposed in the right place, on early diagnosis, better patient education, and comprehensive and holistic care services.
Home-based options for hemodialysis, where blood is pumped out of the body under supervision into a machine that acts as a kidney and filters the blood before returning it to the body, and peritoneal dialysis, where blood vessels in the lining of the belly filter the blood with the help of a cleansing fluid, exist and should be utilized to the fullest extent possible.
Starting in 2021, ESRD patients will also be able to enroll in Medicare Advantage plans – great for the ESRD patients, but it could increase premiums for all seniors if we don’t help these plans negotiate for fair rates and prevent costs from rising. The Centers for Medicare and Medicaid Services should remove any roadblocks that exist to making this option viable.
With COVID-19 is changing how people go about their lives, the incentive to adapt and innovate in the health care sector is there. Telehealth, which was generally frowned upon before the current crisis, has taken off like a moonshot. Changing the kidney dialysis model to one where the care is mostly provided at home could liberate those receiving treatment now held prisoner by their illness and could lead the transformation of American medicine. Anyway, it’s worth a try.
President Trump has signed an executive order that aims to tackle U.S. prescription drug spending, but won’t implement it until the public, including private sector drug makers, can comment.
The order pegs the prices of certain drugs covered by Medicare to the lower prices paid in other developed countries, whose governments impose strict price controls.
The order might save the federal government some money — at least temporarily — but at great expense to patients and long-term scientific progress.
History shows that adopting government price-setting inevitably stifles medical innovation and reduces patients’ access to lifesaving drugs. This move is particularly dangerous and baffling in the middle of a pandemic.
Trump is well-intentioned. But when it comes to healthcare policy, it’s not the thought that counts. Americans can only hope the president rescinds this order, which will have harmful long-term effects.
Right now, Medicare pays 80 percent more for drugs than government health insurers in other developed countries, such as the United Kingdom and Japan. So, the administration wants to tie Medicare reimbursements to the significantly lower prices in those countries.
It’s no accident that drugs are cheaper abroad. Many foreign nations have heavily socialized healthcare systems that regulate drug prices. If pharmaceutical companies don’t accept pitifully low reimbursement rates, foreign government officials simply ban firms from selling their medicines at all.
Pegging Medicare reimbursements to those artificially suppressed prices would, in effect, impose price controls here. That might have some superficial appeal — after all, who doesn’t like the idea of cheaper drugs — but price control schemes never end well.
Government price-setting invariably restricts patients’ access to novel therapies. Right now, 96 percent of all new cancer medicines invented worldwide between 2011 and 2018 are available in America. That’s because our country has a relatively free-market drug pricing system that gives firms a chance to earn back their research and development costs.
Contrast that with the United Kingdom and Japan, where patients have access to just 71 percent and 50 percent of those cancer drugs, respectively. In these countries, drug companies stand little chance at recouping their R&D costs and earning a profit on many drugs. So, they often stay away.
Even if drug companies do enter those markets, foreign patients often wait months — or years — to receive new drugs. While Americans typically have immediate access to breakthrough cancer therapies, patients in Japan wait 23 months, on average, after a drug’s initial launch before gaining access.
Imagine if the 44 million Americans on Medicare — 15 percent of the U.S. population — had to wait an extra year and a half before they could take a new immunotherapy. That horrific consequence explains why, in this case, most congressional Republicans don’t back the president on his executive order.
The administration’s plan would also decimate medical innovation. It takes several billion dollars and over a decade to create just one new drug. The existing pricing system incentivizes companies to make those research investments — and the results have been nothing short of miraculous. Cancer death rates have plummeted more than 25 percent over the last quarter-century, mostly thanks to new treatments.
In fact, in 2019, American life expectancy increased for the first time in four years. One of the key causes was better cancer treatments.
I applaud Trump’s effort to reduce drug prices. But there are ways to do so without bringing foreign price-setting to our shores.
He already got one way right. In the same ceremony, Trump signed another executive order to target middlemen in the drug supply chain called pharmacy benefit managers. These negotiators set the prices for drugs that end up on insurers’ list of covered treatments and on the shelves of local pharmacies.
The instinct to reform the practices of PBMs was spot on. PBMs receive significant rebates from manufacturers for adding a drug to an insurer’s formulary. But they don’t disclose those rebates or use them to lower patients’ costs at the pharmacy counter.
