Surprise Medical Billing: The Pork Chopped
Jeffrey Lord
by
Sen. Lamar Alexander (YouTube screenshot)

Call it the pork that got chopped. And as always, the goal was laudable.

In the world of Washington legislating, the goal is always laudable.

This time around the goal was what is called in the arcana of policy-making “surprise medical billing.” Here’s how it works.

Some 85 million Americans live in rural areas. As it happens in the current virus pandemic, that might be a good thing. Obviously, one is safer on a ranch in rural Montana than a walkup in the middle of Manhattan.

But it is exactly that relative isolation that causes a problem if, say, you have a stroke or you are in a car accident in the proverbial “middle of nowhere” — and your life depends on getting you to the nearest big-city hospital. Now what?

The answer can frequently come in the form of air medical transport, a helicopter or sometimes a plane that swoops in to pick you up to get you to that nearest big-city hospital in what is called in the trade the “golden hour” — the critical first 60 minutes it can take to get you the needed medical assistance.

The obvious question: Who pays for this? That’s the laudable goal here — getting people paid for this life-saving service. And the answer to the question of who gets paid is, of course, insurance companies. The question in “surprise medical billing” is not who, but how. How are the billing rates set? And with that question we are off into the woods of policy-making and just exactly what so many Americans object to in Washington, particularly in the middle of a crisis.

Here’s how the game went.

The obvious crisis is the country’s battle with the coronavirus. The necessity has arisen to shut down a good bit of the American economy in favor of “sheltering in place” (i.e., stay at home and don’t leave the house beyond a periodic grocery run). So what does government do? It does what government is supposed to do in a crisis — act to protect, in this case, the economic well-being of the country.

Which, as all of America knows, has resulted in Congress passing in seriously bipartisan fashion a $2.3 trillion relief package. The president signed it instantly, and, in a serious relief to millions of Americans, help is on the way.

But in the doing of this there was the always-expected if always-disgraceful scene of Washington insiders taking advantage of the crisis to slyly and sometimes not so slyly insert rewards for their favorite lobbies.

This is where what might be called the non-surprise of “surprise medical billing” comes in.

In a move that is exactly the opposite of free-market principles, no less than Tennessee Republican Sen. Lamar Alexander, working with New Jersey Democrat Rep. Frank Pallone, moved to mandate the government — say again: the government — setting the rates for transporting rural Americans to urban hospitals. There would be no free-market negotiation between the hospitals/doctors and insurance companies. Instead the federal government would set the rates — government price controls.

In typical big-government style, this would mean setting up some version of a Bureau of Surprise Medical Billing in some concrete hive in Washington, replete with a raft of well-paid federal bureaucrats to issue regulations.

And who has this sudden (?) aversion to the free market? That would be the insurance industry, which lobbied mightily to get this government-mandated rate-setting provision into the virus relief package. One can understand why the liberal Democrat from New Jersey, Mr. Pallone, would believe in this. He does, after all, belong to the Bernie Sanders–Elizabeth Warren Party of Big Government.

But Sen. Alexander? How in the world did someone who once sought the GOP presidential nomination ever decide to hook up with the Sanders–Warren party?

I have no idea. Cynics will point to the usual tie between Washington legislator and X industry campaign contributions. A look at Federal Election Commission campaign data and it appears to show the senator, who serves as chairman of the Health, Education, Labor and Pensions Committee, was on the receiving end of just over $300,000 in individual and PAC contributions from the health-care insurance industry over the last two cycles. Notably, he is retiring from the Senate this year. And also, it must be sadly noted, he recently announced that his daughter has tested positive for the coronavirus. We wish her well.

But there is a larger point here. This time the effort to have the government plunge into the middle of rate setting for emergency trips to the hospital for rural Americans failed — Senate Majority Leader Mitch McConnell stopped it. But in the way of Washington, it will surely be back on the table somewhere along the line.

To his credit, Mississippi Republican Sen. Roger Wicker has tried to help by supporting the idea of having a neutral, non-government third party mediate disputes over the obviously necessary bills incurred. No one wants to decimate the insurance industry or hospitals and doctors. But the last thing any conservative should want is injecting the government into the midst of this.

To their vast credit, one conservative organization after another has stood up to oppose government rate setting. Grover Norquist and his always reliable Americans for Tax Reform to the Heritage Foundation, the Club for Growth, FreedomWorks, Americans for Prosperity, and others banded together to successfully keep this latest government intervention ploy into the free market out of the virus bill.

But, rest assured, as the sun rises in the east, this effort to get government tentacles into surprise medical billing rate setting will be back.

President Reagan used to say that “Government programs, once launched, never disappear. Actually, a government bureau is the nearest thing to eternal life we’ll ever see on this Earth!”

The late British Prime Minister Margaret Thatcher used to talk about episodes like this as the “socialist ratchet,” with the government always, slowly but surely, being expanded as conservatives, interested in the niceties of “working across the aisle” and “bipartisanship,” all too frequently go along.

In microcosm, this one example of how government expands is exactly the reason the U.S. government is nearly (if not already) $24 trillion in debt — and that was before the virus bill of $2.3 trillion.

Make no mistake. When the coronavirus is finally under control, replete with vaccinations and successful treatment, the financial virus of an ever-expanding national debt and government control of the American economy will still be here, metastasizing.

It seems that this episode was one very useful if small way to get it under control.

Jeffrey Lord
Jeffrey Lord
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Jeffrey Lord, a contributing editor to The American Spectator, is a former aide to Ronald Reagan and Jack Kemp. An author and former CNN commentator, he writes from Pennsylvania at jlpa1@aol.com. His new book, Swamp Wars: Donald Trump and The New American Populism vs. The Old Order, is now out from Bombardier Books.
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