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We’ve all seen the stories of outrageous health care bills. What’s next?

We’ve all seen the stories of outrageous health care bills. What’s next?

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Earlier this year Vox launched an ambitious reporting project inviting readers to send in their emergency room bills. Some whoppers showed up like the $18,000 bill a family visiting from South Korea got for making sure their 8-month-old son was okay after he fell off a hotel bed. Vox says what they do with all these hospital bills — some 1,400 to date — will depend on how many they receive, although they continue to write about them with the goal of bringing “transparency to these extremely common but little-understood fees.”

Transparency is good, of course, and arguably has led to the public outrage over the high price of medical care, particularly ER services and prescription drugs. Jonathan Oberlander, who heads the Department of Social Medicine at the University of North Carolina-Chapel Hill, told me “the renewed attention to price regulation right now in health policy discussions is striking.”

Last week came more evidence that one of the favored solutions for solving the problem of high prices — transforming patients into shoppers searching for the cheapest services — wasn’t the answer. A working paper just published by the National Bureau of Economic Research noted that the vast majority of consumers studied did not shop for an elective MRI but instead went where their doctor recommended. In his Upshot column for The New York Times, Austin Frakt argued that if people can’t shop for elective M.R.I.s,” there’s hardly a chance they are going to do so with other health care procedures that are more complicated and variable.”

As I found out during my recent four-month hospitalization for an infection that shut down my organs and nearly killed me, shopping is often impossible. On my first day in the hospital there were billings for 95 drugs, treatments and diagnostic tests. Hospital care, responsible for about half of the system’s costs, is driven by your condition and hardly amenable to shopping once you’re a patient.

The newly reported study is another powerful reminder that consumers aren’t going to shop their way to lower-priced care, and indeed it raises the question: How much more evidence do we need before we acknowledge that the “shopping solution” isn’t slowing the rate at which health costs are rising? I’ve heard this so-called “solution” pushed for more than two decades, and prices are still going up, including for drugs that have been on the market for years.

The current crop of price-of-care stories is mostly about outrageous medical bills and the struggles of patients to pay them, and they are good — some even very good — as far as they go. Take a recent example in the June/July issue of AARP The Magazine about a woman named VJ Sleight, who had two bouts of breast cancer and incurred a barrage of bills that substantially altered her life. The magazine reported that “people who ‘beat’ cancer often face a whole new round of expenses if it returns, and the costs of treatment can double or triple from one diagnosis to the next.” KTNV-TV in Las Vegas weighed in with its story of the family of a 9-year-old girl who got gasoline splashed in her eyes when she was learning how to pump gas. They went to a local ER and were told to spend more time washing out the girls’ eyes. Her parents got a $600 bill from the hospital and one for $800 from the doctor. They, too, were outraged. And a few weeks ago a woman’s leg got stuck in the gap between the train and the platform in Boston’s subway system. She begged those around her not to call an ambulance. “It’s $3,000,” she yelled. “I can’t afford that.” The New York Times editorialized, “The clear and urgent need for medical attention is weighed against the uncertain and potentially monumental expense of even basic services, like a bandage or a ride to the hospital … This discord, between agony and arithmetic, has become America’s story, too.”

Outrage, however, over high health care prices  — whether for a fancy new cancer drug, a humdrum insulin pen, or an ambulance ride — aren’t resulting in any systemic changes to America’s health care cost problem. Anecdotes have yet to coalesce into a movement that calls for serious price controls or other measures that will put the lid on rising prices. A one-off story here and there about the Jones family angry at a high ER bill won’t result in significant change. Even sustained series, like those from Vox or Kaiser Health News’ Bill of the Month, have yet to become catalysts for change. Price outrage stories have been great for boosting awareness, but the next batch needs to take a harder look at remedies and the politics that prevent significant change. As Vox’s Sarah Kliff acknowledges in her series’ overview, “Health care prices are unlikely to fall without some level of government intervention.”

“Price regulation is the foundation of health care cost control in countries outside the U.S.,” health policy expert Jonathan Oberlander told me. But in the U.S., health care spending amounts to someone else’s income, so health system stakeholders historically have sought to evade price regulation. “The fragmented system of government in the U.S. is permeable to interest group pressure.”

That means reporters will need to move beyond ER bills and drug prices. Bob Herman, who covers hospitals for Axios, recently implicated the nation’s hospitals for their role in America’s pricey medical system. As he points out, the hospitals aren’t saying much about high prices, unlike the drug companies, which have said they will roll back, freeze, or delay some of their planned increases — basically a cosmetic response to high pharmaceutical prices. When Herman asked 27 of some of the highest-priced hospital systems in the country whether they planned to follow the lead of the drug makers, none said they would. Most declined to respond or comment. Yet it’s the rare news outlet that challenges the prices of the local hospital, or shows how they compare to competitors.

I asked Oberlander why the U.S. has such a hard time controlling health care spending when other countries are able to do it, even while covering all their citizens and enjoying better outcomes. “Price regulation is the foundation of health care cost control in countries outside the U.S.,” he told me. But in the U.S., he noted, health care spending amounts to someone else’s income, so health system stakeholders historically have sought to evade price regulation. “The fragmented system of government in the U.S. is permeable to interest group pressure.”

The politics of price regulation are daunting, but that could change. “Price regulation, common in other nations, is extraordinarily difficult to adopt here. Difficult, not impossible,” Oberlander said. As evidence continues to roll in that the latest fad for addressing high prices — shopping for health care like cars and computers doesn’t work — maybe policymakers will embrace other approaches as the public exceeds the limits of what it can pay. A few years ago, Oberlander and his co-author Theodore Marmor explored the failure of the U.S. to control health care spending. In an essay in the Journal of General Internal Medicine, they traced U.S. cost control efforts through HMOs and Accountable Care Organizations. Their prescription: The U.S. needs less innovation and more emulation. Other countries have overcome the sway of interest groups and figured this out. “Global budgets, fee schedules, and system wide payment rules may not be modern, exciting, or ‘transformational.’ But they have the advantage of working.”

Veteran health care journalist Trudy Lieberman is a contributing editor at the Center for Health Journalism Digital and a regular contributor to the Remaking Health Care blog.



[Photo by kate hiscock via Flickr.]


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The discussion of the work of Whitaker and Baxter in relation to their campaign against healthcare was inaccurate in one respect. They did not 'coin' the term 'socialized medicine'. It already existed and had been used by the American Medical Association in the late 1930s as a search in Proquest News & Newspapers will demonstrate. What Whitaker and Baxter did was to supercharge that claim and offer private medicine as a preferable alternative in the same era that 'free enterprise' was also being supercharged by the National Association of Manufacturers --


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