Requiring them to pass along savings directly at the point of sale will help achieve the president’s desired reduction in drug prices without costing Americans access to lifesaving cures.
Additionally, the administration could stop the unfair trade practice of banning an American medicine unless it’s sold at an artificially low price. That would stop developed countries from benefiting off the backs of American taxpayers, who foot the bill for new drug development.
Government price-setting would snuff out future medical breakthroughs while limiting patients’ access to existing drugs. The savings aren’t worth the cost in American lives. Let’s hope the administration decides to reverse course on its new executive order.
ATR today released a coalition letter signed by 70 groups and activists in opposition to the Pelosi drug pricing proposal to create a 95 percent tax on pharmaceutical manufacturers.
As noted in the letter, this bill calls for a retroactive tax on sales that is imposed in addition to existing against income taxes:
Under Speaker Pelosi’s plan, pharmaceutical manufacturers would face a retroactive tax of up to 95 percent on the total sales of a drug (not net profits). This means that a manufacturer selling a medicine for $100 will owe $95 in tax for every product sold with no allowance for the costs incurred.
The tax is used to enforce price controls on medicines that will crush innovation and distort the existing supply chain as the signers note:
“The alternative to paying this tax is for the companies to submit to strict government price controls on the medicines they produce. While the Pelosi bill claims this is “negotiation,” the plan is more akin to theft.”
This proposal will create significant harm to American innovation to the detriment of jobs, wages, and patients, as the letter notes:
”[The Pelosi] proposal would crush the pharmaceutical industry, deter innovation, and dramatically reduce the ability of patients to access life-saving medicines.
The full letter is found here and is below:
Dear Members of Congress:
We write in opposition to the prescription drug pricing bill offered by House Speaker Nancy Pelosi that would impose an excise tax of up to a 95 percent on hundreds of prescription medicines.
In addition to this new tax, the bill imposes new government price controls that would decimate innovation and distort supply, leading to the same lack of access to the newest and best drugs for patients in other countries that impose these price controls.
Under Speaker Pelosi’s plan, pharmaceutical manufacturers would face a retroactive tax of up to 95 percent on the total sales of a drug (not net profits). This means that a manufacturer selling a medicine for $100 will owe $95 in tax for every product sold with no allowance for the costs incurred. No deductions would be allowed, and it would be imposed on manufacturers in addition to federal and state income taxes they must pay.
The alternative to paying this tax is for the companies to submit to strict government price controls on the medicines they produce. While the Pelosi bill claims this is “negotiation,” the plan is more akin to theft.
If this tax hike plan were signed into law, it would cripple the ability of manufacturers to operate and develop new medicines.
It is clear that the Pelosi plan does not represent a good faith attempt to lower drug prices. Rather, it is a proposal that would crush the pharmaceutical industry, deter innovation, and dramatically reduce the ability of patients to access life-saving medicines.
We urge you to oppose the Pelosi plan that would impose price controls and a 95 percent medicine tax on the companies that develop and produce these medicines.
President, Americans For Tax Reform
James L. Martin
Founder/Chairman, 60 Plus Association
Saulius “Saul” Anuzis
President, 60 Plus Association
Chair, Alabama Center Right Coalition
President, AMAC Action
President, American Business Defense Council
President, American Commitment
Executive Director, American Conservative Union
President/CEO, The American Consumer Institute Center for Citizen Research
Lisa B. Nelson
CEO, American Legislative Exchange Council
Vice President of Policy, ALEC Action
President, Americans for a Balanced Budget
President, Americans for a Strong Economy
President, Campaign for Liberty
President, Center for a Free Economy
Andrew F. Quinlan
President, Center for Freedom & Prosperity
President, Center for Individual Freedom
Executive Director, Center for Innovation and Free Enterprise
Peter J. Pitts
President, Center for Medicine in the Public Interest
Senior Fellow, Center for Worker Freedom
President, Citizen Outreach
President, Club for Growth
President, The Committee for Justice
Vice President, Competitive Enterprise Institute
Executive Director, Conservatives for Property Rights
President, Consumer Action for a Strong Economy
Fred Cyrus Roeder
Managing Director, Consumer Choice Center
President, Council for Citizens Against Government Waste
Executive Director, Digital Liberty
Co-Chair, Florida Center Right Coalition
President, Frontiers of Freedom
President, Galen Institute
Director of Healthcare Policy, Goldwater Institute
The Honorable Frank Lasee
President, The Heartland Institute
Vice President, Heritage Action for America
Rodolfo E. Milani
Trustee, Hispanic American Center for Economic Research
Founder, Miami Freedom Forum
Mario H. Lopez
President, Hispanic Leadership Fund
President, Independent Women’s Forum
Heather R. Higgins
CEO, Independent Women’s Voice
Resident Scholar, Institute for Policy Innovation
President, Iowans for Tax Relief
Vice President of Policy, The James Madison Institute
The Honorable Paul R LePage
Governor of Maine 2011-2019
President, Less Government
Director, Lone Star Policy Institute
Chair, Maine Center Right Coalition
CEO, The Maine Heritage Policy Center
President, Maine State Chapter – Parents Involved in Education
President, Market Institute
Jameson Taylor, Ph.D.
