SPH’s Shine Lecture to Focus on the High Prices of America’s Emergency Rooms
Kliff’s reporting has revealed patients’ struggles with surprise medical billing, including one family who got a $629 hospital bill for a Band-Aid given to a child during an emergency room visit. Photo by Getty Images
SPH’s Shine Lecture to Focus on the High Prices of America’s Emergency Rooms
Event today will feature NYT investigative reporter Sarah Kliff
Americans make more than 140 million trips to the emergency room each year, but usually don’t know what it’s going to cost them until a bill shows up in the mail. A recent Harris Poll survey found that more than two-thirds of privately insured US adults have received unexpected medical bills. Of those, 33 percent were not immediately able to pay the bills.
Surprise medical billing—which can range from a few hundred dollars to tens of thousands of dollars—is a nationwide issue that has been exacerbated by the wide-ranging medical needs resulting from the COVID-19 pandemic. In December, as part of a sweeping coronavirus economic relief and government funding package, Congress passed a bill that would eliminate many unexpected medical bills for emergency care—a major step forward, but not a complete solution to a problem that can become a devastating and unanticipated financial burden for patients.
The School of Public Health’s Center for Health Law, Ethics & Human Rights will examine the issues resulting from surprise emergency room billing during the annual Cathy Shine Lecture Wednesday, February 10, from 1 to 2:30 pm. Titled $629 Band-Aids and $20,243 Bike Crashes: The High Prices of America’s Emergency Rooms, it is free and open to the public.
Moderated by Wendy Mariner, an SPH professor emerita of health law, policy, and management, the lecture will feature a conversation with health policy journalist Sarah Kliff, a New York Times investigative reporter, who has spent years covering policy and legislative developments, including Washington’s battle over the Affordable Care Act. She has previously written for Vox, Newsweek, and Politico, and in 2012, the Supreme Court cited her work in its decision to uphold the healthcare law.
Kliff’s reporting focuses on the American healthcare system and how it works for patients. She spent 18 months collecting thousands of emergency room bills and making public many prices that hospitals tried to keep secret—such as $629 for Band-Aids and $5,571 for sitting in a waiting room. During the lecture, Kliff will discuss what her reporting found, what it reveals about the American healthcare system, and the policy solutions Congress could implement to fix it.
The Cathy Shine Lecture is endowed by the family of the late human rights advocate Cathy Shine, who died in 1992, in recognition of the work of George Annas, a William Fairfield Warren Distinguished Professor and an SPH, School of Medicine, and School of Law professor. Annas wrote about Shine’s experience of being restrained against her will at a Boston hospital recovering from an asthma attack and her subsequent avoidance of hospitals, and about the importance of respecting patients’ rights, in a frequently cited article in the New England Journal of Medicine.
Kliff spoke with SPH’s Public Health Post (PHP) about healthcare reform, the COVID-19 pandemic, journalism in a time of misinformation, and the relationship between healthcare and public health in advance of today’s lecture.
Q&A
With Sarah Kliff
Public Health Post: You last spoke with PHP in 2017 after interviewing President Obama about the Affordable Care Act. What are your predictions about the Biden administration successfully protecting and building on Obamacare?
Sarah Kliff: Well, it’s come a little full circle since then, since we’re talking right after President Biden’s inauguration. What I do expect is them to move forward on the suite of changes the Democrats have really wanted to make to the Affordable Care Act. Generally, this is all in the category of making health insurance more affordable and doing that by giving people bigger subsidies.
This is something we’ve already seen President Biden tackling in his first stimulus plan, that $1.9 trillion stimulus. There’s a sentence in there, and it’s only a single sentence, but it would be quite important to the Affordable Care Act, that would strengthen subsidies, basically make higher-income people eligible for subsidies who are not currently eligible and give stronger subsidies to lower-income Americans. I think those are the type of changes that are quite likely to happen. If you start getting into bigger ideas—a public option—or if you want to go biggest—Medicare for All—I think those ones will struggle a little bit. I think something that has quite good odds of passing is increasing the ACA subsidies.
What does it say about the political environment and the healthcare system in the United States that you still have to report on high healthcare costs?
It’s kind of a never-ending series of stories. That’s really even been true through coronavirus, where you have patients with coronavirus encountering all sorts of odd bills. I think it’s still quite true that the United States has the highest prices in the world. There is little political appetite to tackle that because you have such strong interests in favor of those high prices. That being said, there is a bit of a glimmer of hope in legislation that passed at the end of this year. This new ban on surprise medical billing is something that actually will tackle costs, possibly in a significant way.
Which policy solutions should Congress and the Biden administration implement to improve access to affordable healthcare in this country?
If you look at pretty much any survey of marketplace enrollees, the biggest complaint is always affordability. The premiums are too high. The deductible is too high. I think that’s really what they’re going to be tackling first. The other area is how to deal with this Medicaid gap situation, where you still have about a dozen states that haven’t expanded Medicaid. You have millions of people living in those states. Texas and Florida are responsible for a lot of the remaining uninsured in the United States. There isn’t quite as clear of a policy solution to that, but I think that is one that they’re going to be thinking about. If you can close that gap, you’re getting the Affordable Care Act a lot closer to the original goal of who it was supposed to give coverage to.
As an investigative journalist, what were the first questions you started to ask about the government’s response to the pandemic?
I personally have been really interested in testing infrastructure and why it has struggled so much. It also intersects with a lot of the work I do on billing because a lot of this is running through health insurance, so it’s a little bit different than most other countries. Here, when you go to the doctor, they’re likely going to bill you for it, and you could get some surprise. I think that’s been a really ripe area of investigation that I’ve been focused on.
Right now, I’m starting, with my colleagues, to look at vaccine distribution. One of the things I’ll probably be focused on, because it kind of fits into my reporting space, is if people are facing costs for their vaccines. They’re not supposed to, but there’s many instances where you’re not supposed to get billed for something in healthcare, but you inevitably face a bill.
How do you see journalists overcoming the pressing challenges of fake news, misinformation, and plandemics that many Americans buy into?
It’s become more and more of a challenge the longer I’ve been a reporter and the more widespread that kind of misinformation gets. For me, what I really try and do is give the best information that I can in hopes that it’s going to be credible. It’s much harder to do the job that I do when people can really curate their news environment.
What are your thoughts on the evolving relationship between healthcare and public health? How has it evolved given the last year?
I think the coronavirus has kind of exposed and laid bare how public health and healthcare often are thought of as two separate entities in the United States, but actually, when you have something like a coronavirus pandemic, they need to work much closer together. It will be interesting to see if going through this pandemic changes that relationship because I think it’s really shown a lot of the weaknesses. It shows how much weaker it leaves us as a country if you don’t have that strong connection between the people providing healthcare and the people doing the public health work.
Sarah Kliff will discuss her reporting on the high costs of healthcare at the 2021 Cathy Shine Lecture, $629 Band-Aids and $20,243 Bike Crashes: The High Prices of America’s Emergency Rooms, today, Wednesday, February 10, from 1 to 2:30 pm on Zoom. The event is free and open to the public. Find more information and register here.
Nicholas Diamond is the managing editor of the BU School of Public Health’s Public Health Post; he can be reached at njd15@bu.edu.
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