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Out-of-Network Medical Bills Are a Problem. Health-Care Networks Are a Bigger One.

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The scourge of so-called “surprise medical bills”—a label nearly always referring to out-of-network emergency care provided by an in-network facility, resulting in outlandish bills for the patient—has stoked outrage in recent years. Since 2017, investigative reporting driven by outlets including Vox, NPR, and Kaiser Health News has highlighted cases like that of Scott Kohan, who was saddled with an $8,000 bill for emergency oral surgery it turned out had been performed by an out-of-network surgeon. Some 57 percent of Americans have reportedly experienced this problem; three-quarters say government action should be taken against it.

In Congress, opposition to surprise medical bills appears to be a rare matter of bipartisan consensus: The House of Representatives held its first-ever hearings on the issue in early April after President Donald Trump himself declared a distaste for the practice, and senators from both parties allegedly are working on legislation to curb them. In late April, the California state assembly unanimously voted to pass further patient protections against surprise bills out of committee.

While any relief for patients experiencing astronomical bills is an undeniably good thing, surprise medical bills are but one product of the systemic failures of the health-care system in the United States—and are a narrow category of harms that befall patients within it. Placing such outsized focus on surprise bills as a uniquely galling one replicates the market logic that’s so badly perverted American health care in the first place. An equitable health-care financing system simply cannot include networks and such wildly different plans for different people.

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