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Why Universal Public Insurance Will be Brutally Difficult to Enact

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Hospitals and allied interests have killed a bill curbing surprise medical bills using leverage to charge exorbitantly high rates in California:

Providers, especially hospitals, have gone to war over the state’s billing proposal. They insist they are all in favor of protecting patients from surprise bills. The problem, they say, is the remedy. The California bill would, in effect, force out-of-network providers to accept some form of Medicare or in-network reimbursement rates, or some blend of them. That would be less than the providers can charge now, obviously, and it would also set a precedent ― namely, allowing the government to dictate their fees.

Doctors and hospitals have a lot of clout in Sacramento, as they do in most state capitals. As Anthony Wright, executive director of the consumer advocacy group Health Access, quipped to HuffPost, “We have 450 hospitals in California and we suspect that each of those CEOs has the personal cellphone of the assembly member from the district.” 

Supporters managed to get the bill through the State Assembly but two weeks ago its co-sponsors, Assemblymember David Chiu and Sen. Scott Wiener, tabled the measure (meaning they will hold it over until 2020) just as the Senate was preparing to take it up. 

They didn’t mince words about why. “This bill curtails a practice that generates billions of dollars of profits for hospitals, and lobbyists and CEOs for the most profitable hospitals in California have made it abundantly clear they will protect profits over patients,” Chiu and Wiener said. “That level of moneyed opposition proved insurmountable at this time.” 

As Cohn goes on to say, “extremely difficult” doesn’t mean “impossible.” But it’s critical to know what the barriers are, and if hospitals can wield this kind of power in a deep blue state with Democratic supermajorities you can imagine what trying to get single payer through the United States Senate will look like.

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