AMAC Action In The Media / Opinion / Politics

Fighting for Transparency in Health Care

health careLast June, President Trump issued an Executive Order instructing his Health and Human Services Department (HHS) to create a rule that would require hospitals to disclose the prices for medical services they negotiate with insurance companies, in addition to the cash prices they accept for specific procedures. These “shoppable” medical services include those that are commonly offered by multiple providers. The Executive Order’s intent is to equip patients with the information they need to empower them to shop for health care services much in the same way they do for every other purchase they make throughout their lives. 

The information would be accessible electronically in an easy-to-read format and allow for patients to compare the real prices for their care, not an estimate, average or out-of-pocket cost. They would then be able to make informed decisions based on cost and quality of care.

Imagine knowing the cost for a knee replacement from hospitals in your town before having the surgery. Further imagine the impact this kind of pricing transparency would have on the cost of the procedure. Hospitals would actually compete with each other for your business and we all know how competition benefits consumers. How about having the option to choose a cash price for a service if it’s cheaper than an insurer-negotiated price? Gone would be the days of receiving health care only to find out its true cost after you’ve been treated. This transparency would also protect patients from the predatory “surprise billing” business practice where hospitals invoice patients, again, after they’ve received treatment, for an exorbitant sum from an “out-of-network” provider from whom they had no choice in receiving care.

AMAC – Association of Mature American Citizens recently joined an Amicus Brief with other patient advocacy groups supporting the President’s price transparency initiative. The brief argues that, among other things, hospitals routinely disclose prices in their explanation of benefits statements (EOB). So, their prices are not truly “secret”, they’re just disclosed after it’s too late for patients to have a choice in more cost-effective care. One would think that this disclosure in the EOB would negate any First Amendment argument.

Price transparency in health care is a vastly popular issue among Americans, regardless of their political persuasion. According to a Harvard-Harris poll, 88 percent of Americans, including both Democrats and Republicans, say they support government mandates for hospitals and insurance companies to show their prices.

Hopefully, the Court will recognize how price transparency in health care leads to a competitive environment for medical services and drives down costs for Americans. If it sides with the amici and grants HHS’s motion for summary judgement, AHA’s case would be dismissed and the transparency rule will stand. And a positive step towards meaningful health care reform will be taken.

Andrew Mangione is Senior Vice President for AMAC’s advocacy affiliate, AMAC Action. He leads AMAC’s grassroots efforts, represents AMAC’s membership in Washington, D.C., and helps chart the association’s policy course. He also serves as a national spokesperson.

Reprinted with Permission from - Townhall by - Andrew Mangione

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1 year ago

Using the EOB argument for disclosing prices is a non-starter. It’s nearly impossible to determine prices from this document. The only thing you get from EOB’s is what insurance companies are willing to pay, which is much less than the “charge.” No transparency at all.

Margaret portman
1 year ago

BeRst health ins supplement after medicare???

My major med is going up 150%.

1 year ago

One of the few industries that do not disclose prices for their services. Then when a person that has Medicaid they just pile on the cost because they know they will get paid. Between Medical and politicians they are putting the shaft to the American public. How did this start? Industries paying off politicians to pass laws that benefits their bottom lines. Definitely time for term limits for all politicians including federal judges!!

Michael J
1 year ago

Transparency in health care, then what?
Those people who get free medical could care less what it costs and only those who pay complain about the cost.
Politicians express fake outrage for obscene medical costs, but in reality they don’t pay either. As for hospitals and pharmaceuticals, they are not concerned because they know somebody’s going to foot the bill.

Pat R
1 year ago

I’m rooting for transparency. After-the-fact pricing leaves open door for gouging. When you see the price of surgeries, gouging may already be in use.

Li Ryder
1 year ago

I do not believe hospitals are chosen bAsed on price of surgery. I believe they are chosen based on one’s surgeon affiliated hospital. All the physicians with I have had surgery were connected with a particular hospital or hospitals. None did surgery wherever I wanted to go. Often the surgeon is chosen because of a particular affiliation with a reputable hospital.

