James Nguyen wrote an opinion piece for The Hill titled Don’t blame insurers for what doctor and hospital cartels did to US health care (28 December 2024).
« How much does health insurance actually cost us? According to the American Medical Association, it’s just 6 percent of health care spending. In other words, if insurers were to donate every cent of profit they made, your health care would become just 3 percent cheaper. Health insurance mostly operates as a pass-through to send premiums to health care providers. That 6 percent cost covers insurers’ profits, staff and other expenses needed to manage themselves. »
« The first problem is that hospitals in the U.S. do not compete for patients with respect to price. For decades, until the Trump administration unveiled price transparency rules in 2020, the cost that insurers (usually your employer) and patients paid for their surgeries was secret, never to be disclosed before the bills arrived. Hospitals sued but failed to block the rules. Even today, 34 percent of hospitals continue to break those rules, according to the Department of Health and Human Services. The department has fined hospitals only four times to enforce the rules, and so avoidance of contentious talk on costs remains deeply embedded in health care’s culture. »
[Comment: List prices are meaningless. They are absurdly high fictions from which every health plan has negotiated discounted rates. There is no real price transparency unless all of the negotiated rates are easily accessible to the public.]
« Even insurers are unable to effectively negotiate with providers: One private insurer may pay 10 times more than another for the same MRI. On average, private health insurers pay 254 percent more than Medicare to cover their patients. »
« Nearly half of all metro areas in the U.S. have just one or two hospitals (i.e., a monopoly or duopoly) for inpatient care. From 2000 to 2020, major health systems made 1,164 mergers, only 13 of which have been challenged by the Federal Trade Commission, despite raising prices for patients, insurers and employers. »
« Our second major problem is an artificial doctor shortage. America needs more health care workers. Hospital lobbyists have sounded the alarm on a shortage of 100,000 health care workers by 2028, even though the average physician made $405,000 annually in 2017 during their peak earning years. How did we get here? »
« Throughout the late 20th century, again and again, the American Medical Association, the doctors’ lobby, claimed that the U.S was “on the verge of a serious oversupply of physicians.” They demanded in 1997 that the U.S. train fewer physicians (as many as 20 percent fewer), and so training jobs for medical school graduates declined or remained flat from 1970 to 2010 even though medical students became more competitive and far more qualified. »
« Only experienced Canadian doctors are consistently permitted to practice in the U.S. without going through years-long residencies with grueling 60-80 hour work weeks. Doctors with decades of experience in countries with high-performing health systems, including the Netherlands and Australia, are not. »
« As a result, two seemingly contradictory things are true: We have fewer physicians per capita than most wealthy countries, even though physicians in the U.S. are paid more than anywhere else, at twice as much as in Europe, even after accounting for how much Americans earn. »
« Meanwhile, understaffed hospitals have burned out so many physicians, despite their pay, that the AMA has reversed its position by asking the government to train more doctors. »
« James Nguyen is a health care attorney who has practiced on behalf of mid-sized hospitals in Ohio. »
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