Regarding the Sept. 2 editorial “An epidemic of financial toxicity,” I agree that charges by out-of-network providers are often unconscionable, but if we don’t allow them to set their own prices, who should set prices for them?
In one proposal being considered by the government right now, the prices would essentially be set by hospitals and insurers based on their agreements for in-network providers. Out-of-network providers are out-of-network specifically to avoid having these two groups negotiate their prices for them, and they shouldn’t be dragged into accepting fee schedules against their will.
The proposal to let insurers and providers sort out the price after the service has been performed is an even worse idea: It allows the purchaser to decide on a price for a product that has already been irretrievably delivered. That’s as if somebody stole my car and called me an hour later to tell me how much he’ll pay me for it. I shouldn’t expect much under those circumstances.
The only entity that can set prices prospectively for services is the government: This is the attraction of Medicare for All or something similar. If a doctor wants to see Medicare patients, they have to accept Medicare’s price for their services. The only decision the doctor has to make is whether or not to see Medicare patients. This has been an imperfect solution for patients already on Medicare, as it has made some services regrettably scarce (gerontologists) and others unnecessarily abundant (cataract surgeons), but it has solved the problems of price transparency and price-gouging.
Dr. J. Timothy Ames