Red Lake Nation News - Babaamaajimowinan (Telling of news in different places)

"Surprise Billing" Legislation Destroys Patient Choice


February 12, 2020

The House Ways and Means Committee is considering the Consumer Protections Against Surprise Medical Bills Act, which it claims will “better shield patients from bankrupting surprise medical bills.”

Bills are a surprise because patients expected their insurance to pay. These come from “out-of-network providers,” even though patients went to an “in-network” facility.

The network is a recent managed-care innovation. Before the government started pushing managed care in Nixon’s HMO Act of 1973, patients went to whatever hospital they wanted and were treated by their private physician. The insurance company paid whatever it decided, and patients paid the balance.

If patients couldn’t afford the doctor bill, they worked something out. I am not aware of any independent doctors putting a lien on a patient’s property. The bankrupting bills are generally from hospitals, which do take people’s homes, or these days from a private-equity firm that buys doctors.

Networks are becoming narrower and narrower. Hospitals could not offer many needed services without relying on out-of-network physicians. Physicians are out-of-network because the megacorporation wants to limit service, and thus the number of physicians, in order to increase profits—or because physicians decline to sign unacceptable, one-sided contracts.

The safety net for patients who want timely, high-quality care, instead of delayed or cut-rate service, is the availability of independent physicians not bound by managed-care constraints. “Surprise billing” legislation would damage or eliminate this option. It would force unacceptable fee limitations on all physicians for “emergencies,” and impose delays and bureaucratic chores even for those elective procedures with fees decided by patients and doctors.

This legislation would force managed-care rationing methods on all, enforced by government. It would increase the power of hospitals and insurers to control the practice of medicine, with their financial interest in reducing their own spending as the first priority.

The real answer to high medical costs is honest price signals—transparency for both fees and insurance coverage—and freedom to choose both medical care and a wide variety of payment options. Patients may be surprised to learn that they might be able to get a prompt procedure for a cash payment less than their insurance copay.

For information on a voluntary way, see AAPS white paper and “10 Solutions.”


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