Terry H. Schwadron
July 27, 2019
Well, let’s grudgingly give Donald Trump some credit for taking a rational position to require insurance companies, doctors and hospitals to give us more financial information about the costs we are about to run into.
After all, it’s not every day that you find Trump on the same side as progressives in government.
There are just too many cases of patients finding out after hospitalization that one doctor or prescription was out of network, and now they face a steep bill that had not been anticipated. Apparently, Trump heard some of these stories, and it appealed to the “populist” in him.
That said, this is a policy that costs the president nothing, either in terms of budget or in authority. Indeed, it may even enhance his own re-election campaign a bit, since somewhere in the country, there will be a case in which simple knowledge about a hospitalization cost will prompt a re-thinking, and an alternative, lower charge will emerge.
Besides, Trump keeps promising a health care system that is better than Obamacare without being Obamacare that magically does what Obamacare already is supposed to do, only at lower prices in underserved portions of the country — you know, those areas that call themselves Trump country. This might be one incomplete plank in such a platform.
Trump may need it, since his Justice Department went to court this month to argue for tossing out the Affordable Care Act as unconstitutional — again. Despite two U.S. Supreme Court cases upholding the law, the current case now argues before the Fifth Circuit Court of Appeals that the law cannot be based on a “tax” of required participation in the health insurance plan now that Congress has set that tax at zero. Arguments aside, it will take weeks to get a decision that undoubtedly will be appealed again to the Supreme Court.
The point is, the Trump tribe is looking at health now, and finding little parts and pieces to advance for which they can take election credit.
The Trump administration has won some and lost other attempts to change health policies by fiat. One recent loss was an order to force pharmaceutical companies to list prices for drugs they advertise on television; the court said the administration had exceeded its authority to force the price listings, though this may well be an argument about process rather than substance. On the other hand, the Senate Finance Committee did vote to advance a measure that might help reduce prescription drug prices for a small slice of Medicare patients.
While unusual to find Trump taking a position that we normally would assign to a regulatory approach favored by Democrats, this one fits into anyone’s view of good, passable, consumer-aware policy. Too bad that this president doesn’t stay on this theme and go after prescription drug prices, and the other various outrageously expensive medical bills we all face daily.
But then again, he only sees health (and everything else) as money in or out and not actual health policies that might also bring prices down. Imagine if he pushed the government to ensure good food provisions, attacking hunger and the diseases that cluster around diabetes and obesity. Imagine if he actually looked at mental health services as preventing physical and mental breakdowns. Imagine if he saw well-care as foundational rather than a waste of good taxpayer dollars.
For years, hospitals and insurance companies have come up with negotiated prices for a wide array of services that have remained secret from patients, and even from participating doctors. So, if you take yourself to the emergency room, or you bring a sick baby into a medical facility, who’s to know that the anesthesiologist fees are not covered for this procedure, even if your insurance policy covers the surgery itself? Of course, at that particular moment of surgery or important treatment, concern likely concerns the illness rather than the money involved.
The price arrangements are secret, in part, so that competitors don’t learn about what one contractor has gained from each surgery, for example. As a result, prices for the same surgery varies a lot among different institutions, and certainly from one state to another.
All that said, this is an executive order that Trump has issued and not a law. As a result, it is fairly general in its language, and it remains unclear what exactly must be disclosed to the patient, and there is no enforcement mechanism. These details about making ideas operational actually have become such a pattern as to represent a Trump approach to a problem. Knowing that a hip surgery costs $25,000 to your insurer probably will not make it more or less necessary to solve the kind of pain you are feeling.
For their part, hospitals and medical insurers have been heavily lobbying Congress over such legislation, and they argue that overall, disclosed price lists may well result in higher costs rather than lower costs.
In the recent past, the government has been involved in improving transparency for health care costs in general. Drug companies now are required to disclose fair prices in advertisements, and hospitals are being asked to disclose prices charged to uninsured campaigns. But when they do so, hospitals seem to list the prices they are willing to accept from insurance companies rather than what is charged to full retail patients.
As a result, deductibles for health care insurance policies are increasing substantially, even under the Affordable Care Act. Patients are charged the negotiated price list until insurance coverage starts to kick in.
Hospitals and insurers are likely to appeal to the courts. They want to protect some price information that they see as proprietary. A law requiring disclosure in Ohio has yet to get started after two years.
Whether such price lists will persuade us to go health shopping, particularly when we are disabled or sick. Having the price list does no good if we don’t go shopping for the most price-effective hospital.
Nevertheless, it’s a step in the right direction.
However, “populist” Trump came to it, it is a welcome sign for the country.