Just pass a law

President Biden outlined his strategy to deal with inflation. Here is one element.

Lower prescription drug and healthcare costs: The administration called on Congress to fix the “family glitch” issue in the Affordable Care Act that keeps hundreds of thousands of families from qualifying for premium tax credits, pass laws to lower prescription drug costs and health insurance premiums, and allow Medicare to negotiate drug prices and make other reforms to prescription prices.

Investopedia

I am always amazed when politicians seek to solve a problem by attacking the end result and not the cause. Will passing laws to lower prescription costs and health insurance premiums have a lasting impact without consequences? Not likely because the drivers of costs remain.

This strategy is like trying to help a person pay their credit card debt while they continue to charge new spending.

8 comments

  1. Disagree. Another vote-buying exercise. He can have 50 stand behind him as he signs it into law, then hold it up over his head on the campaign trail. With respect to the “family glitch”, employers will likely raise the cost of dependent coverage to “push” individuals to consider marketplace coverage (increasing opt out rates, and increasing taxpayer spend). And, with respect to insulin copays, that will simply shift the costs to other products, services, Rx, etc. within the plan. In both situations, individuals will pay more to subsidize others – either in their own employee contributions, a reduction in wages to offset the increased cost of coverage, and/or increased taxes.

    As you may already know, generally speaking, only those who get substantial taxpayer subsidies enroll in the public exchange for coverage.

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  2. The first thing I would like to see is a “truth in medical billing act” law before mandating a “price fixing” law.

    I was just reviewing my latest EOB this morning. Total amount requested / billed was $528.00 The allowed amount from the insurance company (including copay) was $75.68. $281 was billed for the doctor office visit and $247 was billed for a urinalysis sample collection which was sent to Labcorp. The doctor accepted payment of $72.87 for the office visit and $2.81 for sterile sample cup. Labcorp billed $72.00 for the urinalysis and accepted $7.75 for the test. In total, $600.00 was billed and they accepted $80.62 or only 7.87% of what they asked for. Now I find it hard to believe that the cost to transport the urine sample to the lab at the opposite end of the state and testing supplies were less then $10.56. But it must be true because the lab is in business to make money and they are still in business.

    Now if I didn’t have insurance, would I have been billed $600.00 or $80.62? I am willing to bet that the same is true for drugs. Medicare reimbursements are less than most insurance companies, which is too low in some cases. I know this because some “for profit” hospitals have closed because they could not make money. This makes “non-profit” hospital dependent on fund raising efforts to makeup for the charity care and shortfall in reimbursements which is just another cost shifting measure and hides the true cost.

    My point here is that I don’t think you can mandate any price control or any price cuts until you know what the real prices or costs are. Make a law that providers can only bill everyone regardless of insurance at one rate and accept only what they bill, nothing less. Some insurance companies will have to pay more, some doctors will have to accept less. If the doctors bill too much, they may lose patients because insurance companies won’t pay the bill. This will stop having patients subsidized other patients and people without insurance or with good insurance. This will also help stop patients from being ripped off and paying for the shortfall in the insurance subsidies.

    Until we know what the real cost is, how can you demand price cuts? If you legislating a 10% price cut, is that on the $600 or on the $80.62? Or are the providers just going to raise their prices by 20% to make up for the 10% price cut?

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    1. Socializing medical industry in our capitalistic country? Sounds like the start of a slippery slope to me.
      While working insurance did not pay for my blood tests, but now Medicare covers and pays 100%. I now chalk up those earlier blood test charges to having to prepay for my lifetime use, similar as we prepay our Medicare Part A hospital premiums during our working careers with payroll taxes.

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      1. I don’t want socialize medicine. I just want honest billing so that you can shop around when you can. I get that insurance companies get to “buy in bulk”. But what is the real price that they are getting a discount on? For capitalisms forces to work, the price has to be known. Fortunately or unfortunately, most of us never pay full price or even know what it is or was. Most people complain about their out of pocket expenses. I also feel really sorry for the people without insurance that get charged the full price and have to pay 92% more than my insurance company and I paid. If I had to pay $319 for a urinalysis and I found out that I could have gone to Labcorp and paid only $72, you know that for the next lab test, I would be shopping around and not having it collected at the doctor’s office. Maybe I would have only had to pay $10.56 at Labcorp? So what price do the politicians want to price fix?

        For the record, I had no idea that they were going to send it offsite from the doctor’s office either.

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      2. Do you really want to shop the best price for health care? Would you go with the lowest price?

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      3. Do you really want to shop the best price for health care? Would you go with the lowest price?

        Yes and no.

        I want the best healthcare that I can afford and in healthcare I mean doctors and hospitals. So no, I am not going to shop around by price first. Actually, I really can’t shop around. I have to “shop” for in network providers and pick the best that I can find. For some specialties, I don’t get a choice without travelling long distances. In theory, my insurance company has already done that for the price or have they really just found “qualified” doctors who will accept the company rates without a concern for their quality of care? I am settling for low bid care by the insurance company?

        For other things, if I had to pay more out of pocket I would shop around. Like the GoodRx commercials, drug pricing is not the same for the exact same drugs at different drug stores. I always try generic drugs first. I get mail order drugs because it is cheaper for me. Even though my insurance has low copays I do feel for people who do not have insurance. If I had to pay more money for drugs, I would definitely shop around. The same for lab tests. But the fact is so far I have found that everybody takes my insurance for tests so may I assume that they all get reimbursed at the same rates? I also do shop around for glasses considering that Luxottica controls 80% of the major brands worldwide but you don’t have to hundreds of dollars.

        I also try to pick the correct and most cost effective provider in emergency situations. Do I go my primary care doctor, urgent care, or emergency room at the hospital? Sometimes that answer is not easy either. I can shop urgent care centers and but I can’t shop which hospital emergency room unless the paramedics want to fly me somewhere else.

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  3. I enjoy your columns. I remember Nixon’s price and wage controls, Ford’s ‘Whip Inflation Now’, and Carter’s ‘It’s a Beautiful Day in the Neighborhood-Just don’t walk by the Grocery Store or Gas Station.’ I also remember gas at 19.9 cents, June 1969, Burlington, Iowa.

    Thank you

    Louis Peasley

    Sent from my iPhone

    >

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    1. Stop in at Mazzio’s Pizza. Still the lowest price buffet in Burlington. The owner Dann, is my brother. Tell him Gregg sent you.

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