Vice President for Policy, Mississippi Center for Public Policy
The Honorable Tim Jones
Leader, Missouri Center-Right Coalition
CEO, Montana Policy Institute
President, National Taxpayers Union
The Honorable Bill O’Brien
The Honorable Stephen Stepanek
Co-chairs, New Hampshire Center Right Coalition
The Honorable Beth A. O’Connor
Maine House of Representatives
The Honorable Niraj J. Antani
Ohio State Representative
Executive Director, Ohioans for Tax Reform
Honorable Jeff Kropf
Executive Director, Oregon Capitol Watch Foundation
CEO, Pelican Institute for Public Policy
Executive Director, Property Rights Alliance
President, Rio Grande Foundation
James L. Setterlund
Executive Director, Shareholder Advocacy Forum
President and CEO, Small Business Entrepreneurship Council
David Miller & Brian Shrive
Chairs, Southwest Ohio Center-right Coalition
Executive Director, Taxpayers Protection Alliance
President, Tea Party Nation
Director, Right on Healthcare – Texas Public Policy Foundation
President, Trade Alliance to Promote Prosperity
Executive Director, Wyoming Liberty Group
Atop the list of what America’s senior adults want are the preservation of their independence and a secure retirement. Admirably they don’t want to end up being a burden anyone, not their spouse, not their children, and not the rest of us. The way the system is rigged, however, almost guarantees they will
Medicare-for-All, which most of the Democrats running for president have endorsed, will only lead to increased dependency. It’s a typical one-size-fits-all proposal that sounds good from the stump and may look good on paper. The numbers though, just don’t work.
The way forward is to expand choice and to allow seniors to take advantage of competition in the health care marketplace to bring prices down. Some already have supplemental insurance that helps fill the financial gap between what they need and what Medicare will pay for but it’s not enough. Some people need more than one walker in order to stay in their homes.
This is where creativity is needed. The green-eye shade types who approve Medicare expenditures spend lots of time thinking about what things cost. Considering how many taxpayer dollars are involved in later-in-life health care, that’s not such a bad thing but it doesn’t always take into consideration what people need.
That forces seniors to make hard choices that can threaten their independence. They need to have more options as they would under a proposal by Dr. Ami Bera, D-Calif., and Jason Smith, R-Mo., that would let them use pre-tax dollars stored up in health savings accounts to fill the gaps between items covered under Medicare and what they are expected to pay for out of pocket.
“Having a Health Savings Account is a powerful resource that reimburses everything from doctor and dentist visits to prescription drugs, first aid supplies, and eyeglasses. Health Savings Accounts also incentivize saving for health-care expenses by providing critical tax benefits, just as we do for saving for retirement or college,” says Kevin McKechnie, the executive director of the American Bankers Association’s Health Savings Accounts Council.
Money put away in an HSA can stay there for decades. Under current law, there’s no “Use it or lose it” provision. That means younger workers can start saving for retirement health care upon entering the workforce and, through the magic of compound interest, build up a nest egg that’s there for them anytime they need it.
That means, if they’re lucky enough to remain relatively healthy and can be disciplined financially, it can be there for them in their retirement years which, it has suddenly become clear to me, come around a lot faster than it seems they will when you’re just starting out.
The tax benefits associated with HSA’s, McKechnie wrote in a recent op-ed, “have become even more important as deductibles and other health-care costs continue to skyrocket.” Struggling families, especially those that include senior adults facing the challenges associated with aging, are finding it harder and harder to plan for they can’t see coming. Expanding the range of services that can be paid for out of health savings accounts give them an additional hedge against the unexpected.
