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Surprise billing is our health care system’s moral failing

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Let’s put a circle — with a line in it — around out-of-network opportunists

Thanks to Dr. Ashish K. Jha for drawing attention to physician companies that make money by sending surprise out-of-network bills to the most vulnerable patients — those in emergency rooms or under anesthesia (“Ending surprise billing: A moral test for physicians,” Opinion, Dec. 9).

Jha says that 15 percent of hospitals account for more than 80 percent of this immoral practice. Until physicians or Congress stop them, why not publish the names of the hospitals that make up that 15 percent? Consumers would happily avoid those facilities.


We might also benefit from a new card to hand over with our insurance cards, stating, “I demand to be seen by in-network doctors, including when under anesthesia.”

Lee Bluemel

North Andover

The op-ed by Ashish K. Jha suggests a strategy for decreasing out-of-network billing. If most of the unexpected charges come from a small subset of hospitals, I would like to see the Globe publish a list of those hospitals. Not only could patients avoid them when they have a choice, but the publicity may encourage hospitals to go back to hiring individual physicians and avoid the practice of using companies that employ physicians.

John Samp


A national health care system would see to this problem

Ashish K. Jha’s cogent and captivating essay on surprise billing is welcome but slight. As Leo Tolstoy said, “Money is a new form of slavery.” We doctors and patients are at the mercy of at least six kinds of corporate profiteering in health care.

In a national health care system like that of the US Department of Veterans Affairs, there is no mucking around in computers to charge more money. The payment for each procedure, nationwide, is roughly the same. That’s the issue, and that’s the solution. Private insurance could continue, but eventually it will lose market share.


Dr. Samuel Shem


The writer is the author of “Man’s 4th Best Hospital.”

The in-network hospital should be on the hook

As a longtime health care provider, I was heartened by Ashish K. Jha’s op-ed, in which he described as “morally repugnant” the “deception” of the health care system and the out-of-network physicians who contract with hospitals and are the source of surprise billing.

Jha discussed various billing arbitration solutions to ease the financial burden on patients for such unanticipated charges. However, shouldn’t it be the responsibility of the in-network hospital to pay these charges? Shouldn’t there be legislation to mandate this when the hospital, not the patient, chooses to contract with an out-of-network provider? Arbitration suggests that it’s morally acceptable for these charges to be passed on to the patient in the first place, which it is not.

Sadly, not all physicians feel compelled to abide by the oath they took to do no harm, which is why we need a law to close this health care system loophole.

Bette E. Kisner


The writer is a certified clinical nurse specialist.

Overhaul health system to make all fees transparent

Ashish K. Jha wrote a beautiful hit piece about surprise billing that misses the point.

Surprise billing exists only because our health finance infrastructure is purposefully skewed to involve health insurance. I run a direct-pay psychiatry practice, and there is no surprise billing. The Surgery Center of Oklahoma does bundled payments, and there is no surprise billing.


Jha places blame with physicians groups, and that’s damaging to us.

I advocate for overhauling the health finance system to make all fees transparent and direct. The approach I promote creates universal access to quality affordable care and empowers patients to buy their care directly from physicians.

Dr. Brian J. Dixon

Fort Worth