shefaliluthrakhn

Great question. Health care costs are a big, big public policy concern, and they have been for quite a while! But alas, in health care, nothing is ever simple. (The ACA was more than 900 pages!)

A lot of wonks have studied this: The big issue is that, compared to other countries, we simply pay a lot more for hospitals, for outpatient care, for prescription drugs, etc. Some people say single-payer, or an expanded public option is a good way to address this.

The ACA also pushed some experiments to try to pay hospitals for better outcomes, or to penalize them if people kept coming back sick. It also built an “innovation center,” whose whole job was to experiment with new ways to pay more efficiently for health care – moving away from the so-called “fee for service” model and instead “paying for performance.” We have seen some results start to trickle in, but nothing revolutionary yet. This week, though, officials from the Trump administration signaled they’re interested in trying to continue those experiments. So that could be something.

Drug costs are also of course a big concern – but so far, no one really knows WHY drugs cost as much as they do. (This is why states are pushing “drug price transparency” laws.) Other nations, like Canada, have cost controls, but those also come with their own tradeoffs.

Tl;dr: there are no “simple” changes to fixing the cost of health care. It’s a big issue, and one that lawmakers could tackle, but it requires lots of serious thought, effort, and time!

Wow! That is such a fascinating story. Would you be interested in submitting it to our bill of the month project? Our team of reporters is investigating crowd-sourced medical bills and trying to shed light on what happened and what consumers can do. (Link to submit here, if you're interested: https://khn.org/send-us-your-medical-bills/)

Two thoughts on this, mostly on the front of how people can and are rethinking billing structure:

1) This is where we come back to being a sharp consumer. Even after an ER visit, you patients can – and probably should! – try to negotiate, see what was actually provided, what other health plans pay for this care, etc. You can probably end up paying less than appears on the billing statement.

2) KHN is actually diving into the very question of medical billing. We’ve been partnering with NPR to crowdsource patients’ medical bills and then try to investigate what actually happened, why they cost so much, and what sort of weird charges and such get added on. It’s a fascinating project – our first story is the one about the $17,850 urine test, and the next will come out later this month. If you want to help us answer this very question, please send us your crazy bills! https://khn.org/send-us-your-medical-bills/

Direct-to-consumer advertising is such a controversial issue, especially when it comes to pharmaceuticals.

We’ve seen drug companies use this to market drugs when they aren’t universally recommended or needed. Meningitis B is one example I’ve written about – it’s an uncommon disease that can be deadly (but is also treatable!). The vaccine is not universally recommended, because it’s such a rare disease (and such an expensive vaccine!). So its manufacturers (Pfizer and GSK) have pumped up advertising. It’s made doctors and some industry watchers pretty uneasy, and some experts argue that this kind of approach bolsters sales of health care that maybe isn’t necessary.

Many pharmaceutical companies and doctors would argue that money / donations don’t influence prescribing decisions. But it’s controversial, and there have been steps toward addressing it. The ACA created an Open Payments database that requires drugmakers to report what they give to doctors and hospitals, and it publishes them online.

There’s also been some really good journalism on this. ProPublica, another nonprofit news outlet, did a fantastic project called Dollars for Docs: If you want to see whether your doctor has gotten money from a drug company, I recommend their database! https://projects.propublica.org/docdollars/

I’m also linking to two stories KHN did on direct-to-consumer advertising – my meningitis B story and another by my colleague, Julie Appleby: https://www.nytimes.com/2017/09/07/business/meningitis-b-vaccines.html https://www.nytimes.com/2017/05/12/business/media/pseudobulbar-affect-drug-advertising-sales.html

This is an important point to consider. Hospitals have what's called the Chargemaster rate – which is the list price. This is a far higher price than what insurers pay or what Medicare pays. If someone is simply paying for a service out of pocket and a) doesn’t ask a question and b) doesn’t get financial assistance, that person could easily be billed the full Chargemaster rate. (Hospitals are required to offer financial assistance for lower-income patients, but many don’t discuss it until the patient asks.)

My editor, Elisabeth Rosenthal, wrote a series on this when she worked for The New York Times. It’s great. https://www.nytimes.com/interactive/2014/health/paying-till-it-hurts.html