A recent Luntz Global poll found 46 percent support for the Bera-Smith plan and the idea of using HSA funds to fill the Medigap. Expanding the list of approved items upon which HSA dollars can be spent without tax penalties is low hanging fruit as far as health care reform goes. That’s probably why the idea has bipartisan support.
The challenges presented by an aging America in which people living longer and healthier must deal with diseases that can lead more quickly to economic ruin should give us all pause. New thinking is needed, not just where treatments are concerned but in how we make it possible for people to pay for it. We could as a country decide to turn the whole business over to the government but that inevitable means care will be rationed, fewer options will be available, and decisions regarding life and death matters will almost inevitably be taken out of our hands by the bureaucracy.
No one wants to live like that, and no one wants a loved one to die like that. The Bera-Smith Health Savings for Seniors Act will cover the gaps and help bring the cost of health care under control. At least 82 percent of those who answered the Luntz Global survey think it will. It’s time to give it a chance.
The best way to ensure better medical care for all is to reject Medicare for All.
Health care ranked as most important issue, save for “the ability to beat Donald Trump,” for Democratic voters in a FiveThirtyEight/Ipsos poll taken before and after last week’s presidential debate.
The debate revealed fissures among the party’s presidential aspirants on health care.
Bernie Sanders pronounced his desire that “every American has health care as a human right and not a privilege.” But under the senator’s “Medicare for All” scheme, private health insurance becomes illegal.
Would any American regard it as in keeping with the First Amendment if the government limited all 330 million of us to one church or one newspaper? The senator’s conception of rights, several opponents seemed to say, is wrong.
“While Bernie wrote the bill, I read the bill,” Amy Klobuchar quipped. She objected to Medicare for All forcing about half of Americans off their existing private insurance. “I don’t think that’s a bold idea,” the Minnesotan noted. “I think that’s a bad idea.”
Mayor Pete Buttigieg said he supported “Medicare for all who want it.” He objected to the one-size-fits-all quality of Sanders’ plan. “I trust the American people to make the right choice for them,” he told Sanders. “Why don’t you?”
Joe Biden balked at the price, estimated to eclipse what the federal government currently takes in in revenues. The former vice president pointed out, “Nobody’s yet said how much it’s going to cost the taxpayer.”
Sanders and Sen. Elizabeth Warren, who supports his plan, pushed back. Vermont’s junior senator railed against “the drug companies and the insurance companies.” Warren explained, “I’ve never met a person who likes their insurance company.”
Given that insurance companies issue bills to consumers, this necessarily makes them unpopular. But the majority of costs come from hospitals (33 percent) and physician and clinical services (20 percent), according to the Center for Medicare and Medicaid Services (CMS). We want to kill the messenger. Those primarily responsible for the message — $25 for two aspirin pills, $120 for a cloth sling, $57,000 for a knee replacement — somehow not only escape our wrath but also win our admiration.
Hospitals gouging patients occurs most glaringly in places where hospitals operate as a monopoly and in emergency situations. The common denominator in both circumstances involves the inability to compare and shop.
In a paper published earlier this year in the Quarterly Journal of Economics, academics at Yale, Penn, MIT, and Carnegie Mellon note hospital price increases for the privately insured when competition decreases. “Prices at monopoly hospitals are 12% higher than those in markets with four or more rivals,” their abstract reads.
Monopoly hospitals also have contracts that load more risk on insurers (e.g., they have more cases with prices set as a share of their charges). In concentrated insurer markets the opposite occurs — hospitals have lower prices and bear more financial risk. Examining the 366 mergers and acquisitions that occurred between 2007 and 2011, we find that prices increased by over 6% when the merging hospitals were geographically close (e.g., 5 miles or less apart), but not when the hospitals were geographically distant (e.g., over 25 miles apart).
In the emergency room, when circumstances necessarily kill the ability to shop, spending per patient more than doubled from 2008 to 2017, according to research compiled by Kevin Kennedy and John Hargraves for the Health Care Cost Institute.
Reducing health-care costs requires more competition, not a monopoly. Change soon comes, and not necessarily legislative change of the Medicare for All variety. Data stored in the cloud and available via an app may make medical costs and outcomes transparent, which should reduce cost. Medicare for All will retard this process since the whole health-care industry will lobby against the smartphone apps, and the consolidation of the entire industry necessarily leads to less competition.
