A bipartisan health care reform bill could make it easier for Americans to find out the cost of a doctor's appointment or procedure before a patient gets it — a task that currently ranges in difficulty from enormous to impossible.
The bill requires hospitals, diagnostic laboratories, imaging services, surgical centers and pharmacy benefit managers to publicly post prices. That, advocates said, could lower health care costs as “consumers” shop around.
“We all know that health care is too expensive and the system is far too complicated,” said House Energy and Commerce Committee Chairman Cathy McMorris Rodgers, a Republican from Washington state. mood on the floor in the House. The bill passed 320 to 71. The new bill “lowers costs for Americans through greater transparency of health care prices,” McMorris Rodgers said.
But while transparency has many fans, including consumer advocates, it has few outside the Republican party have seen the bill as a silver bullet to providing Americans with affordable health care.
The bill “is a huge step forward,” said Patricia Kelmar, health care campaign director for the US Public Interest Research Group, a consumer group that lobbied for the bill.
“It's such basic information that consumers just deserve to know,” Kelmar said, adding, “There is no one solution to high health care costs or prices.”
Healthcare has consumed an increasing share of gross domestic product since the mid-twentieth century 5% of GDP in 1960 to over 18% in 2022. Today, the U.S. spends an average of more than $12,000 per person on healthcare.
Individuals have increasingly borne the brunt of these skyrocketing health care prices over the past decade, thanks in part to a philosophy that has dominated political discourse on health reform since the turn of the millennium.
The ideology, often promoted by Republicans, emphasizes that patients are “consumers,” promotes the need for “personal responsibility” and requires people to have “skin in the game” (read: money).
With this ideology in mind, Republicans helped popularize the “consumer-driven” health care plan by creating a tax-free savings plan coupled with health insurance with very high deductibles.
Patients are now often referred to as high-deductible health plans and have to spend thousands of dollars before insurers start paying the bills. as much as $9,050 per year for individual plans.
Over the past decade, large employers have found these plans particularly attractive, even as they are blamed putting patients in medical debt. The overall high-deductible health insurance market grew from just 4% of employer-sponsored health plans in 2005 to 28% in 2022. About two-thirds of Americans who work for large companies (more than 1,000 employees) now have high own risk. plan.
When Democrats passed the Affordable Care Act in 2010, these plans went largely untouched. At the time, the most prescient issue in health care reform was seen as providing insurance to millions of people who had no way to obtain it. In some ways, these reforms have succeeded: the percentage of people without health insurance in the US has never been lower, and is currently fluctuating about 8%, or 26 million people.
But the number of people who are below-insured, or who cannot afford to use the insurance they have, has been steadily growing with the popularity of high deductible health plans. In 2022, 43% of working-age adults were inadequately insured Commonwealth Fund.
“This is really the Republican ideal of a health care system,” says Eagan Kemp, health care policy advocate at Public Citizen, of today's American health care system. “You can get maximum profit out of it, it is the wild west compared to comparable rich countries.”
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It's also easiest for Republican members of Congress to agree. Donald Trump, the front-runner for Republican presidential nominee, continues to advocate repealing Obamacare even though it is broadly popular. An attempt to repeal the ACA failed dramatically in 2017. Hospital transparency was introduced two years later by executive order. From February 2023 only a quarter of hospitals has complied with the law.
“The real problem is often inequality of information and inequality of bargaining power – and transparency does not solve the latter,” said Harold Pollack, a health economist and professor at the University of Chicago. “Many of the high prices in medical care are not the result of a lack of transparency. They come from the pure ability to ask what they want to ask.”
In addition to the lack of bargaining power — Pollack compares the power imbalance between patients and hospitals to playing a one-on-one basketball game with LeBron James — there are also vulnerable moments when people need health care, and comparison is simply unrealistic. To take just one example from Pollack's life, there was an incident a few years ago in which his wife required emergency cardiac care.
“At the time, I was a health care research expert and I wasn't doing any comparisons at all — I wasn't even looking at the relative proficiency in providing cardiac care” between hospitals, Pollack said. “My wife had an emergency – I took her to the nearest hospital.”
Critics of market-based transparency rules argue that getting a knee replacement is not the same as buying a car, and that even if the US health care system were not an opaque and labyrinthine viper's nest of predatory billing, the “demand” for health care would not be the same is like asking for a new mattress. In other words, you can't negotiate from a stretcher.
“The only people who are really doing well are insurers, pharmaceutical companies, some of the big for-profit hospitals and even some of the nonprofit hospitals that have billions in reserves. Those are the people who do it well,” Kemp said. “The people who are doing poorly are patients.”
Public Citizen promotes Medicare for All, a single-payer system that is more similar to the National Health Service in the United Kingdom than traditional private insurance. In that system, payments would be negotiated between the government and healthcare providers – not purchased by patients.
The Lower Prices, More Transparency Act must still be passed by the Senate and signed by Joe Biden to become law. Advocates like Kelmar hope the Senate will pass the bill before Jan. 19, 2024, when Congress faces a self-imposed budget cliff.
The bill also includes a number of important funding measures, including payments to hospitals that provide care to large numbers of low-income people (called Disproportionate Share Hospital payments), funding for community health clinics, and significant cuts to Medicare payments to hospitals that provide care. outside the premises.