Heroes, Hospitals and Transparency

Whether the word “hero” has been overused to the point of meaninglessness during the pandemic is worthy of debate, few would question that health care professionals have done themselves proud in their dedication to serving others, at grave risk to themselves and their families and under conditions that no doctor or nurse should endure.

And some of that magic rubs off on the building where this happened. Without ICU beds and, dare I say it, ventilators, how could the defense against COVID-19 been as valiant as it has? So hospitals get our love too, to the tune of $100 billion in the stimulus package plus whatever additional monies they can glom off the $349 billion in rescue money. And as additional funding gets debated within the bathrooms of Congress, the Democrats are seeking another $100 billion dedicated to hospitals. After all, they’re heroes, right?

The nation’s hospital groups sued the Trump administration on Wednesday over a new federal rule that would require them to disclose the discounted prices they give insurers for all sorts of procedures.

They argued that the administration exceeded its legal authority in issuing the rule last month as part of its efforts to make the health care system much more transparent to patients. The lawsuit contends the requirement to disclose their private negotiations with insurers violates their First Amendment rights.

It’s not their “private negotiations” at issue, but the end result of those negotiations, the charges paid by insurance companies and accepted by the hospitals. If a hospital charges an insurer $12 for a saline drip, why do they charge you $19,478 (I’m making these numbers up, but then, so do hospitals so fair is fair)?

Enter into the mix the now-understood and appreciated fact that hospitals stock up on things they might not need at the moment, like personal protective equipment and ventilators, just in case a pandemic strikes. There they are, sitting in a storeroom in the basement of the hospital, unused and uncharged for, but available in case of emergency.

Somebody has to pay for them. And if they are never used, and neither you nor insurers are ever billed so they exist merely as an expense to the hospital, somebody has to cover the cost. It’s even worse when the stored items have a shelf-life and eventually get throw away or sold on eBay. You want hospitals to be prepared, don’t you?

American hospitals are taking a scalpel to the hands that feed them. They have received $100 billion in coronavirus bailouts from the federal government, and they can draw on the $349 billion in rescue funds for businesses. At the same time, they have the gall to sue the government — to block new federal rules requiring them to come clean about their opaque prices.

Last week, hospital groups ­requested virtual oral arguments in their lawsuit, which has been postponed by the outbreak. Meanwhile, congressional Democrats have demanded an additional $100 billion in hospital funding on the grounds that the original tranche wasn’t enough to cover corona-induced costs.

At essentially the same time, hospitals are beloved as our heroes, and appreciated for what they are and have been capable of doing to save our lives even as government preparedness has fallen a tad shy of responsibilities at times, and yet are in court arguing that the prices charged the big boys shouldn’t be revealed or you’re going to be miffed when you compare them to the deal revealed on your surprise hospital bill.

Clear prices before care are the key to reducing out-of-control health costs. They will allow ­patients and employers, which provide health coverage for 181 million Americans, to shop around for the best quality of care at the lowest price.

Revealing this information threatens hospitals’ sky-high revenues, which depend on a murky price model ripe for price-gouging, overbilling and waste. Hospitals deviously pass on these costs to powerless, often ­unsophisticated patients via bills weeks after treatment.

We have an unfortunate tendency to valorize or vilify based on the one thing, the last thing, in the public consciousness. At the moment, hospitals are wonderful, beloved and adored as the places that allow our heroes to save lives. Indeed, they are perceived as heroes themselves, even if they’re buildings with beds and their respective pans, and inanimate objects can neither be good or evil.

Perhaps the administrators who had the foresight to stock up on a month’s supply of PPE for our heroes are hero-adjacent? In any event, they are not the evil behemoths who send out bills for absurd amounts that destroy lives of the un- and under-insured. And, of course, those who can’t cover the $16,300 deductible and co-pay of Obamacare.

The novel coronavirus doesn’t obviate the need for price transparency — it only reinforces it. The Trump administration has (rightly) announced that the government will shoulder the cost for coronavirus treatments for the ­uninsured. Congressional Democrats want a similar guarantee from health insurers for those in the private market.

America got a free ride on the hospital cost of coronavirus, which is good in the sense that it enabled anyone who couldn’t breathe to go to the emergency room without having to consider the impact on the rest of their lives. Then again, why that shouldn’t be the same for a heart attack or stroke is a mystery as well.

But when payment is mandatory and prices are opaque, providers can jack up rates without repercussions. Price transparency for treatments provides accountability for hospitals, arming patients and ­employers with the information they need to shop for value.

Do people price shop doctors or hospitals? When an emergency strikes, do you call the local ambulance to inquire as to their pricing options? Would you negotiate with your surgeon on the operating table? Few of us would. At least few who value their lives. But after the pandemic, the heart attack, the stroke, a bill will arrive at your door step for some absurdly high price, maybe for some services never performed, and you will have basis to challenge whether your hero just charged you for ventilators in the backroom that the government paid for with its bailout.