Earlier this month, Sen. Tina Smith (D-MN) questioned experts on medical costs, insurance coverage, and medical debt during a Senate Health Education Labor and Pensions Committee hearing.
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NewsTranscript
00:00Senator Smith.
00:01Thank you, Chair Sanders, for holding this hearing, and thanks to all of you for being
00:06with us today.
00:07You know, I was just thinking about what you were saying, Dr. El-Sayed, at the beginning
00:12about how what's causing medical debt is the high cost of care and then the poor insurance
00:20coverage and constantly people are finding some new thing that they are supposed to pay
00:24for that they didn't know that they were supposed to pay for.
00:26And just to be clear, my view of it is that health care should be a human right and your
00:30opportunity to get the health care that you need shouldn't depend on who you are or where
00:34you live or how much money that you have.
00:37And I do agree that the solution should be universal health care.
00:40My question, so this is where I want to go with my questions, because I think that since
00:46that is not the world that we live in right now, I'm very interested in trying to get
00:50at like how much this damn stuff costs.
00:55And you know, I just want to say I'm glad Senator Cassidy is here, because Senator Cassidy
00:58and others of us did really important work on getting at the surprise medical bill and
01:04people finding suddenly there's a surprise and a cost that they weren't expecting and
01:09how that that shouldn't be borne by patients in that transaction.
01:17I'm also really interested in a bit of what Senator Budd was getting at, which is like
01:22there is so little transparency for people who are seeking health care to know how much
01:28things cost.
01:29So of course, one thing if you find yourself in an emergency room with an urgent need and
01:32you don't really have any choice, but if you're trying to say, for example, do a, you know,
01:38do a knee replacement or a hip replacement, it's almost impossible to figure out what
01:42the actual cost is or like how much you would pay if you went to this place, you know, place
01:47A versus place B.
01:48Now CMS in January of 2023, the Biden administration put out rules requiring hospitals to post
01:56upfront prices.
01:58But I mean, the compliance with that is very low.
02:03I'm very interested in the bill that Senator Braun and Senator Sanders have worked on,
02:09the Health Care Price Transparency Act, which I think would help to get at some of this
02:14issue, requiring some easily understandable way for people to understand how much, how
02:19much things are costing so that they can make educated decisions.
02:23I wonder if Dr. Messick or Dr. El-Sayed, if you would be interested in just commenting
02:29on this and what you've seen in your practice about the challenges of knowing, you know,
02:33basically how to be a good selector when you're trying to figure out how much stuff costs.
02:39Let me first speak from a policy level.
02:40And I'm going to answer this question in an interesting way.
02:43I love Costco.
02:44And one of the reasons I love Costco is because Costco has a policy where their markup is
02:49not going to be greater than 15% the cost of the actual good.
02:53Part of the issue is that our costs are non-transparent, so they hit people in some really profound
02:57ways.
02:58And they hit them when they're hurt the most, literally insult to injury.
03:01But the other part of it is also what those costs are.
03:04And we don't really have a way, to your point, about assessing why the Advil you got in the
03:08hospital was so much more expensive than the Advil you got at Costco.
03:12And if we're serious about addressing this issue, we really do need to be thinking about
03:16the ways that prices grow.
03:17The second thing I want to say about this is just that it's not only that we have the
03:21highest prices and the fastest growing prices in the world, it's that we have the highest
03:24overhead for healthcare in the world.
03:26And a lot of that is about billing complexity.
03:28It's about all of the billers that you have to hire on either side of a financial transaction
03:32that allow that transaction to happen because we have such multiplicity in our system of
03:36both providers and payers.
03:38The provider side is great.
03:39You get to pick which provider you go to.
03:41But when it comes to that many payers, each of them with an army of billers, it creates
03:44a real problem.
03:45Yep, that's right.
03:46Dr. Messick.
03:47And I just want to say, I mean, I have talked to hospitals who tell me the extensive amount
03:50of money that they have to invest in getting the insurance companies to actually pay for
03:55the stuff that they're supposed to be covering.
03:57And that adds costs to the whole system as well.
03:59But Dr. Messick.
04:00Yeah, thank you, Senator.
04:01I think price transparency is a good step.
04:04Taken by itself, it would do some good.
04:06I know a lot of my patients often ask how much things will cost.
04:10And I can't answer their question because I don't know myself.
04:13And it's a big source of concern.
04:15I do worry, being in the emergency room, like you said, that patients come to me delirious,
04:21sometimes unconscious, and they have no choice in where they end up.
04:25And the last thing I want my patient with a stroke or heart attack to do is start shopping
04:30around and looking at which would be the cheapest place to get their emergent procedure done.
04:34I want them to show up as close as possible, as quickly as possible.
04:38So I do worry that if we marry this with high-deductible health plans, as has been
04:42done in the past, that we're not going to solve the problem.
04:45Price transparency doesn't solve the problem of high-deductible insurance plans.
04:49And it doesn't solve the problem of people who are in a crisis situation.
04:55So it is not a solution to all problems.
04:57But I do think in the short term, it is a way of trying to get some accountability in
05:02a system where, even sometimes within the same institution, you might have very different
05:07prices for the exact same procedure, just depending on whether you have what insurance
05:12you have or whether you're paying cash, which might actually be the cheapest way of paying
05:19for your procedure.
05:21I'm out of time.
05:23Thank you, Chair Sanders.
05:25Senator Murphy.