19 Dec 2019 Baseball-Style Arbitration Could Prevent Medical Bill Surprises

When a medical emergency strikes, there are few better places to be than in an American hospital – armed with a team of highly trained doctors and medical staff. But, in the aftermath of life-saving care, proponents of the new Lower Health Care Costs Act (LHCC) are proposing solutions to surprise medical billing that would inspire Third World socialist dictators.

David W. Almasi

There’s no argument that a majority of Americans agree that surprise medical billing is a problem in desperate need of a solution.

In a medical emergency, the hospital staff’s focus is on saving your life and not who’s in your insurer’s network. This means patients receiving such care may later be deemed “out of network” by their insurance companies and liable for large bills for medical care not covered by their policy.

Unfortunately, the solution to this currently pushed by the large and powerful insurance lobby in Washington is for the federal government to set price controls on what medical procedures cost. It ignores the fact that government-controlled price fixing has always led to a shortage of products and services and lower quality care overall.

If doctors and hospitals are forced to meet certain price points for care, their options will be to work at a loss, restrict their involvement in the market or just remove themselves entirely.

At a time when the health care industry is already facing shortages in doctors – especially in rural areas – the last thing we need is to discourage medical professionals and providers from being involved in the marketplace.

Any politician who supports a plan allowing insurance companies off the hook while letting the government dictate costs to health care providers is obviously not interested in ensuring their constituents have access to the best health care available.

The good news is that there is an alternative proposal that incorporates free-market principles with a successful track record.

The STOP Surprise Bills Act of 2019, introduced by Senator Bill Cassidy (R-LA) and in collaboration with a bipartisan group of his colleagues, would protect patients from surprise medical billing while creating a way for providers and insurers to reach reasonable consensus on costs.

The “STOP Act” establishes independent dispute resolution (IDR) boards that follow baseball-style arbitration. This technique is a well-established practice in Major League Baseball for settling contract disputes. In this style of arbitration, each side is required to submit a reasonable cost for care, with the most reasonable claim being selected by the independent review board. This approach ensures that a provider would not get away with price-gouging and an insurer could not lowball the cost of provided care.

If the solution of reasonable offers – decided by independent experts – makes more sense to you than one side (the insurance companies) asking for government price control for medical providers, you’re not alone.

What’s not sensible is for Congress to allow America’s world-class emergency care providers to risk being subject to schemes more at home in failed, Third World socialist regimes.

It’s time our elected officials in Congress recognize that America’s health care industry must operate by the free-market principles upon which our nation was founded.

David W. Almasi is Vice President at the National Center for Public Policy Research.