




Scott Kohan woke up in an Austin, Texas, emergency room after an attack that broke his jaw. The hospital was within his insurance network. But the oral surgeon who set his jaw wasn’t. Mr. Kohan’s insurer refused to pay the surgeon’s $8,000 bill.

He’s not alone. An estimated 51% of ambulance rides, 22% of emergency-department trips, and 9% of elective cases, in which patients have time for due diligence, lead to surprise bills. These typically come from providers who refuse to join insurance networks so they can charge astronomical fees.

Congress could eliminate the Part D “protected classes” rule which forces insurers to pay for any drugs in six arbitrary categories, regardless of their price or value. (The Trump administration had proposed just such a reform, but withdrew it in a sop to the drug lobby.)

More substantially, Congress should require that drug companies selling drugs into Part D rebate any price increases above consumer inflation to Medicare, to offset the program’s taxpayer-funded subsidies.

Without reforms of this type, it’s highly likely that restructuring Part D would drive costs upward.

Consolidation in the health system and health insurance industries has been a focus for years. But a new report sheds light on how the “bigger is better” mantra has taken hold in companies that make syringes, X-ray machines or other healthcare products

The report, prepared by the Open Markets Institute using data from IBISWorld, shows a small handful of companies dominate their respective markets in certain healthcare sectors that tend to get less of a spotlight than their payer and provider counterparts.

Instead of debating how to expand Medicare coverage, politicians should focus on fixing the fatal financial flaws in the existing program that threaten to bankrupt the nation.

Medicare spent 3.6% of gross domestic product in 2016, more than six times the share it consumed in 1967, the first full year it was implemented. The forecasts I have analyzed show that the share of GDP will rise to at least 9% within 75 years—and that’s the good-news scenario. Other plausible forecasts show that Medicare could spend more than twice that.






