Physicians are sounding an alarm about the health care system
by Patty Hymansom - Bangor Daily News - February 4, 2024
Patty Locuratolo Hymanson, a neurologist, is a former Maine state representative. She lives in York.
Visionary leaders looking into the future of our health care system
imagine complex systems changes. They identify trends that will help
people be healthy, find and treat diseases, improve efficiency, and
focus on wellness as well as illness. The trends include artificial
intelligence integration, medicines tailored to our individual biology,
convenient care through our computers, payments to keep people healthy
rather than only paying when we are sick.
The trouble is, when trying to grow a system, like a tree, the roots
and trunk must be healthy. Our health care system, for most people, is
sick. How can complex changes be grafted onto a sick system? This is
especially true when the sick system has grown by encouraging branches
that make the most profit.
The Maine Medical Association has written a three-page statement on
“Reform of the U.S. Health Care System.” This statement was developed
after polling the membership of the association and researching
alternative models of care. It is a start and worthwhile reading to
understand where Maine physicians see our system failing both patients and physicians. If the problems are not laid out, they cannot be cured.
Of the many problems, one is particularly personal. As a neurologist
practicing on the seacoast for 28 years, I closed my private practice to
run successfully for the Maine Legislature largely because I could not
give my patients the amount of time they, and I, needed to diagnose and
treat them. Physicians are forced to see too many patients in too little
time. Squeezing every drop from professionals and patients drives good
profits but worsens care.
You will read in the medical association’s statement: “Physicians are
burdened with documentation increasingly geared toward system
requirements rather than patient’s care. … Put the patient first and
protect the physician-patient relationship, particularly respecting the
physician’s autonomy as an advocate for the patient. Provide health care
that is high quality, comprehensive, reflects a physician-patient
collaboration and is not profit driven. Promote patients’ freedom to
select their physicians and other clinicians.”
“The secret of the care of the patient is in caring for the patient,” said Dr.
Francis Peabody of Harvard Medical School in 1925. Providers of that
care are burning out, suffer moral injury and need a restructured
system. I cannot build that change but I can sound an alarm. Thank you
to the Maine Medical Association for sounding this alarm, too.
Opinion: We need to shift our thinking from ‘thing-oriented’ to ‘person-oriented’
by Susan Henderson - Portland Press Herald - February 3, 2024
In 1970, a professor told his class that the computer revolution
would be greater than the Industrial Revolution. He was right. The
computer revolution is part of massive scientific changes accelerated by
World War II. The world has changed rapidly.
It’s hard to give meaning to what is happening; we do yet grasp the
full implications of what we are seeing. We struggle to orient ourselves
in a chaotic swirl of changes. We attack each other over our
differences about parts of a whole that we do not fully understand.
Being clear about our values might help us set goals to calm the chaos.
Our Declaration of Independence declares that all people are endowed
with certain inalienable rights by their creator. This revolutionary
statement constitutes a core social value. However, we have not
demonstrated that value in our actions. In a 1967 speech at Riverside
Church in New York City, Dr. Martin Luther King said:
“We as a nation must undergo a radical revolution of values. We must
rapidly begin the shift from a ‘thing-oriented’ society to a
‘person-oriented’ society. When machines and computers, profit motives
and property rights are considered more important than people, the giant
triplets of racism, materialism and militarism are incapable of being
conquered. … A true revolution of values will soon cause us to question
the fairness and justice of many of our past and present policies.”
As the economist Rashi Fein has pointed out, people live in a
society, not an economy. Capitalism is an efficient and effective
economic system, but today, this system is out of balance and does not
adequately serve social needs.
Fair trade laws need to ensure real competition. Every corporation
needs to contribute to the well-being of society. Wage equity must be
improved so working people can at least minimally meet their basic needs
for food, housing and health care. The science of climate change
requires changes to how and what we produce and nurture. Fixing the
economy requires taming the power of lobbyists and campaign
contributions. Economic systems need to enable people to meet needs so
basic as to be rights. Economic decisions should reflect social goals.
