Private equity groups profit from out-of-network medical bills. Congress goes home without treating the problem: Our view

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In health care, it is always best to treat the disease, not just the symptoms.

In the politics of health care, however, treating symptoms is about all we can hope for. And even that can be a slog in Washington.

Witness the issue of those surprise medical bills that patients receive, like unwelcome Christmas gifts, thanks to private equity groups that have bought up medical practices and organized doctors. 

The insidious practice involves placing doctors who are not part of insurance networks in hospitals that are. Patients might think they will only be liable for a manageable co-pay then get slapped with massive bills for, say, an out-of-network surgeon and anesthesiologist.

OPPOSING VIEW: Reject premature rate-setting deal to address surprise medical bills

Committees in the Democrat-controlled House and Republican-controlled Senate passed measures this summer to clamp down on the surprise bills. They even appeared to have a deal for a common measure going forward. 

Then these private equity groups went on a lobbying and advertising blitz. Maybe you saw their ads. They attacked insurers for what they called “rate setting” and promoted the warm and fuzzy concept of “doctor-patient unity.”

Lawmakers had hoped to add the legislation to the catch-all spending measure that passed last week, but they adjourned for the holidays without acting to curb surprise medical bills. Now they have their sights on a similar measure in the spring.

For now, let’s be clear about one thing: This outrageous practice of springing surprise medical bills on people — bills they are typically in no position to dispute —  is simply the latest symptom of a sick health care system.

Americans pay far more for health insurance than people in other countries for the simple reason that nobody has the ability to say no to providers. Insurers lack the market power; government, with some exceptions, is barred from negotiating.

The ease with which drug companies, hospital chains and other providers have gotten rich off the system has not gone unnoticed on Wall Street, prompting hedge funds and private equity groups to rush in to the multi-trillion dollar health care field.

Addressing the surprise medical bill scam would only fix one narrow issue within health care. What’s more, Congress might simply create a new problem in addressing this one.

The proposals under consideration start by holding the patient harmless, which is good. But rather than simply banning the practice of sneaking in out-of-network doctors, they would set up a complex dispute-resolution system to determine when and if the higher costs are justified.

You can bet that private equity will pour its money and lobbying muscle into ensuring that insurance companies ultimately eat the cost of the out-of-network doctors — and then pass them on to consumers.

Provider networks of are one of the few ways in which insurers have successfully pushed back to hold down health care costs.

Now, in comes Wall Street to get rich by undermining these efforts. The result, as always it seems, will higher costs for hard-working Americans — if not from outrageous bills out of the blue then in higher premiums.

USA TODAY's editorial opinions are decided by its Editorial Board, separate from the news staff. Most editorials are coupled with an opposing view, a unique USA TODAY feature.

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