Wayne Winegarden: Coerced pricing is price controls by another means

Keywords Viewpoint
  • Comments
  • Print

Sustainably addressing the problems of rising prices and declining quality requires reforms that empower patients and doctors, improve price transparency and eliminate the perverse incentives of our current health insurance system that drive up costs and limit care.

Instead of addressing the health care system’s core deficiencies, policymakers push for counterproductive policies like price controls. Efforts in Indiana show that politicians do not need to pass legislation to implement bad ideas. The threat of legislation is sufficient.

Indiana’s Senate president pro tem and House speaker asked state hospitals “to work collaboratively with third-party payers to present a plan to the Legislature by April 2, 2022, that would lower Indiana’s hospital prices to at least a national average by January 1, 2025 … [otherwise] we will be left with no choice but to pursue legislation to statutorily reduce prices.”

Channeling their inner Michael Corleone—making an offer these hospitals can’t refuse—the legislators are demanding that hospitals impose price controls on themselves, otherwise they will do it for them. Price controls imppose large costs that reduce quality and availability of health care.

The legislators raise an important point. Hospital prices are expensive, and it is difficult to justify Indiana hospital prices that are 50% more expensive than the already inflated national average. However, the disincentives created by the growing government share of spending coupled with the broken health insurance system are driving the problem. Price controls do not eliminate these disincentives.

Consider that government spending through programs like Medicare, Medicaid and the Veterans Administration account for nearly 51 cents of every health care dollar spent, according to the Centers for Medicare and Medicaid Services.

As a Medical Group Management Association poll shows, “more than two-thirds (67%) of medical practices” report that Medicare’s reimbursement rates do not cover the cost of delivering care. To offset the losses, practices increase prices to shift the costs onto private insurers.

The shortfalls are significant. Medicare pays 84 cents per dollar of actual expenditures and Medicaid pays 88 cents on the dollar, according to the American Hospital Association. Hospitals must consequently charge private insurers $1.14 on the dollar just to break even.

Private insurance practices that encourage opaque prices and diminish patient control over their own health care decisions only worsen the situation. Without transparent prices and empowered patients, we can’t control inflating hospital prices.

Given that hospitals earn a 6.5% profit margin compared to an economy average of about 15%, it is exceedingly likely that, in response to price controls, we could see hospitals cut staff and services or even close.

Reduced access to lower-quality health care services imposes significant costs on patients that include worse health outcomes. The reality is that price controls substitute one bad outcome—inefficient prices—for a worse outcome—reduced health care outcomes.

Establishing affordable health care prices and promoting better health outcomes requires reforms that remove the systemic inefficiencies driving the cost problems. Reforms should eliminate the government’s adverse impacts on hospitals, promote pricing transparency for patients, and reform the health insurance system to empower patients and doctors rather than payers.

Imposing voluntary price controls in lieu of government price controls does not address the problems afflicting the health care system. Improving health care affordability while increasing the quality of health care we receive is possible but requires fundamentally reforming the ineffective health insurance system.•


Winegarden is director of the Center for Medical Economics and Innovation at the Pacific Research Institute.

Please enable JavaScript to view this content.

Story Continues Below

Editor's note: You can comment on IBJ stories by signing in to your IBJ account. If you have not registered, please sign up for a free account now. Please note our updated comment policy that will govern how comments are moderated.