Access to health care is a human right. A robust public health system
would promote healthy behaviors and help prevent disease. Access to
mental health and substance abuse care would reduce the suffering of
those who misuse substances and reduce the pain these disorders cost
friends, families and communities. If every woman had easy access to
prenatal care, outcomes for mothers and babies would be improved. A
system for follow-up educational and supportive visits for new families
has been shown to decrease child abuse.
When private insurance plans have payments and deductibles so high
that people have no money left over to seek care, and when MaineCare
reimburses so little that providers do not chose to see patients, that
is not access to care. Society has made the choice to not have universal
access to care or a strong public health system. If we calculate the
full costs of this choice, we would see it has high monetary and social
costs.
In this election year, we need to identify our values. Our problems
have no quick fixes, but a start is to recognize that our present
economic functioning is not geared to meet the goals of a
person-oriented society. Value-based goals direct us through chaos to
achieve economic equity and through that access to health care, housing,
decreased violence, protecting our planet and ending war. By seeking
policies that honor the dignity and worth of all individuals, we can
have a chance of survival.
Sometimes in this job I have a kernel of a column idea that
doesn’t pan out. But other times I begin looking into a topic and find a
problem so massive that I can’t believe I’ve ever written about
anything else. This latter experience happened as I looked into the
growing bureaucratization of American life. It’s not only that growing
bureaucracies cost a lot of money; they also enervate American society.
They redistribute power from workers to rule makers, and in so doing sap
initiative, discretion, creativity and drive.
Once you start
poking around, the statistics are staggering. Over a third of all health
care costs go to administration. As the health care expert David
Himmelstein put it
in 2020, “The average American is paying more than $2,000 a year for
useless bureaucracy.” All of us who have been entangled in the medical
system know why administrators are there: to wrangle over coverage for
the treatments doctors think patients need.
The growth of bureaucracy costs America over $3 trillion in lost economic output every year, Gary Hamel and Michele Zanini estimated
in 2016 in The Harvard Business Review. That was about 17 percent of
G.D.P. According to their analysis, there is now one administrator or
manager for every 4.7 employees, doing things like designing
anti-harassment trainings, writing corporate mission statements,
collecting data and managing “systems.”
This situation is especially grave in higher education. The Massachusetts Institute of Technology now has almost eight times
as many nonfaculty employees as faculty employees. In the University of
California system, the number of managers and senior professionals swelled by 60 percent between 2004 and 2014. The number of tenure-track faculty members grew by just 8 percent.
Conservatives
complain that diversity, equity and inclusion administrators are
injecting a dangerous ideology into American campuses. That’s true. But
the bigger problem is that these workers are among the swelling ranks of
administrators.
The general job of administrators, who are
invariably good and well-meaning people, is to supervise and control,
and they gain power and job security by hiring more people to work for
them to create more supervision and control. In every organization I’ve
interacted with, the administrators genuinely want to serve the mission
of the organization, but the nature of their jobs is to enforce
compliance with this or that rule.
Their power is similar to what Annie Lowrey of The Atlantic has called the “time tax.”
If you’ve ever fought a health care, corporate or university
bureaucracy, you quickly realize you don’t have the time for it, so you
give up. I don’t know about you, but my health insurer sometimes denies
my family coverage for things that seem like obvious necessities, but I
let it go unless it’s a major expense. I calculate that my time is more
valuable.
As Philip K. Howard has been arguing for years, good
organizations give people discretion to do what is right. But the trend
in public and private sector organizations has been to write rules that
rob people of the power of discretion. These are two different
mentalities. As Howard writes,
“Studies of cognitive overload suggest that the real problem is that
people who are thinking about rules actually have diminished capacity to
think about solving problems.”
Not long ago, an airline
accidentally canceled one of my flight reservations. I called the 800
number and the guy on the other end of the line seemed truly unable to
wrap his mind around the idea of getting me on another flight, because
the rule said that my reservation was nonrefundable. I had that by now
familiar feeling of talking to a brick wall.
