The following op-ed was submitted to The Capitolist by Leslie Dougher and represents the opinion of the author.
Now that Congress is back in session, our lawmakers must finish a task they started earlier this year—and that is passing common-sense legislation that once and for all eliminates the problem of surprise medical billing. As someone who has served the best interests of Floridians both as its governor and now as senator, I trust that Senator Rick Scott will help lead on this issue.
Surprise medical billing happens most commonly as a result of patients unknowingly receiving out-of-network care. During a medical emergency, patients often have little say in which hospital or ER they are taken to—if they even have the ability to provide input at all—so they can easily end up an out-of-network facility. However, even if patients are treated at a hospital they know to be in-network, there is still a fairly good chance that one of the physicians or specialists they are treated by won’t be contracted with the same insurance company.
Either way, patients are left stuck with high, unexpected medical bills that come weeks or months after patients have received treatment. This creates financial burdens that no one still recovering from surgeries, medical treatments, or illnesses should have to worry about. Clearly, this is a problem that must be solved at the national level; however, members of Congress must be sure to pass the right solution as not all the ones that have been proposed would be good for patients in the long run.
One particularly harmful proposal would attempt to fix surprise billing by getting the federal government more involved in our health care system. Known as “benchmarking,” this approach would lead directly to government rate-setting, giving the government broad authority to determine physician rates. By setting artificially suppressed rates, this method could end up undermining our entire health care system.
Essentially, benchmarking would end up costing local hospitals and ERs across the country hundreds of millions or even billions of dollars. As these financial losses mount, rural hospitals in particular would end up having to scale back services and could even be forced to consolidate or close down altogether. That would mean fewer options and higher prices for patients. That is what naturally happens under government price controls.
Congress should pass a different solution that fixes the problem of surprise medical billing without blatantly skewing the free market and undermining access and affordability for patients. Independent Dispute Resolution (IDR), as has been outlined in other legislative proposals, offers just such a solution.
IDR would create a fair, transparent negotiation process for providers and insurers to negotiate out-of-network payments in good faith, giving each side a voice in the process. An impartial mediator would make the final decision based on a number of factors to ensure a payment reflects the true market value of the services provided. Along with the initial payments to providers, this approach would help keep rural health care facilities strong so that no one’s access to care is compromised. Ultimately, IDR is the only proven, market-based approach under consideration right now.
Congress has a good start on this issue—now it is time to finish the job. Senator Scott has always been a vocal champion for leveraging the free market to help lower health care costs and increase options and access for patients, and this issue is no different. I believe Senator Scott will continue to lead by supporting and ultimately helping to pass common-sense legislation that includes the IDR framework to eliminate surprise medical billing without getting the federal government needlessly involved in our health care.
Leslie Dougher is a former Chairman of the Republican Party of Florida.
Photo by 401kcalculator.org via Flickr.