Commentary: Congress Must Pass a True Conservative Solution for Surprise Billing

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by Judson Phillips


Congress is poised to address surprise medical billing, an issue that has hurt too many patients in Tennessee and throughout the nation—that is, if they can muster the fortitude to pass a commonsense proposal that upholds the free market ideals conservatives should embrace. However, some of the so-called solutions that have been put forward betray these values and would result in greater government interference into our health care system, which is the last thing we need.

One such anti-free market approach is known as federal benchmarking and it would essentially lead to the establishment of government price controls in the health care sector. Under this misguided proposal, the federal government would be given the power to dictate rates paid to physicians by insurance companies. To determine these rates, Uncle Sam would rely on insurers’ own highly flawed and biased data, fundamentally tilting the scales in their favor.

Distorting the marketplace and paying doctors rates that are substantially and artificially lower than what they should be is the exact opposite of what a conservative approach should be. Yet, benchmarking is at the heart of legislation introduced by purported Republican Senator Lamar Alexander. Any conservative who would advocate for even more government intervention into the free market or our health care system needs a serious reality check. No wonder Senator Alexander ranks sixth on Conservative Review’s list of the Top 25 RINOs.

As called for in Senator Alexander’s Lower Health Care Costs Act, benchmarking would only put at-risk hospitals and ERs out of business, threatening access and affordability most acutely in rural Tennessee communities. Tennesseans deserve better than this highly problematic proposal. Fortunately, there are much more responsible options for Congress to choose from.

Louisiana Senator Bill Cassidy’s STOP Surprise Medical Bills Act would employ a completely different approach known as Independent Dispute Resolution (IDR)—which is a process similar to the one used in Major League Baseball to settle salary disputes between players and teams. Not only would this protect patients from surprise billing, but it would do so without skewing the health care marketplace or threatening rural access to care.

Basically, IDR creates a framework for transparent negotiations between medical providers and health insurers, allowing both parties to put forward their best payment offers for out-of-network services over which disputes arise. An impartial mediator would review each side’s offer and take into consideration a broad range of factors—including location, complexity of care, provider experience, and more—to determine a final payment amount.

This approach incentivizes both providers and insurers to submit their most reasonable offer while also ensuring interim payments until such time as the mediator has reached a decision. These payments are especially vital in preserving the financial strength of rural health care centers, which in turn benefits patients by protecting their access to care.

When all is said and done, IDR is the only solution that is firmly rooted in the free market, and therefore is the only approach that any true conservative in Congress should support. For the good of Tennessee patients and all Americans, Senator Alexander should rethink the ill-advised benchmarking method in his legislation and replace it with the free-market IDR framework currently found in Senator Cassidy’s bill.

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Judson Phillips is the founder of Tea Party Nation.




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