This state
of affairs pervades American life. Childhood is now thoroughly
administered. I’m lucky enough to have grown up at a time when parents
let children roam free to invent their own games and solve their own
problems. Now kids’ activities, from travel sports to recess, are
supervised, and rules dominate. Parents are afraid their kids might be
harmed, but as Jonathan Haidt and Greg Lukianoff have argued, by being
overprotective, parents make their kids more fragile and more vulnerable
to harm.
High school students design their lives to fit the
metrics that college admissions officers require. And what traits are
selective schools looking for? They’re looking for students who are
willing to conform to the formulas the gatekeepers devise.
I’ve
found the administrators’ code of safety first is now prevalent at the
colleges where I’ve taught and visited. Aside from being a great school,
Stanford used to be a weird school, where students set up idiosyncratic
arrangements like an anarchist house or built their own islands in the
middle of the lake. This was great preparation for life as a creative
entrepreneur. But Stanford is apparently now tamed. I invite you to read
Ginevra Davis’s essay “Stanford’s War on Social Life”
in Palladium, which won a vaunted Sidney Award in 2022 and details how
university administrators cracked down on student initiatives to make
everything boring, supervised and safe.
Professors used to be
among the most unsupervised people in America, but even they are feeling
the pinch. For example, Mark Edmundson teaches literature at the
University of Virginia. The annual self-evaluations he had to submit
used to be one page. Now he has to fill out about 15 electronic pages of
bureaucratese that include demonstrating how his work advances D.E.I.,
to make sure his every waking moment conforms to the reigning ideology.
In a recent essay
in Liberties Journal, he illustrates how administrators control campus
life by citing the rules they have devised to govern how members of the
campus community should practice sadomasochistic sex: “When parties
consent to BDSM 3, or other forms of kink, nonconsent may be shown by
the use of a safe word, whereas actions and words that may signal
nonconsent in non-kink situations, such as force or violence, may be
deemed signals of consent.” Do institutions really need to govern
private life this minutely?
Organizations are trying to
protect themselves from lawsuits, but the whole administrative
apparatus comes with an implied view of human nature. People are weak,
fragile, vulnerable and kind of stupid. They need administrators to run
their lives. They have to be trained never to take initiative, lest they
wander off into activities that are deemed by the authorities to be out
of bounds.
The result is the soft despotism that Tocqueville
warned us about centuries ago, a power that “is absolute, minute,
regular, provident and mild.” In his Liberties essay, Edmundson writes
that this kind of powermmel is now centerless. Presidents and executives
don’t run companies, universities or nations. Power is now held by
everyone who issues work surveys and annual reports, the people who
create H.R. trainings and collect data. He concludes: “They are using
the terms of liberation to bring more and more free people closer to
mental serfdom. Some day they will awaken in a cage of their own
devising, so harshly confining that even they, drunk on their own
virtue, will have to notice how their lives are the lives of snails
tucked in their shells.”
Trumpian populism is about many things,
but one of them is this: working-class people rebelling against
administrators. It is about people who want to lead lives of freedom,
creativity and vitality, who find themselves working at jobs, sending
their kids to schools and visiting hospitals, where they confront “an
immense and tutelary power” (Tocqueville’s words) that is out to
diminish them.
On Jan. 26, the Portland Press Herald reported a state legislative proposal to establish a state board that would permit affordable housing projects (“Lawmakers considering proposal for state board to permit affordable housing”). Although this proposal seems a step in the right direction, the state has a long way to go to adequately address Maine’s housing crisis.
Maine’s minimum wage just increased to $14.15/hr. According to the National Low Income Housing Coalition, a Mainer working full-time (40 hours per week, 52 weeks per year) would need to earn $24/hr. to afford fair market rent for a two-bedroom rental home, without paying more than 30% of their income.
There are more than 400,000 poor and low-income people in Maine. Lack of affordable housing is only one of many interlocking injustices they face. Others include inadequate wages, skyrocketing health care costs and medical debt, unaffordable and often unavailable child care, and insufficient education and job training programs.
