Rep. Mike Sparks

Recently during our Tennessee House Insurance Committee chaired by Robin Smith we listened to testimony from Dr. Lawrence Van Horn, an Associate Professor of Management (Economics) and Executive Director of Health Affairs at Vanderbilt Owen Graduate School of Management.

He spoke passionately about the need for more transparency as a part of health care reform.

This past summer, President Donald Trump issued an executive order on healthcare price and quality transparency, much of it due to the insights and analysis offered by Van Horn. The professor was also on hand at the White House last summer for the announcement of two new rules requiring hospitals and insurers to make their negotiated prices public.

Sadly, many hospitals and insurance companies are doing everything they can to force the Trump Administration and the Centers for Medicare & Medicaid Services to stop their plan to force negotiated price disclosures.

Many hospitals and insurance companies believe the president’s proposal to make hospitals post their prices for medical services would be bad for business and patients. Fortunately, economists and patients themselves see price transparency as a good thing — after all, who purchases a dinner, a home, clothes, or a car without first knowing what the price is and possibly shopping the competition for a better deal.

During his presentation, I had the opportunity to ask the professor a few questions: “Dr. Van Horn, my late father who served in WWII often used the term ‘cattywampus,’ have you ever heard that term? How has our healthcare system become so cattywampus?” There was a chuckle in the crowd (I thought everyone knew what cattywampus meant). I went on to explain how Nashville and Middle Tennessee have become hubs for healthcare with great hospitals and many innovative healthcare startups, but we still have problems.

I went on to explain how my family has been personally affected by the high cost of healthcare. First, I shared the story of my sister Vickie, who is in a nursing home with three others in one room at a cost of $6,000 each month and has lost everything and how her insurance company wasn’t there for her despite her having faithfully paid her premiums.

Across our country, patients are frustrated with the increased costs and lack of transparency within our health care system and are asking for solutions.

Can anyone think of a worse business model than our current healthcare system? When an entire industry is afraid to disclose its prices, common sense tells me it has something to hide.

Last year I contacted Ralph Weber, CEO of MediBid Inc. and author of several books, including “Rigged: How Insurance Ruined Healthcare (and how to fix it)”. I called Ralph to ask for advice on what we, as a state, could do to improve our healthcare system.

That is what led to House Bill 1366 on referenced-based pricing, which we feel has the potential to save the state’s taxpayers $80 million to $100 million dollars.

There is no doubt a lack of transparency in our healthcare system today.

Maybe that explains why BlueCross BlueShield of Tennessee has filed an antitrust lawsuit against our state’s executive director of the Department of Finance & Administration and 100 state employees in an attempt to block the release of 2018 claims data related to the state’s employee health plans by Chairman Martin Daniel — a move they believe violates their contract with the state along with several federal laws.

Rising healthcare costs, lack of transparency, suppressed competition, our aging Baby Boomers and the need for better healthcare outcomes is at a crisis level. As individuals age 65 or older spend, on average, three times more on healthcare per person than working-age individuals and five times more than children, it is clear that this path is totally unsustainable.

I am proud that President Trump initiated a campaign on ways to drive down drug prices and find savings for patients. Ironically, right after the President made the announcement, more than a dozen major drug makers enacted price freezes, rollbacks, and price reductions. His administration’s efforts helped to lower prescription drug prices for the first time in nearly 50 years.

I am grateful for the work being done by the leadership in the Tennessee General Assembly on the topic of healthcare. Before I voted for Cameron Sexton for Speaker of the House and both Chairman Jeremy Faison and Leader William Lamberth, I asked them how assertive they would be on healthcare, treatment for drug addiction and other needed reforms. They all agreed those would be among their top priorities.

There is considerable amount of work to do regarding healthcare. It’s an issue that sooner or later, we will all face in our lives.

Mike Sparks represents House District 49 in Rutherford County. He is the chairman of the Consumer Subcommittee and serves on the Insurance Committee, Consumer and Human Resources Committee, Naming, Designating, and Private Acts Committee, and the Property and Casualty Subcommittee. He can be reached at (615) 741-6829.

 

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