In a recent editorial [“Rally For Independents,” October 24], The Press correctly brought into focus the role that the profit motive plays in engendering market concentration in health care. The editorial highlighted how the Pharmacy Benefit Manager system distorts the drug prescription market, to the disadvantage of both the health care consumer and small, independent pharmacies. As editorialized, conflicts of interest and unfair competition may lead to higher prices for consumers and less business opportunity for independent pharmacies.
That is one health care cost/billing dilemma to confront; another is the phenomenon of patients receiving unanticipated hospital or outpatient bills. Again, as with the Pharmacy Benefit Program, the profit motive plays a distorting role.
Researchers Eileen Applebaum and Rosemary Blatt, writing in The Institute for New Economic Thinking, find that: “Surprise medical billing has become a critical issue facing Americans across the country because of purposeful corporate practices designed to increase profits. As hospitals have outsourced emergency rooms and other specialty care to reduce costs, private investors have bought up specialty physician practices, rolled them into powerful national corporations, and taken over hospital emergency services. The result: large out-of-network surprise bills. The hidden actors: leading private equity firms looking for ‘outsized’ returns.”
The Kaiser Family Foundation found that “1 in 6 insured hospital patients get a surprise bill for out-of-network care,” and “as many as 26 percent of admissions from the emergency room resulted in a surprise medical bill.” Other researchers find unnecessary up-coding to increase reimbursement.
Believe it or not, there is actually a bipartisan approach to solve this problem. U.S. Senators Patty Murphy (D-Washington) and Lamar Alexander (R-Tennessee), along with House members Frank Pallone (D-New Jersey) and Greg Walden (R-Oregon), have introduced legislation (End Surprise Billing Act of 2019) to fix this problem.
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