We need sound public policies to address all these issues, and that is why the Maine Poor People’s Campaign will hold a State House assembly in Augusta on March 2. There, we will present to the Legislature and the governor the policies we demand to lift hundreds of thousands of Mainers out of poverty. We invite every individual and organization that shares our goal of racial, social and economic justice for all to join us that day as we come together to say loudly and clearly: “Fight poverty, not the poor.”
NYC joins a growing wave of local governments erasing residents' medical debt
by Yuki Noguchi - NPR - January 23, 2024
This week, New York City pledged to pay down $2 billion worth of
residents' medical debt. In doing so, it has come around to an
innovation that started in with local governments in the Midwest, and is
ridding millions of Americans of health care debt.
The idea emerged a couple of years ago in Cook County, Ill., home to
Chicago and surrounding towns. Toni Preckwinkle, president of the county
board of commissioners, says two staffers came to her with a bold
proposal: The county could spend a portion of its federal pandemic
rescue funds to relieve residents' medical debt.
The result: In 2022, Cook County became the first local government to
partner with RIP Medical Debt, a nonprofit group that uses private
donor funds to buy up and pay off health care debts.
RIP's model turns debt collection on its head: Normally, debt
collectors buy unpaid bills to then try to collect the owed funds. RIP
identifies unpaid hospital bills owed by people making up to four times
the federal poverty level, then buys that debt on secondary markets or
directly from hospitals at a small fraction of the original value.
Instead of trying to collect, RIP forgives it — so it simply disappears
for the patients who owe.
In the Chicago area, as it is across the country, medical debt is an
ongoing problem, creating mental and financial strain that can follow
patients for years. An estimated100 million people in the country carry some form of health care debt.
Preckwinkle says the RIP Medical Debt model dovetailed nicely with
Cook County's health care mission. For nearly two centuries, it has
funded its own hospital and health system, Cook County Health, in part
to provide care to all residents, regardless of income.
"We have a legacy commitment to delivering quality health care to
people without regard to their ability to pay," Preckwinkle says.
She says that health care mission eats up nearly half of the county's
$9.3 billion annual budget. The county is now in the process of
spending $12 million — a tiny portion of its budget — to ultimately
retire $1 billion worth of hospital bills for residents.
In the year and a half since Cook County announced its program, seven
other local governments have followed suit, including Akron, Cleveland
and Toledo, Ohio, New Orleans, Wayne County, Mich., Washington, D.C.,
and now New York City, which announced its commitment Monday.
In comments at the announcement, New York's mayor Eric Adams noted that medical debt disproportionately affects
Black and Latino communities who are more likely to be uninsured or
under-insured. For the city's low income residents, he said, "taking on
medical debt isn't a choice."
"Working class families often have to choose between paying their
medical bills or some of the basic essentials that they need to go
through life," he said.
RIP is in talks with 30 additional municipalities and states, including Connecticut, New Jersey and Michigan.
Typically, RIP can retire at least $100 worth of debt for every $1 of
government funds, so the local initiatives could end up wiping out
several billions in medical debt. The software selects eligible patients
who remain anonymous, so it's hard to know what the impact of
eliminating that debt might be across a community, or for the families
that benefit.
An unusual move for local government
Amber Clapsaddle says having the city of Toledo eliminate a $1,500 medical bill from three years ago has given her hope.
In the past, Clapsaddle says she looked down on those who didn't pay
their bills. "I was like, 'I'll never do that,' and I judged people
really hard," she says.
Then, several years ago, her entire family of five each got sick with
various ailments, requiring numerous surgeries, ultrasounds, and
diagnostic tests. She had insurance, but she and her husband, a
warehouse worker, couldn't meet the $6,000 deductible. Clapsaddle, a
social worker, realized why medical debt is such a prevalent problem:
"It just takes one bill, one bad insurance plan, just one extra
diagnosis to have it all fall apart."
