Posted on 12/07/2025 6:52:48 PM PST by SeekAndFind
Their record isn’t just spotty; it is downright awful. The Emergency Medical Treatment and Active Labor Act of 1986 was designed to prevent “patient dumping” by hospitals of emergent patients without insurance.
The unintended consequences of that law are hotly debated. What is not in controversy is the hospital lobby’s insistence that the law drives up their operating costs.
That argument has done decades of service to protectionist policies that limit competition and protect prices.
Then there is the Affordable Care Act. It was a compromise between advocates of “universal health care” and the “Third Way” or “New Democrats” who viewed big business not as an obstacle to their ambitions but a facilitator.
The latter group was successful beyond their wildest dreams. The former is still trying.
In the wake of an unprecedented government shutdown, Congress is taking up another attempt to make the American health care system behave.
Unfortunately for the American people, they seem completely flummoxed by the problem. With apologies to James Carville, “It’s the prices, stupid.”
A simple question of “How much will this cost?” is met with howls from the mandarins of a system who believe there is something so unique, so special about the sale of health care services that we must all support its protection from market realities.
Concepts like “adverse selection” may be foreign to your average American but it and others seem to overrule all other considerations like the impact of health insurance premiums on take-home pay.
The economic realities of America’s households have been ignored to protect margins at health insurance carriers with the full-throated support of Congress.
Instead of hanging on the prospect of another disastrous policy effort, the White House and Congress should fully deploy the most powerful tool available to contain costs.
Health care price transparency is bipartisan – its statutory authority rests with the Affordable Care Act, ironically.
Both Trump administrations and the Biden White House have made incremental progress on providing guidance and implementing enforcement.
Thus far. What the transparency data tells us is that health insurance for the young and the healthy is mostly a tax.
At one Alabama hospital the discounted cash price for a screening mammogram is $148.33. According to their disclosure the hospital is paid anywhere from $67.55 to $385.28 by insurers.
For the privilege of paying $500 to $1,000 per month in health insurance premiums, an insured woman in Alabama saves $80.78 negotiated by her insurance company.
Mammograms are generally excluded from cost sharing. A knee arthroscopy is not.
That same woman in Alabama could pay a cash price of $1,651.33 or have her insurance company negotiate $3,075.26.
If Miss Alabama has met her deductible, she will pay 20% of the negotiated rate. If she has not, she will pay the full cost of the negotiated rate, not the cash price.
When wages are growing, health insurance premium increases are less of a concern. That was the case from 2017 until 2022. Add the economy-wide inflation the US experienced from 2022 until just recently and you get what you got, a cost-of-living crisis.
Health insurance for the young and the healthy becomes a nice-to-have instead of a got-to-have.
The most economically sound response to the current environment is for the young and the healthy to purchase health insurance with the highest deductible with which they feel comfortable and pay cash for everything else.
The Affordable Care Act’s employer mandate makes such rational behavior nearly impossible. Anecdotally, it appears some hospitals actually prohibit cash payment for their services!
There will be no shortage of economists and policy apparatchiks offering advice on risk pools and pre-existing conditions and very legitimate and serious questions centered over that portion of the population that is not young and healthy.
The more pressing problem is unburdening wage earners from economic insanity. Ending the employer mandate and embracing price disclosures will translate into a raise for about 160 million Americans who sorely need it.
Gallup. (2024). Few Americans know healthcare costs.
Centers for Medicare & Medicaid Services (CMS). National Expenditure Data – Historical NHE Tab
Federal Reserve Bank of St. Louis (FRED). “Consumer Price Index: Total % Change (FPCPITOTLZGUSA).”
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Who are the 5ish% of idiots in the first chart who don’t think healthcare costs should be transparent??
Has to be insurance people and the doctors
Since 1971, there is no effective means to limit Congress’s spending.
Since Medicare in 1965, every health care law passed by Congress has involved “compromise” - meaning, the GOP gets something, and the Democrats get something.
Unfortunately, both get what they want with borrowed money and without any inout from anyone who knows anything about care or the sick.
The end is very close now.
Obviously.
“A simple question of “How much will this cost?” is met with howls from the mandarins of a system who believe there is something so unique, so special about the sale of health care services that we must all support its protection from market realities.”
States could require Medicare multiple pricing. If Medicare would pay the hospital $22,000 for a DRG and hospital posts a multiple of 1.4, the patient amount would be $30,800.
The hospital and each billing provider would post their multiplier on or near each external door used by the public, along with specific item exceptions not exceeding 10 pages.
Any federal PPACA subsidy enhancement continuation could be contingent by state on such posting no later than the first Tuesday of March 2026.
My Latest Suggested EMTALA (and Medicaid ER) Reform
FOR CARESEEKERS
To get care under the EMTALA or Medicaid for yourself or custodial child, the hospital might require you to
1. pay $100 in cash or by financial organization card accepted at the emergency care facility,
2. hand over your valid SNAP card and tender a matching valid domestic governmental picture ID,
3. hand over your valid domestic driver’s license,
4. hand over your valid US passport,
5. hand over your operable Apple or Samsung cellphone model listed by a current regulation issued by a Secretary of HHS, or
6. hand over a valid domestic governmental picture ID of yours and
a tender matching financial institution statement less than 70 days old showing a domestic governmental or employer direct deposit of at least $150, both for hospital photocopying and recordkeeping.
States might be allowed to authorize emergency care facilities to contemporaneously debit SNAP cards for EMTALA incidents.
Items handed over may be retained by the emergency care facility until retrieved within one month by the responsible party by paying $100, or more, for the care, plus a retrieval fee not exceeding $20 in a manner the facility accepts. Items not timely retrieved may be disposed of in a legally allowable manner.
NOTE: People can get the care they need, but only by paying $100, forfeiting an expensive cellphone, or going through the hassle of replacing a SNAP card or government picture ID.
FOR HOSPITALS
I would allow hospitals collect up to $1,000 per incident of EMTALA service from employers, with payment not in excess of $50 per week per employee concerned being due to any and all EMTALA providers and not for more than 100 weeks after service. Such payments on behalf of an employee would be considered to be a debt of the employee to the employer. Employers could collect back from employees and ex-employees (and require EMTALA incident employees to participate in an employer plan).
“...meaning, the GOP gets something, and the Democrats get something.”
Yes. And we citizens are screwed as we close in on $40 trillion in debt that can’t be paid back, the uniparty will make it even worse coming up shortly when KeyanKare soon expiries.
The Oklahoma Price Transparency law:
https://www3.oklegislature.gov/cf_pdf/2025-26%20INT/SB/SB889%20INT.PDF
I saw some of the talking heads this morning on the subject. How stupid do they really think we are? They have proposed nothing to make anything better or to deep six obama care or reign in cost factors.
When I was young, a teen, my kidneys started failing. Auto-immune stuff. I was very expensive for a long, long time. I’m sure Canada would have killed me before I could receive a kidney and start contributing.
Obamacare made a biiiig mess of things.
There was no healthcare insurance before 1940 minus a few hospital plans. That’s where we should be headed.
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