Guest commentary: We have a way to get rid of these surprise medical bills | AspenTimes.com
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Guest commentary: We have a way to get rid of these surprise medical bills

George Bohmfalk
Guest commentary

Most Americans assume that a commercial insurance card in their wallet will protect them from unexpected medical bills. They pay their premiums and deductibles, scour the pages of fine print, and keep up with the revolving door of “in-network” doctors and hospitals. They play by the insurance company’s rules in return for the peace of mind that they will be protected from financial ruin when illness or injury strikes.

But when many insured Americans need health care, they are shocked to learn that their commercial policies are no better than bindings that come loose on the first turn.

Forty percent of privately insured patients face surprise medical bills after visiting emergency rooms or being admitted to hospitals, most often when they are unknowingly treated by an “out-of-network” specialist within an “in-network” hospital. Fortunately, that doesn’t happen at Aspen Valley Hospital, where all hospital-based physicians like ER, anesthesiologists, radiologists and pathologists are required to have contracts with the same insurers as does the hospital. But that’s not the case at most urban hospitals, and it’s nearly impossible to determine that before you’re treated.

Surprise bills can punch major holes in most family budgets. The average surprise hospital bill is $628 for emergency care and $2,040 for inpatient admission. That’s on top of the more than $10,000 families pay in premiums and deductibles each year. Half of Americans say that a surprise $500 medical bill would force them either to borrow money, go into debt, or simply not pay it. It’s no surprise that medical bills are the leading cause of personal bankruptcy, and that the vast majority of households filing for medical bankruptcy are also insured.

Nobody who values patient care and public health would design a system like ours. What makes America’s health care system uniquely predatory is our reliance on private health insurance, whose business model is to restrict patient choice, deny claims and pass more costs onto enrollees. In short, pay less for care, and spend the rest on overhead, marketing and profits.

It doesn’t have to be this way.

Politicians promise to solve surprise bills, but bills to do so are stalled in Congress. The only plan that would permanently end this is single-payer Medicare for All, which would cover everyone in the nation for all medically necessary care. Out-of-network surprise bills would end, because every doctor in every hospital would be included. Patients would never see another medical bill, because Medicare for All would pay doctors and hospitals directly, with no deductibles, copays or insurance paperwork in the way of needed care.

Some people say we should settle for incremental reform like a public option, which would allow some Americans to pay a large premium to enroll in Medicare, Medicaid or some new program. What they don’t say, or realize, is that a public option preserves the worst parts of our broken health care system, including restrictive networks and surprise bills. A public option would do nothing to control overall health care costs and would leave Americans with job-based insurance to fend for themselves. As insurance companies pass more costs onto patients, surprise bills and medical bankruptcies will skyrocket.

I’m sick of our system where insurance companies — not doctors and patients — call the shots and people delay or avoid needed care for fear of surprise bills and financial ruin. But there is a cure. As a physician concerned for everyone’s welfare, I prescribe to Medicare for All.

Dr. George Bohmfalk practiced neurosurgery in Texas before retiring to spend half of each year in the Roaring Fork Valley. He is active in Physicians for a National Health Program (PNHP.org), a physician-driven group advocating for a single-payer health care system. He may be contacted at ImprovedMcare4All@gmail.com.


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