1 year ago

Hospital transparency should be no different than at an automotive repair shop. Would you have repairs on your car and hope not to receive a double or triple bill when the mechanic is finished

Gail P.
1 year ago
Reply to  Steve

The answer is that I always hope not to receive a double or triple bill from my umpteen auto mechanics used over the years. Good luck with that! Transparency is also very much like dealing with the used car dealer guy whose service is in terms of payment for services, “as is”. No choice of recourse.

James S
1 year ago

As a retired physician I have watched Corporate America take total control of the health care system with the attitude that if we all increases prices corporate medicine benefits. They have been looting the system for 30 plus years. Forcing hospitals, pharmacies, drug companies, medical device companies and medical clinic companies to disclose prices ahead of service provided would greatly limit the current abuse and place competition into the system.

Jim Fagan
1 year ago

I hope this change included prescription drug pricing. Why can Americans buy the same drugs overseas for half the price? Congress protects Pharma.

1 year ago

I’m sure the Dem’s will fight this tooth and nail.

1 year ago

How much is liability insurance & lawsuits adding to cost of medical care??????? A lot I would bet. We need tort reform!!!!!!!!!!!!!!!!!!!!!!!!!

Gail P.
1 year ago
Reply to  JohnH

We need insurance company reforms. Blue Cross is definitely not without fault in all of this price gouging.

1 year ago

A lot of insurance companies have a list of doctors that network with them.. My insurance/bill shows hospital cost for xxx and then it shows the amount that insurance will pay for this xxx procedure. Seems like the insurance companies are already putting pressure on costs of medical care. If you go out of network or do not have insurance, you might be at the mercy of ??? but you should try to negotiate a payment plan that you can meet

1 year ago

I wonder if Trump is still considering his statement of “buy prescription drugs from Canada if US producers do not drop price”. Sort of goes against the buy America grain

Ed J
1 year ago
Reply to  JohnH

True regarding the “Buy America” sentiment. However, sometimes reality must prevail. In 2018, my wife required some life-saving medication. Prescription price at Walgreens was quoted at $1,200 and at CVS was quoted at $800. Had the prescription filled across the border in Mexico for $73.

Allan Brem
1 year ago
Reply to  Ed J

The interesting thing about the Buy America thing is the origin of the medicine. It is arguable that American made medications are sold to countries at a lower price than they charge in the US. Those countries then sell the medications to US citizens at that price plus a small margin of profit. Personally, I suspect that many medications coming from Canada originate in the US>

1 year ago

All this transparency is all good and great, but the hospital bill doesn’t cover the doctors bill. If you are going to require the hospitals, then you need to include the doctor’s charges, otherwise listing the hospital bill is deceptive.

Stephen Lykins
1 year ago

Since the hospitals don’t want price transparency, require them to pay the additional charges for out of network doctors when the patient is otherwise in network!

1 year ago

The same issue with prescription drug prices. The pharmacy in not able to quote the co-pay amount until prescription is filled, but not before that. Pharmacy benefit managers are running the show in great secrecy.

Donald Lonhart
1 year ago
Reply to  Stan

I am a retired pharmacist. I have my doctors give me RX for 100 tablets at a time and I
have them filled at Costco for cash, no insurance. They cost less than co-pays at insurance

Old Silk
1 year ago

These people advertise their hospitals and other facilities, as does big pharma. They are businesses, and truth in advertising applies to them too.

Brenda Blunt
1 year ago

ALL legal American citizens should know in advance what they are paying for. This also includes Congress. There are too many middle people involved and that is why prices are up along with CEOs thinking they need an eight digit salary.

Press ONE for English
1 year ago

I’m not sure what to think about this. The article makes many good points, and there are undeniable benefits to price transparency. But there’s a flip side as well. The article says, “…and we all know how competition benefits consumers…”. This is certainly true if you are talking about cans of beans. One can of beans is much like another, and if you can get the beans for a buck instead of two it is a win. But doctors are not alike. Hospitals and surgery centers are not alike. Procedures are not alike, either, although they may seem so to those of us (like me) who are largely clueless about most medical specifics. I’ll throw in the old adage, “you get what you pay for”. It is pertinent here. I will tweak the article’s quote to offer another truth: “We all know how competition leads to cost cutting, cutting corners, and resultant declines in quality of outcomes .” I don’t know about you but when I go in for a medical procedure I want the BEST procedure I can get not the cheapest. Not the fanciest, if a hospital stay is required I would not hold out for a private room or other amenities, nor would I demand things that are beyond the scope of what is required to get the job done. I just want the best job. And there’s more.

