One Story Shows Fallacy Of GOP Approach As Senate Leaps Into the Abyss On Healthcare

As Republicans in the Senate decided to willingly jump into the abyss of potentially passing an unknown bill that would potentially kill hundreds of thousands of Americans, a single story illustrated the enormous fallacy behind one of the major tropes of the GOP about healthcare while at the same time showing Democrats why relying on the private insurance market in any way to provide quality, affordable, and universal health care for Americans is a fool’s errand.

The story was from the NY Times and it details the tactics of a company called EmCare. EmCare contracted with hospitals to provide emergency room physicians, the lack of whom had become a problem for many smaller and rural hospitals. But many EmCare physicians are not part of an insurance network, meaning that their bills are treated as an out-of-network cost. A Yale University study showed that out-of-network costs at hospital emergency rooms that contracted with EmCare saw them increase by over 100% after EmCare took over. In addition, the use of the highest billing codes for complex care increased from 6% to 28% after EmCare took over, an increase of nearly 500%. According to the story, “At about 15 percent of the hospitals, out-of-network rates were over 80 percent, the study found. Many of the emergency rooms in that fraction of hospitals were run by EmCare.” Of course, these out-of-network costs were not covered by most insurance plans and had to be paid directly by the patient.

The EmCare experience is part of a larger pattern of hospitals trying to use the emergency room as essentially a profit center. Part of EmCare’s appeal is that they claim they can increase testing and hospital admissions, basically creating more revenue for the hospital. According to a Rand study, nearly half of all hospital admissions now come from patients originally received at the emergency room. In addition, the doctors working for EmCare were paid based on their own billing and the additional testing and admissions that they can provide. Obviously, this creates quite an incentive for widespread abuse, which is exactly what the Yale study shows. More disturbingly, EmCare looks to be trying to expand this kind of program into radiology and anesthesiology, probably creating even more hidden out-of-network costs. The hospital may save money in the ER and increase revenue in admissions and testing, but much of those savings end up being borne by the patient in out-of-network costs.

The whole situation with EmCare makes a mockery of the constant GOP line that patients much have “more skin in the game” in order to keep health costs down. For individuals, of course, this is simply impossible to manage. Even if you are lucky enough to be able to pick an in-network hospital when you go to an emergency room, you are now being asked to inquire whether the ER doctor attending you is also in-network before he treats you. And, of course, that assumes you are even conscious to actually make these inquiries. This insanity will be compounded if EmCare expands into providing anesthesiologists and radiologists, both of which are even further out of a patient’s control.

For Democrats, it is another indication that the profit motive for the health insurance industry will always create incentives for companies to rip off the patient and drive unnecessary treatment to simply create revenue. While the GOP complains about the cost of unnecessary procedures, most of those procedures are driven by doctors and hospitals at this point. To really attack the cost of health care in this country, we obviously need a public option that is highly regulated. In addition, we must dismantle the existing medical cartel. As Dean Baker constantly points out, the legal and medical professions are two of the most highly protected industries in this country. That means busting the AMA’s control of medical school accreditation and simply creating more medical schools. At the same time, we should it make it far easier for foreign-trained doctors to come work in this country. As we reduce the cost of doctors, we should be increasing the pay of nurse practitioners and giving them far more responsibilities, most of which are currently and needlessly handled by doctors.

While the GOP deliberates on how to destroy the health insurance market in order to give massive tax cuts to the plutocrats that it answers to, Democrats should be starting to talk about totally rebuilding the current medical delivery system in this country. This goes beyond Medicare-for-all and focuses on the real reasons that this country pays far more for healthcare and gets worse outcomes than any other industrialized nation. As we saw with expanding Social Security and the fight for $15, you have to at least start talking about it in order to make it a reality. For Democrats on healthcare, that time has come.