OPINION

Surprise Billing: A Blight That Needs to Be Fixed by Doctors, Not the Government

As doctors, patients are our priority.  This is why we took an oath when we donned the career of one of the highest callings that a human being can obtain: the right to be called a healer.

“First, do no harm,” is the mantra of our field — yet in our inaction, we have allowed great harm to be inflicted upon the people of this country.

We have allowed ourselves to become ostracized from the politics of the health care industry — our industry. It’s the industry that millions of people rely on each year to ensure that their families are healthy, happy and can live their lives in a meaningful way.  And yet, we as doctors have failed it.

Even now, we are witnessing another push to remove doctors further from the decision-making process.  Our inaction and abstention from the political discourse need to end.  It is time that we follow our training, deal with the disease of government over-interference in the medical industry and insist that our patients — not the “almighty” dollar — come first.

To wit, Sen. Lamar Alexander (R-Tenn.) has introduced a bill called the Lower Health Care Costs Act to the Senate.  The LHCC is a bill designed to eliminate a practice called “surprise billing,” which is a way for insurance companies to punish people who travel outside of their medical network.

For those unfamiliar, when a person is rushed to a hospital outside of his or her insurers’ network in an emergency, doctors still provide treatment — the same as we would for any other patient. But for these out-of-network patients, insurance companies have the option to pay the bill or not. Unfortunately, they all too often choose the latter, and the ailing patient is stuck with the check as a result.

President Donald Trump has called out this manipulative practice and vowed to enact legislation to eliminate it. On this matter, the president is correct.

There’s no legitimate reason that people with insurance should be forced into bankruptcy because their insurer refuses to cover health insurance costs. After all, patients shouldn’t be punished for the emergency medical technician’s decision to rush them to the nearest hospital — that simply isn’t right.

Doctors understand that patients must be encouraged to receive care and be protected when they do. Unfortunately, under the current system, neither is the case.

The LHCC is going about rectifying this issue in the wrong way.  Alexander’s bill would create a government group to fix the price of medical treatment and pharmaceuticals. These price controls are the same type of government involvement that has caused prices to skyrocket in the auto industry, the mortgage market and several other sectors of the economy, including, of course, health care.

Any time that bureaucrats “fix” a price, they force companies to cut costs by shifting their resources away from innovation. As a result, price controls never succeed in controlling costs.

For example, according to a 2019 study by the Manhattan Institute, price-fixing in Maryland has resulted in substantially higher prices. Compared to the national average, Medicare rates in Maryland are now 40 percent higher for inpatient services and 60 percent higher for outpatient services. These soaring prices aren’t occurring in spite of Maryland’s price controls, but because of them.

If we are going to allow the government to take another shot at correcting the health care crisis, we need to take an approach similar to Sen. Bill Cassidy’s (R-La.) plan. This plan puts patients and doctors in a position to negotiate with insurance companies to resolve the problem of surprise medical bills.

Through a procedure known as arbitration, both hospitals and insurers submit “best price” bids to an independent arbiter. The arbiter then selects the more reasonable of the two proposals, resolving the conflict and empowering doctors without the need for government interference.

Whereas empirical data show that price control plans don’t work, arbitration methods have found impressive success in places like New York. After the Empire State adopted arbitration as its principal solution, surprise medical bills have become both less frequent and less severe. 

Indeed, New York’s arbitration system currently serves as a model for other states to emulate. And that’s a solid indication that the policy would find the same success on a national stage.  

The more control we give back to our doctors and patients, the better off everyone will be.  We can always strive to create a system where people will be able to get the health care they need at a reasonable price. And best of all, doctors will not be beholden to insurance companies determining who we can treat. 

 

Benjamin Alli, MD, Ph.D., is a Sakellarides Professor of Medicine and Surgery and the chancellor of the Royal College of Physicians and Surgeons of the United States of America.

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