When Toledo's program with RIP forgave some of her family's medical
debt two months ago, she cried with joy and relief. She says that
motivated her to negotiate with doctors' offices and her insurance
company, to try to prevent herself from getting into debt again. "It's
the spark that lights the fire of getting out of medical debt."
Debt forgiveness is an unusual solution for local governments. But
more are taking on medical debt. That's in part because local
governments had access to federal pandemic rescue funds through the
American Rescue Plan Act of 2021, and RIP Medical Debt offered a quick
and easy fix to distribute those funds to those most burdened by medical
expenses.
Nationally, medical debt is shown to disproportionately affect people
of color and people who earn less. It also contributes to a vicious
health cycle, discouraging many patients from seeking preventative or
follow-up care, leading to worse and more expensive outcomes.
Cook County's Preckwinkle says the pandemic only deepened racial and income gaps that affect peoples' access to health care.
"I always talk about the fact that medical debt is the leading cause of bankruptcy in the United States," she says.
Getting down to the root causes of debt
The idea of forgiving medical debt enjoys broad political support,
says Allison Sesso, CEO of RIP Medical Debt, perhaps because the issue
affects people of all political stripes. She says a recent survey by RIP
shows its bipartisan appeal. "84% of people agreed that it is the
responsibility of government to ensure health care is affordable, and
that position is held by people on the left and the right."
Sesso admits debt is only one of many factors contributing to unequal
access to health care, and as hospital costs continue to rise, new
debts are also piling up perhaps faster than her group is able to retire
it. She says RIP hopes to retire $2.5 billion worth of unpaid medical
bills through various government initiatives this year, but that's a
drop in the bucket of the $195 billion estimated medical debt held by
Americans.
"I'm under no illusions," Sesso says. "I don't think what I'm doing
is the solution to getting rid of medical debt, writ large." Medical
debt is being created at high rates, she argues, and more policies —
such as protecting consumers and strengthening insurance coverage — are
needed to prevent medical debt at the source.
The enduring benefit of the recent local government initiatives is
that they have helped draw more attention to the problem, raising its
profile in useful ways, she says.
"I think the issue of medical debt is becoming a priority, local
governments are talking about it," she says, and that is leading to
other conversations about what else they can do to get more eligible
families insured through Medicaid, or through the Affordable Care Act
insurance marketplace, for example.
It is also inspiring programs like one recently adopted by Milwaukee
County, Wis., which is urging more hospitals and health systems to use
credit reports to screen and automatically enroll eligible patients in
financial assistance programs. These programs already exist to help
reduce medical expenses for patients making up to three times the
poverty level, but often patients are unaware or not told to apply for
them.
By automating the process, as many as 50% more patients may receive
free or reduced-cost care, so they have a better chance of avoiding
incurring medical debt in the first place, says Shawn Rolland, a member
of Milwaukee County's board of supervisors.
"Why make it more difficult than necessary to get enrolled? Because
ultimately this will make it more likely that they'll come back for
preventative care."
This story is part of Diagnosis: Debt, a reporting partnership
between KFF Health News and NPR exploring the scale, impact, and causes
of medical debt in America. Explore the series.
n 2010, at the signing of the Affordable Care Act, a.k.a.
Obamacare, Joe Biden, the vice president at the time, was caught on a
hot mic telling President Barack Obama that the bill was a “big deal.”
OK, there was actually another word in the middle. Anyway, Biden was right.
And in one of his major unsung accomplishments — it’s amazing how many Americans believe that an unusually productive president
hasn’t done much — President Biden has made Obamacare an even bigger
deal, in a way that is improving life for millions of Americans.
As you may have noticed — as many Americans finally seem to be noticing — Biden has been racking up some pretty good numbers lately. Economic growth is still chugging along, defying widespread predictions of a recession, while unemployment remains near a 50-year low. Inflation, especially using the measure preferred by the Federal Reserve, has fallen close to the Fed’s target. The stock market keeps hitting new highs.
Biden
deserves some political reward for this good news, given that Donald
Trump and many in his party predicted economic and social disaster if he
were elected, and that Republicans, in general, are still talking as if
America were suffering from high inflation and runaway crime. (Trump,
of course, has been dismissing the good jobs numbers as fake. Wait until he hears about falling crime.)
