Rising healthcare costs have plagued the USA for many decades, and unfortunately, these costs often fall on the unsuspecting consumer. This has manifested itself most egregiously in the prevalence of “surprise billing” from emergency hospital visits.
Surprise billing occurs when a patient goes to a hospital seeking emergency care and is afterwards presented with an unusually pricey bill. This typically occurs because the patient has gone to an out-of-network provider (i.e. their insurance does not have a working contract with the doctor that treated them), so the hospital can charge the patient high, non-negotiated prices without consequence. For example, patients have been charged upwards of $200 for an over-the- counter medication that retails around $15.
This situation is difficult to remedy after the bill has been presented. The healthcare industry is unique in its lack of price transparency. Since the average consumer has no idea what the standard price is for a healthcare procedure, it is very difficult for them to negotiate prices with the hospital. Patients who are successful in this endeavor typically have some institutional knowledge (perhaps some higher education or a doctor in the family) and they have the time and resources to withstand mountains of paperwork, long wait times, and a great deal of frustration.
All the issues described above are problematic to the average consumer, but the burden is heaviest on marginalized and low-income communities. The American healthcare system is incredibly complex, and it requires some level of special knowledge, connections, money, and English proficiency to navigate. Specifically, emergency rooms, where most surprise billing occurs, tend to be a frequent destination for low-income individuals and families who do not have health insurance. Going to the emergency room could result in an extraordinarily high bill, but foregoing treatment out of fear of high costs could result in more severe health and financial issues down the line. It is simply unacceptable that our healthcare system places such a huge burden on the most vulnerable members of our society.
I would strongly recommend that Congress focus on passing strong legislation, such as that proposed by Senator Maggie Hassan, which seeks to use the existing multi-actor situation to make the environment friendlier for consumers. This bill proposes that the insurer and provider engage in a “baseball-style” negotiation process where they both put forth a price for the service provided and an impartial arbiter makes the final call. This reverses the current incentive to simply go with the highest quote.
However, I would caution that there is a bigger problem to be solved. Our current American healthcare system favors insurance companies and healthcare providers rather than the patient. With the abundance of actors in the healthcare system, it is almost impossible to lower healthcare costs in any significant way despite bipartisan calls to do so. I hope to use my undergraduate education in health policies and economies, along with my future legal education, to restructure this system and return the power of health and wellness to the patient.
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