Bob — I think medical debt caused by surprise bills is a solvable problem without new taxes. It would take making hospitals resolve the billing dispute with doctors who practice in their hospitals but patients generally have no role in choosing. These include radiologists, anesthesiologists, pathologists, emergency medicine doctors, assistant surgeons and, sometimes, surgeons for care that must be done on an emergency basis. I think it’s an outrage that some of these doctors deliberately refuse to join any networks so they can submit huge, unconscionable bills to patients who have no role in choosing them and need care that can’t be shopped or scheduled in advance.

I’m not sure how best to handle the ambulance bills. A lot of the fire and first aid service around here is provided by volunteers who are getting harder and harder to find. Even if organized on a regional basis as opposed to a town by town basis, most of these people and equipment are likely to spend a significant percentage of their time sitting around doing nothing. Even in New York City, fires are WAY down from 40 or 50 years ago but a lot of their time is now spent responding to vehicle accidents and drug overdoses. Air ambulances are unbelievably expensive. Maybe it would be most appropriate for regional ambulance services to be owned by hospital systems and partly funded by subsidies provided by tax revenue but I just don’t know how best to handle that issue.

My point later on is that medical debt can be reduced without relatively little in new taxes.

For example, cancelling balance bills that violate fair trade laws requires no taxes.

Cancelling chargemaster bills for emergency care requires no taxes.

Having a firm statute of limitations on old debts requires no taxes.

Requiring all hospitals to respect charity care guidelines and cease patient lawsuits requires no new taxes.

The only tax that I really want for now is about $20 billion a year for the government to take over the ambulance industry. That should be a public function just like fire and police.

That will not get rid of all medical debt, because many Americans are just too broke to pay for all their care at the point of service.

But my proposed legal reforms will wipe out many debts!
Bob Hertz

I would also note that three factors that make our healthcare system much more expensive than those in other countries are defensive medicine driven by our overly litigious society, way too much marginally useful or even futile care at the end of life which is much less prevalent in other countries and the fact that everyone who works in healthcare from doctors, nurses and techs, to executives, IT specialists, administrators, food service workers and transporters make 50% – 100% more than their counterparts in other countries. Under the Bernie Sanders Medicare for all approach, none of that would change. High prices for brand name and specialty drugs are also a problem but I think it’s overstated in the scheme of things. Multiple insurance plans add some administrative complexity but that’s the price we pay to have choices instead of a monolithic one size fits all government plan. We like choices in our society and culture.

Insurance plans with low deductibles and out-of-pocket maximum amounts would come with high premiums that most people and even many employers outside of the public sector can’t afford. There are sensible approaches that could address the problem of out-of-network surprise bills like having hospitals work it out with anesthesiologists, assistant surgeons and emergency medicine doctors. Most Americans don’t want to pay to provide health insurance to illegal immigrants. People just don’t want to pay the taxes it would take to address the issues you raise and there simply aren’t enough high income and wealthy people to soak to give everyone else a free or at least an inexpensive ride.