It’s
less clear how much of the good news on these fronts can be attributed
to Biden’s policies. Presidents definitely don’t control the stock
market. They have less influence in general on the economy than many
believe; I would give Biden some credit for the economy’s strength,
which was in part driven by his spending policies, but the rapid disinflation
of 2023 mainly reflects a nation working its way out of lingering
disruptions from the Covid pandemic. The same is probably true for the
plunge in violent crime.
One area where presidents do make a big
difference, however, is health care. Obamacare — which arguably should
really be called Pelosicare, since Nancy Pelosi (who is not, whatever Trump may think, the same person as Nikki Haley) played a key role in getting it through Congress — led to big gains in health insurance coverage when it went into full effect in 2014.
Trump tried but failed to repeal Obamacare in 2017, and the backlash
to that effort helped Democrats win control of the House the next year.
Trump was nonetheless able to create some erosion in the program, for
example by cutting off funds for “navigators” that help people enroll.
That erosion has now been decisively reversed. The Biden administration just announced
that 21 million people have enrolled for coverage through the A.C.A.’s
health insurance marketplaces, up from around 12 million on the eve of
the pandemic. America still doesn’t have the universal coverage that is
standard in other wealthy nations, but some states, including Massachusetts and New York, have gotten close.
And
this gain, unlike some of the other good things happening, is all on
Biden, who both restored aid to people seeking health coverage and
enhanced a key aspect of the system.
Obamacare isn’t
simple. Many of the health care economists I know would have preferred
something like Medicare for All, if that had been politically feasible.
But it wasn’t and isn’t, so what we have instead is a sort of Rube
Goldberg device, a mix of gadgets designed to expand access to health
care with minimal disruption of existing arrangements. Those
marketplaces, in which insurers are forbidden to discriminate against
people with pre-existing conditions and buyers receive subsidies to help
them pay premiums, are a key part of the system.
It’s not an
ideal mechanism, but it’s vastly better than nothing. Originally,
however, the marketplaces were underfunded: The subsidies were too low,
so many people still had trouble paying insurance premiums, and there
was also a cutoff, with subsidies available only to individuals up to
400 percent of the poverty line.
Biden, as part of the 2022
Inflation Reduction Act, largely resolved these problems, reducing
maximum premium payments (net of subsidies) and eliminating the cliff
at 400 percent. The result is to make health insurance coverage
substantially more affordable, especially for middle-income Americans
who previously earned too much to be eligible for subsidies. Hence the
surge in marketplace enrollments.
I don’t know whether health care will be a big issue in the 2024 election. But it should be.
Biden has made health insurance coverage more accessible and more affordable for millions of Americans.
If
Trump wins, however, he will try again to do away with Obamacare; he
has said as much, and this time he could very well succeed. He promises
to replace it with something “MUCH BETTER.”
I guess this depends on your definition of better: In 2017, the
Congressional Budget Office estimated that Trump’s health plan would
raise the number of uninsured by 32 million within a decade; that number would probably be larger today.
So, one more reminder of how much is at stake this year.
Task force calls for reforms to regulate hidden hospital fees
by Joe Lawlor - Portland Press Herald - February 2, 2024
A Maine legislative task force that examined so-called facility fees
charged to patients at hospitals and other medical settings is calling
for advanced warning about the fees and restrictions on when they can be
collected.
The task force released a report to lawmakers this week detailing the
billing practice and recommending law changes to protect consumers from
hidden and unexpected charges that can add hundreds of dollars to
routine medical bills. A bill based on the report could go before
lawmakers this spring.
Sean Dundon, of Portland, was one of many patients who shared stories of unexpected and often hidden charges. He was socked with a $510 facility fee
at Northern Light Mercy Hospital on Christmas Day 2021 for emergency
department treatment for a cut finger, which didn’t require stitches.
