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The president recently signed an executive order to advance the disclosure of healthcare pricing. Details still need to be worked out, but this order seems to be an extension of a previous order mandating that hospitals post their list prices online. This order seems to mandate disclosure of prices that have been negotiated between hospitals and insurers, which would give patients a more accurate picture of the charges.
So far, I have not read too much of the effects of the previous executive order. It could be that the it takes time for the publication of list prices to have some effect, or it could be that the publication is difficult enough for consumers to find and understand and insufficiently related to out-of-pocket costs that they will not have much effect. This executive order seems like it would certainly be a step in the right direction. Even better would be mandating pricing disclosures at physician offices, where a substantial portion of non-emergency care takes place.
Kaiser Health News published an article describing how Texas recently passed legislation to protect patients from surprise medical bills, a topic of recent interest. Patients can be surprised by medical bills even when they go to an in-network facility, since that facility might employ or consult an out-of-network physician. While the state government does not mandate prices, the new legislation appears to require that the hospital and the insurer settle their disputes without involving the patient.
This protection seems quite reasonable in that once a patient has checked whether a facility is in-network (or not, in the case of an emergency), the patient has done what s/he can to minimize costs. That a hospital is unable to verify before the procedure that all involved providers are in-network or that an insurer was unwilling to establish an agreement with emergency providers in the area seem to fall within the responsibility of the providers and insurers, not the patient. The article reports that more than a dozen states have enacted some legislation or regulation against surprise medical billing, and some have suggested that the federal government may eventually take up the cause.
In what might be a bit of a silver lining to health care's high prices, Kaiser Health News published a piece about churches wiping out others' medical debt for a small fraction of the actual loan value. An example listed in the article is one church paying $22,000 to wipe out $2.2 million of medical debt for others.
This story is a feel-good story of people using leverage to wipe out what is commonly a huge source of stress for others. Unfortunately, the ratio of the amount paid to the nominal loan value speaks to how high the original medical bills were to begin with. Someone not having insurance likely also does not the means to pay for a major medical procedure. Hospitals might try to bill patients for the expensive procedures, only to realize over time that the patients are unable to pay. The medical institutions might then sell the debt for very little to debt collectors, who then in turn might sell the debt after they have tried collecting. One might imagine that a better system would be one in which prices for medical procedures were more affordable to begin with and fewer people had to deal with the stress of outsized medical debt.
Historically, businesses have been reluctant to pay additional taxes and have wanted fuller control over the benefits that they might offer. Health insurance, for example, has long been tied to employment in the US, with various employers offering differing levels of coverage. Over the last couple of decades, businesses have noted the rapid rise in health insurance premiums, but very few have publicly stated that they want nationalized health insurance. Kaiser Health News published a piece highlighting how some small businesses are pushing for Medicare for All.
The piece offered the explanation from a leader of a business coalition that large businesses are still hesitant to publicly support the nationalization of health care. Perhaps small businesses have less budget to accommodate the rapid rise in health insurance premiums and are therefore more open to government intervention. One CEO explained: "It makes no more sense for an airline to understand health policy for the bulk of its workers than for a health facility to have to supply all the air transportation for its employees."
The New York Times published a piece that discusses research showing that a small percentage of physicians are disproportionately responsible for (associated with) a large number of claims ("about 2 percent of doctors accounted for about 39 percent of all claims in the United States").
To conduct the most recent study, authors used the National Practitioner Data Bank, which is a national database that tracks "malpractice payments and certain adverse actions related to health care practitioners, providers, and suppliers." Unfortunately for the public, access to the database is limited to certain entities such as as hospitals. The authors found that "more than 90 percent of doctors who had at least five claims were still in practice" -- meaning that whatever self-regulating mechanism the industry thinks is in place likely is not effective. Given that repeat offenders can continue to practice, it seems that for all of the industry's talk of patient safety, the adverse actions in the National Practitioner Data Bank should be made publicly available.