Beyond the Rhetoric
By Harry C. Alford & Kay DeBow
As the novel coronavirus continues to consume our nation’s attention, we must remain vigilant in protecting ourselves, helping our neighbors, and strengthening our communities. At the same time, we must guard our nation’s healthcare system from any effort by the federal government to implement socialized medicine. These attempts would crush medical professionals – and devastate their patients – at the worst possible time.
It’s now easy to forget that the 10-year anniversary of the Affordable Care Act is this month. At the time, opponents were quick to label President Obama’s health plan as “socialized medicine.”
Fast forward to today, and there is a stream of other healthcare proposals that fit the same bill. Democrats in the House of Representatives are rallying around H.R. 3, legislation that would enable the government to set prices for hundreds of prescription drugs. There’s also of course, Medicare for All, which Senator Bernie Sanders has been cheering up and down the presidential campaign trail.
Yet, another important health issue is quietly falling victim to this socialized approach: surprise medical billing.
Patients receive surprise bills when they seek treatment – usually in emergency situations – and return home to find that their insurance provider ultimately won’t be covering the cost of their care. The outcry over these outcomes has been far from quiet.
Leading proposals in the Senate to address surprise billing, namely the Lower Health Care Costs Act (S. 1895) and the STOP Surprise Medical Bills Act (S. 1531), claim to help patients with this dilemma. These bills, however, amount to “Medicare for Almost All.”
How did socialized medicine creep into attempts to protect patients from surprise bills?
Within the combined 470 pages of these two legislative proposals, one who reads closely will see that these purported fixes empower the government to set payment rates for all healthcare service providers. In S. 1895, senators want to use the median in-network rate as the benchmark for out-of-network providers. Similarly, while some say it’s a better bill, S. 1531 calls for a mandated arbitration process where the arbitrator must only consider the benchmark in-network rate.
Arbitration that only considers in-network rates is little different from benchmarking to in-network rates. That’s just putting lipstick on a pig.
And just last week, Members of the Senate Health and House Energy and Commerce Committees tried to sneak their socialized medicine approach to “fix” surprise medical bills into the third Covid-19 relief package. Thankfully, this shameful attempt was not included in the legislative language.
Should these flawed policies ultimately be enacted, patients and their providers would fare far worse than just a shot in the arm. Our African American community is especially at risk. The rate of Black Americans worried about medical bills is nearly 50 percent more than white Americans.
Moreover, as Dr. Benjamin Chavis wrote for these pages last month, “This outrageous situation benefits one group and one group alone: powerful insurance executives, who have managed to get off the financial hook for such bills, even as insurers shrink insurance coverage networks to wring more and more profits out of the system.”
However, there are market-based alternatives that put patients, their families, and providers first.
One such effort is the Protecting People from Surprise Medical Bills Act (H.R. 3502), which uses a real independent dispute resolution (IDR) process. This process entails a streamlined system to resolving payment disputes between insurers and providers that removes patients from the middle.
Dr. Vidor Friedman, president of the American College of Emergency Physicians, summed up H.R. 3502 perhaps best when he wrote, “[This] solution put forth by Reps. Raul Ruiz and Phil Roe, both physicians, would establish robust patient protections including a workable IDR. The bill currently has more support than any other pending surprise bill legislation in the House of Representatives. IDR [also] has been used successfully in New York State.”
As such, a September report from the New York Governor’s Office found that its surprise out-of-network protection law (the first in the nation) has saved patients more than $400 million. Dr. Nam Pham, managing partner of NDP Analytics and author of a recent economic report on S. 1895, also observed, “A market-based approach, like New York State’s system, will lead to better outcomes for patients, healthcare providers, and insurers alike.”
In addition to patients and their families, small businesses – that are already being decimated by the Covid-19 pandemic – will suffer under these benchmarked, “Medicare for Almost All” proposals. This is especially true for physician practices. Of the roughly 800,000 physicians in the U.S., the American Medical Association estimates that 45.9 percent are self-employed, ranging from 42.6 percent in family practice to 66.3 percent in surgical subspecialties.
These doctors are small businesses unto themselves, with each on average supporting 17 direct, indirect, and induced jobs. The secret price fixing nestled into S. 1895 and S. 1531 would force many small practices to fold, leaving their employees jobless and communities weaker.
Winston Churchill once said that socialism’s “inherent virtue is the equal sharing of misery.” In this light, Congress should take a market-based approach to addressing this surprise billing problem.
It should do so moreover, once this viral outbreak subsides. Anything short of that would fail our medical system and its patients miserably.
Mr. Alford is the Co-Founder, President/CEO of the National Black Chamber of Commerce ®. Ms. DeBow is the Co-Founder, Executive Vice President of the Chamber. Website: www.nationalbcc.org Emails: [email protected] [email protected]