When
Sean Dundon, of Portland, sliced off a portion of his thumb on
Christmas Day in 2021, all the urgent care centers were closed, so he
went to Mercy Hospital’s emergency room. He was hit with a $510 facility
fee, plus many other charges for bandaging his thumb and giving him
painkilling drugs. He said he was in and out of the emergency room in 20
minutes. Derek Davis/Staff Photographer
Dundon called the task force’s recommendations “great progress.” He
said he would have bandaged his finger himself if he had known about the
facility fee in advance.
“Having (the fee) posted and disclosed during intake is key as there
are many times the patient may seek care later or elsewhere if they only
had the choice before the bill arrived,” Dundon said on Thursday.
Patients’ stories about getting surprised by the fees – often
hundreds of dollars tacked onto medical bills – were highlighted in the
investigative report about medical overbilling and insurance denials.
After the story was published in August 2022, Senate President Troy
Jackson, D-Allagash, introduced a bill to regulate facility fees, but it
was amended to form a task force to study the complex nature of
regulating medical costs before recommending reforms. The 10-member task
force met three times in December before coming up with its
recommendations.
Facility fees are imposed by health care providers to help pay the
overhead costs of running large medical facilities like hospitals. They
are sometimes added to bills without explanation. In some cases,
insurance companies will not pay the fees or will pay only a small
portion, leaving patients on the hook for the charges.
Under the task force’s recommendations – which could become a bill
to go before the Legislature this session – health systems would be
prohibited from charging facility fees for outpatient medical
facilities, telehealth providers and other medical services not
conducted in a hospital or on a hospital campus.
Three of the committee members, including Jeff Austin, vice president
of government affairs for the Maine Hospital Association, objected to
the proposal to ban facility fees at certain medical facilities, arguing
that “such a proposal would have a devastating financial impact on
hospitals, including the potential closure of some facilities and the
loss of patient access to health care services,” the task force’s report
said.
The task force also recommends that signs be posted in common areas
of hospitals informing patients of facility fees, that the fees be
listed separately on bills sent to patients and that patients be
informed of the fees prior to the medical service being provided.
It’s unknown exactly how many patients have had to pay hundreds of
dollars in facility fees. But, according to the task force, “with more
health care services being delivered in outpatient settings and more
patients being responsible for a greater portion of costs, more patients
are being directly impacted by facility fees.” The report noted that
facility fees are being charged at urgent care centers, multiple times
for the same visit, and at telehealth appointments.
Ann Woloson, executive director of Consumers for Affordable Health
Care, said regulating facility fees would help reduce medical debt for
Maine people.
“I think this is a really good first step in the right direction,” Woloson said.
Stephanie DuBois, spokeswoman for Anthem Blue Cross Blue Shield, said
the insurer supports the task force’s recommendations, although the
changes wouldn’t have a broad impact because state law already limits
the charging of facility fees in outpatient services for many people
with private insurance. And facility fees are not the only way costs can
be hidden in medical bills, she said.
“We are noticing claims with buried and hidden fees that a patient
has no idea about, and seeing egregious price markups with little to no
transparency – such as a $146 ‘restocking’ fee for saline, which has an
acquisition cost of 2 to 5 cents,” DuBois said.
Twelve states currently regulate facility fees, according to the
National Academy of State Health Policy. The task force’s
recommendations were inspired by model legislation devised by the
academy.
Letter: We must advocate for more accessible health care
We are in a health care crisis. I work as a social worker in Portland
and today I tried to help one of my clients get connected to a primary
care doctor because he has a growth on his chest that may be cancerous. I
called all the major providers in the area. The earliest appointment
available was for August. This is unacceptable.
I asked: “What do you advise a man who has cancer to do? Wait until
August to see a doctor?” I was told: “Get your health care at the
emergency room and urgent care.” This is a tragedy and an urgent crisis
that needs to be addressed by those in power at the local and state
level.
I am angry and I feel deeply frustrated and depressed about the state
of our health care system. We can do better. We must do better. Please
contact our local and state officials and advocate for changes to our
health care system so that all who need it can receive care. Thank you.
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