Worth A Discussion - 27 East


Southampton Press / Opinion / Letters / 1615329

Worth A Discussion

The Express News Group is to be applauded for its recent focus on health care. First, the story [“Independent Pharmacies Feel Helpless As Unregulated Middlemen Influence Profits,” 27east.com, October 15] and editorial [“Rally For Independents,” 27east.com, October 21] that educated us on the ways pharmacy benefit managers gum up the works — and now Press reporter Stephen J. Kotz provides some insight into the latest way patients receive surprise bills [“Surprise Billing: For Many Patients, Financial Pain Follows A Visit To The Emergency Room,” 27east.com, November 19].

Some thoughts about New York’s answer to surprise billing: The Independent Dispute Resolution system, as described in Mr. Kotz’s article, although helpful to patients, is still inadequate and favors providers over the patient.

Loren Adler, associate director of the USC-Brookings Schaeffer Initiative for Health Policy, identifies the flaw in the system: “Providers’ billed charges are unilaterally set, largely unmoored from market forces, and generally many times higher than in-network negotiated rates or Medicare rates.”

Bottom line — it’s hard to win in a rigged system. (See above editorial.)

Congress is currently working on legislation to address surprise medical bills, but the committees working on those bills have been lobbied hard by competing interest groups to favor one approach over the other. A key provision that would be most helpful would end balance billing — that is, no out-of-network provider would be able to bill the patient the difference between what the insurer pays and the posted charge. Very helpful if that provision stays intact — fingers crossed on that one.

I worked for 33 years in a health system that was operated in a way that no patient, ever, had to worry about surprise hospital or physician bills — no patient ever received one. Of course, to replicate a system such as the one where I worked requires certain rare business practices: eliminate fee-for-service billing, and hire staff physicians.

The blend of socialism and capitalism that made that work requires a longer conversation unsuited for this page. But I put it out there to suggest that a robust conversation about many aspects of U.S. health care should be on the table.

Mike Anthony



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