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This Bill Could Shine Light into the Dark Recesses of U.S. Health Care

Marion Mass, MD points out recent updates in the "predatory system of American health care."

August 14, 2023

From 2018 through 2021, the annual cost of the predatory system of American health care rose by 20%, from $3.6 trillion to $4.3 trillion.

In 2018, one of my favorite commentators on that system wrote, “What drives the cost… is lack of transparency, administrative glut, overregulation, and ongoing consolidation.”

In June 2023, the “PATIENT Act,” H.R. 3561 — passed unanimously out of the Energy and Commerce Committee in the House of Representatives.

That’s right. In a refreshing spasm of bipartisan agreement, the committee members of both political parties voted for it.

One of H.R.3561’s features is its promise of exposing certain dark, putrid recesses of American health care, of shining a light into the places where profiteers and parasites thrive.

Led by Republican Rep. Cathy McMorris Rogers of Washington and Democrat Rep. Frank Pallone of New Jersey, the proposed law seeks to build upon recently enacted — and aggressively flouted — transparency requirements imposed by both the Biden and Trump administrations upon hospitals and insurers.

It’s enough to make one think that someone in Washington is actually offended by the fact that the healthcare system’s apex predators — hospitals, insurers, and pharmaceutical and supply chain middlemen, among others —have been hiding something from the American public. After all, could it be possible that lack of price transparency has played a part in the healthcare sector’s staggering rates of inflation year after year?

 

Consider hospital costs. They are the biggest sinkhole in our healthcare landscape, making up about 31% of the trillions spent each year. Yet even though hospitals feed with gusto at a trough maintained by the nation’s taxpayers, they have managed to conceal the financial arrangements they work out in deals with insurance companies.

Would a little scrutiny on how tax dollars are spent be too much to ask?

In the world of prescription drugs, pharmacy benefit managers (PBMs) are powerful middlemen who dictate which medicines insurance companies will cover. Their poorly understood role in the nutty extravagance of American health care is a subject too vast and intricate for development here. You may know the names of the biggest PBMs — CVS Caremark, Optum, and Express Scripts are three of the biggest. More than a few people believe that the PBMs are entitled to a place of honor in a Healthcare Profiteering Hall of Fame.

 

In the world of prescription drugs, pharmacy benefit managers (PBMs) are powerful middlemen who dictate which medicines insurance companies will cover. Click To Tweet

 

H.R. 3561 also trains a spotlight on PBMs, threatening their murky system of legalized “rebates” that are otherwise indistinguishable from kickbacks gouged from pharmaceutical manufacturers, thus contributing to inflationary pressure.

However, H.R 3561 goes even further by seeking to illuminate who owns what.

How many people understand that for years the number of physicians who own their own practices has been shrinking rapidly?

 

"Would a little scrutiny on how tax dollars are spent be too much to ask?"

 

Most physicians have become employees under the control of hospital corporations, private equity firms, and the PBM-insurance complex.

It doesn’t take a wildly astute reader to see the room for conflicts of interest and mischief in these arrangements, for which the word “incestuous” may not be too strong. Does anyone really think that the Hippocratic Oath and the interests of sick patients could possibly win in a face-off with the interests of corporate shareholders?

Despite the unanimous passing of H.R. 3561 from Energy and Commerce, the Ways and Means Committee put out their own bill, H.R. 4822, which excluded transparency for private equity ownership and medicare advantage plans. This was pointed out by the Ways and Means Health Subcommittee ranking member Lloyd Doggett (D-TX)  in his eloquent opening statement.  Less transparency is always a worse option, Representative Doggett is on target that H.R. 3561 is superior.

 

But let’s not kid ourselves. H.R. 3561 does not blow up this country’s increasingly consolidated and corporate health care — a fact that probably helps explain how the bill obtained bipartisan support.

It merely mandates more light for the exposure of the crushingly expensive mess created by the economic ground rules put in place for the healthcare sector by earlier Congresses.

There’s this wacky article of faith among our nation’s exhausted idealists. They believe that people in government should work not for themselves and their cronies, but for the citizenry and the wider public good.

H.R. 3561 is a bouquet tossed in the direction of the weary.

 

 

Please, take a few minutes to let your congressional representatives know that their support for the bipartisan HR3561 legislative bouquet would help cover the stink often associated with the body in which they serve. Urge their passage of the bill. Then hector your senators to get cracking and finish the work.

Maybe, just maybe, once the light shines and transparency reigns, the Congress of the United States will see things clearly enough to start disinfecting a system with dark and putrid recesses where the American people are plundered.

Note: Original piece published in the Bucks County Courier Times.  Additions made after Ways and Means transparency hearing.

Marion Mass, MD

Marion Mass, MD

“If I can do this, anyone can… I am a recovering soccer mom and a community organizer with an M.D. We can and should take back the stewardship of medicine for the sake of our patients and the future!”

All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. For more information, or to submit your own opinion, please see our submission guidelines or email opmed@doximity.com. Do you have a compelling personal story you’d like to see published on SoMeDocs? Find out what we’re looking for here and submit your writing, or send us a pitch.

All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. Do you have a compelling personal story you’d like to see published on SoMeDocs? Submit your own article now here.

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