Beyond transparency enabling health-care consumers to shop, the industry appears ripe for new players. Amazon, JPMorgan Chase, and Berkshire Hathaway, for example, entered the field last year. If they do not ultimately seek to dethrone the status quo, why did UnitedHealth’s Optum sue to stop a former employee from working at the trio’s health-care startup? A $3.6 trillion industry remains too big a cash cow for the giants of tech and finance to resist a milking.
Competition is coming. Price transparency is coming. If Medicare for All is coming, then neither is coming.
By Nan Hayworth • The Hill
As a physician whose career in medicine was dedicated to preserving and improving my patients’ health, I know firsthand how important it is for everyone to have access to care. This is a fundamental precept, morally and pragmatically sound, that should be honored by all who seek to transform for the better America’s flawed system of health care delivery.
Regrettably, since its passage in 2010, the Affordable Care Act (ACA) has had the net general effect of raising the cost of health insurance while reducing the quality and variety of the services that insurance covers. This is the opposite of what was intended — but the suffering engendered thereby is real and painful.
The best-case remedy would be to repeal the ACA completely and replace it with a much simpler, more targeted set of common-sense interventions to empower consumers and ensure their access to Continue reading
By Charles Silver & David A. Hyman • National Review
If you’ve ever been in a collision, you’ve probably dealt with a body shop. In all likelihood, the process went smoothly. You paid your deductible, your insurer paid the rest, and that was the end of the financial side of the repair.
Health care works differently. After eight-year-old Ben Millheim injured himself during a camping trip, his family was stuck with a $32,000 bill from the sky-ambulance company that flew him 88 miles to a hospital in St. Louis. That was the balance that remained after the Millheims’ insurer paid $12,000 for the service. Elizabeth Moreno was stuck with a bill for $17,850 because a physician asked her to provide a urine sample. She didn’t know that the doctor’s testing lab was out of her insurance network. Moreno’s insurer, Blue Cross Blue Shield of Texas, which would have paid an in-network lab $101 for the service, refused to cover the bill at all. Fearing for his daughter’s credit rating, Moreno’s father bargained the bill down to $5,000 and paid.
The Millheims and Morenos are but two of the tens of thousands of families who receive surprise medical bills every year. These are “balance bills,” that seek to hold patients responsible for charges their insurers won’t pay. The problem is so bad and so Continue reading
To: Dr. Thomas R. Frieden, Director, Centers for Disease Control and Prevention CC: CDC Advisory Committee on Immunization Practices
Dear Dr. Frieden and CDC Advisory Committee of Immunization Practices Members,
We write to you today in support of a family’s right to access to safe, effective vaccines for their children. Vaccines have saved millions of lives since their invention and near universal vaccination rates have eradicated a number of horrible diseases from small pox to polio. Unfortunately certain diseases like Meningitis B, the cause of 40% of all meningitis cases in 2012, could persist because the Centers for Disease Control (CDC) may opt to block access to life-‐saving vaccinations.
In late February, your Advisory Committee on Immunization Practices (ACIP) will meet to determine the accessibility of two vaccines the Food and Drug administration recently approved to prevent Meningitis B. ACIP, and therefore CDC, appears poised to recommend its usage only for “high-‐risk group/outbreaks,” meaning private health insurance will cover the cost of vaccination only after an outbreak of this deadly disease has occurred. Continue reading
Swedish researchers report that antioxidants make cancers worse in mice. It’s already known that the antioxidant beta-carotene exacerbates lung cancers in humans. Not exactly what you’d expect given the extravagant — and incessant — claims you hear made about the miraculous effects of antioxidants.
In fact, they are either useless or harmful, conclude the editors of the prestigious Annals of Internal Medicine: “Beta-carotene, vitamin E and possibly high doses of vitamin A supplements are harmful.” Moreover, “other antioxidants, folic acid and B vitamins, and multivitamin and mineral supplements are ineffective for preventing mortality or morbidity due to major chronic diseases.” So useless are the supplements, write the editors, that we should stop wasting time even studying them: “Further large prevention trials are no longer justified.”
Such revisionism is a constant in medicine. When I was a child, tonsillectomies were routine. We now know that, except for certain indications, this is grossly unnecessary surgery. Not quite as harmful as that once-venerable staple, bloodletting (which probably killed George Washington), but equally mindless. Continue reading