Again, from the article: “How about having the option to choose a cash price for a service if it’s cheaper than an insurer-negotiated price?” This may be the murkiest and most confusing part of the article. How would this work? I am having an appalling sum of money extorted from me every month for Medicare Part B. If I find that a procedure can be had for a lower cash price than what Medicare gets billed, am I supposed to go out of pocket just to get a lower price? That’s ridiculous. So far, knock on wood, I have been a net profit for Medicare as I never accumulate annual bills that come close to absorbing even six months of premiums. And now I am supposed to start paying out of pocket? That’s insane.

There’s plenty of room in the medical realm for financial improvement. I’m not saying stay the course without change. We must, though, keep the law of unintended consequences in mind, and make sure that any “improvements” made do not turn out to be harmful to us. I do NOT want to be forced into accepting a substandard procedure (or doctor, or hospital) just because it is the cheapest.

John Karkalis
1 year ago

“Beware of unintended consequences”. Sage advice indeed.
I am a chemist, not a physician. You make an excellent point that I cannot be expected to understand the argot and the arcana of the medical profession; nevertheless, it is my responsibility to do my homework: 1. Is the physician board certified? 2. How many procedures of this type has the physician performed?
Certainly there is a clear qualitative difference between selecting a physician and selecting a refrigerator.
All the more reason for me to do my homework conscientiously.
So far as paying more in Medicare and secondary insurance deductibles? Yes, they are often more than the cost of most procedures.
Knock on wood, I remain a healthy 80 year old with the aches and pains incumbent on one who has exceeded his allotted “Three score and ten”, but I am comforted knowing I have that “backstop” should I need a complicated procedure.
After all that, I do favor greater transparency.
I enjoy your thoughtful posts .

L Ryder
1 year ago

Perhaps if the physician is reputable, he will affiliate with the best hospital(s). Also one would hope that he/she works with the hospital for reasonable costs. I , too, believe that the patient is looking at the skill and reputation of the surgeon, not the costs. We have to finally trust.

tony d willIiams
1 year ago

That would be wonderful.
We were visiting my son in Phoenix, Az. Our youngest, CP, open spine, unable to speak, low motor control and a Grand mal disorder began to seize over & over. He was taken to hospital B. They never worked on him while I was in the room. I left mornings to go to a hotel to sleep for a couple hours. Whenever I fell asleep in his room they woke me up.
I provided our insurance info to them. A rep from our insurance called and said to let hospital B do whatever they needed to do. This surprised me as Kaiser has sent a plane to bring my son and I back to our home hospital before.
When we left I was handed a massive bill, not itemized. Seems they did a lot when I wasn’t there. I fed him through hs G tube when I was there. I contacted Kaiser to check about billing and they were never called. I contacted hospital B and they told me if I didn’t pay in two weeks it was going to collections. Wow, out of hospital and straight into collections.
I spoke to their billing department again, same conditions.
I mailed hospital B a registered letter stating my position, and their actions. I requested a fully itemized bill including ambulance charges, the name of the person who stated they were from Kaiser, and a billing/payment system I would be able to work with. I am forced into retirement by disability, this was not mentioned.
The hospital B called me on the telephone, apologized and said I did not need to pay. I requested again same as on letter, I pay my bills. They refused to send me an itemized bill and stated we would not be charged, said bye and hung up.

I guess they did not want transparency.

Old Silk
1 year ago

You held their feet to the fire. That’s good.

John Karkalis
1 year ago

Tony d, your experience is the stuff of nightmares.
So much for “compassionate care”!
Thank God! you persevered until the nightmare was resolved, more or less.
I am not in the least surprised you are a member of AMAC.

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