Understanding the mess of medical prices, and making sure you’re not burned by big bills

If they put on a game show with Drew Carey about hospital prices, you know it would have to be called “The Price is Wrong.”

Because the price is never right for patients and families trying to understand, much less pay, the bills they get for even brief hospital stays.

Not for lack of trying by government leaders current and past. The hospital price game is still a frustrating mess. 

Trump officials hoped to cut soaring health care costs by pushing for more transparency in hospital prices patients pay, building on part of the Affordable Care Act. It required hospitals years ago to post what became ungainly lists of “standard” rates for hundreds of procedures and items. These were some of the highest prices that institutions charge.

The Trump folks took the next step and ordered hospitals to publish, incomprehensible form, previously secret details of deals they cut with insurers and providers, so patients could see costs of 300 common procedures and items.

The pokey disclosures and analyses of this data are underway. But they have underscored a fundamental well known by health economists: Americans pay more for health care than other Western industrial nations and get poorer outcomes. Some of this is because of more intense use of a few specific medical services. The big driver, however, is the prices themselves. They are unmoored from reality. Providers charge whatever they think they can get.

Patients can be savvy about this. They may not be able to shop around or cost-share as much as economists recommend. But they can track every medical expense, dicker, and fight. And if they do, bills do go down. 

But why should this be so hard? There are ways to fix medical prices, but we all need more help from the government and our employers.  That may be on the horizon.

With the nation graying rapidly and so many Baby Boomers eager to stay active, knee and hip replacements fast became some of the most performed procedures in the country (at least pre-pandemic). But only in recent weeks have patients, surgeons, hospitals, insurers, and regulators — due to new federal requirements on price disclosures — seen detailed information on huge disparities in the cost of these common surgeries.

Figuring in the expense of the hospital room and board and other allowed charges, the average price in the New York metro area for a new knee or hip ($58,193) is more than double the average price in the Baltimore, Md., region ($23,170), researchers with the Peterson-Kaiser Family Foundation Health Tracker system found.

The experts also learned that, among hospitals reporting so far on their negotiated prices with insurers, the average price for knee and hip replacements in the Washington, D.C., area (including Arlington and Alexandria, Va.) was $33,909. That is less than what patients pay, say, in Fort Worth, Tex. ($47,948) or in Tampa-St. Petersburg, Fla. ($40,692) but a bit more than in Los Angeles ($33,297) or Chicago ($30,470).

How can procedures that are so common and similar have such a wide price range? Sure, surgeons may use different techniques, hardware (implants), or equipment (including robots).

But also consider what the Wall Street Journal discovered about the price of just one familiar medical service — a caesarean section — by crunching recently disclosed data from Sutter Health, a Northern California system with 24 hospitals and 2019 revenue around $13 billion:

“When a woman gets a caesarean section at the gleaming new Van Ness location of Sutter Health’s California Pacific Medical Center, the price might be $6,241. Or $29,257. Or $38,264. It could even go as high as $60,584. The rate the hospital charges depends on the insurance plan covering the birth. At the bottom end of the scale is a local health plan that serves largely Medicaid recipients. At the top are prices for women whose plans don’t have the San Francisco hospital in their insurers’ network. The nation’s roughly 6,000 hospitals have begun to reveal the secret rates they negotiate with insurers for a range of procedures. The data offer the first full look inside the confidential deals that set health care rates for insurers and employers covering more than 175 million Americans. The submissions also illuminate how widely prices vary — even for the same procedure, performed in the same facility — depending on who is paying.”

Hospitals and ‘spit-balling’ prices

The Wall Street Journal had earlier reported eyebrow-raising information on hospital pricing and costs, based on a Wisconsin facility’s rigorous study of knee replacements. The procedure had risen in price by 3% a year for almost a decade, hitting $50,000 per such surgery by 2016, including coverage for surgeons and anesthesiologists.

But with insurers and Medicare grumbling, the not-for-profit Gundersen Health System in Wisconsin decided to seek its own evidence about the appropriate price for one of its most frequently performed operations, 400 or so times annually in its flagship community hospital.

It is telling, first off, to know how the suits at the hospital priced knee surgeries before, according to the newspaper: Administrators “had no real idea what it cost to perform the surgery. They set a price using a combination of educated guesswork and a canny assessment of market opportunity.”

Really? Hospitals conduct themselves just like the corner mechanic, who gouges you for a price, which he says he just “spit-balled?”

It’s true — and there’s more aggravation in the story: After conducting a meticulous, 18-month time-and-motion study and consulting with its own people, Gundersen decided that pricey knee operation really cost it $10,550, including doctors’ services.

Wait, there’s more: Based on inefficiencies found in its internal research, the hospital changed practices and policies, improving patient care and outcomes. And that knee surgery cost now went down to $8,700.

Want yet more? Under pressure from an alliance of local businesses and insurers, Gundersen has negotiated even lower prices for some patients, though the parties involved won’t disclose the details.

How can it be that a surgery is priced at $50,000 but costs a non-profit hospital less than $8,700? The free-market-loving folks at the Wall Street Journal describe the economics of profit maximizing this way:

“Competitive forces are out of whack in health care. Hospitals are often ignorant about their actual costs. Instead, they often increase prices to meet profit targets. Patients, especially those with insurance, often don’t know the price of a procedure and rarely shop around. This dynamic is a driving force in the explosion in health-care spending in the U.S. … The rise in hospital prices has outpaced economy wide inflation for decades. ‘When price isn’t tightly linked to cost, that is a sign that the market isn’t competitive,’ said Harvard economist Leemore Dafny.”

A major driver of rising health costs

Indeed, researchers at the independent, nonpartisan RAND Corp. have stepped up their scrutiny of hospitals as they try to assist policy makers in determining how to rein in the nation’s soaring health costs.
 
As consumers too well know, the prices for prescription drugs have risen unbearably, as have the costs of doctors’ care. Efforts to curb skyrocketing expenses in these areas have proven resistant to change, as four years of outrage but mostly inaction in Washington, D.C., showed.

But the RAND experts joined in what other health economists have said for a while now: Hospital costs have become a major driver of health care spending, taking up roughly 1 of every 3 dollars spent in this area (~$1.2 trillion in 2018 alone).

It may seem harsh to zoom in on hospitals, just as they, doctors, nurses, and other health workers have toiled so bravely in battling the coronavirus pandemic. Still, health care costs are not going away and calls are likely to resume soon to get them better in control, the RAND researchers reported.

There are big- and small-picture aspects, though, to considerations of hospital prices: How can individuals better cope with them? And how should the federal, state, and local governments, as well employers and insurers, respond to economic forces that seem so “out of whack?”

For years, some politicians and regulators have insisted that the government should have little or no role in health care and that patients needed to lean in and apply free-market ideas to control costs for medical services. They were supposed to do this by researching rigorously themselves, comparing available data, and choosing their care wisely — with high value and lower costs at the fore.

In short, they were told to shop around, lots, and be smart about it.

The shortcomings for this approach have become clear, as the Los Angeles Times reported. While they may try, ordinary people just don’t have the time, nor the wherewithal to dig through complex, sometimes contradictory medical information and weigh the uncertainty and cost of procedures. They struggle to decide whether clinicians’ professional reputations are appropriate and earned. Their decision making also must occur too often under great duress — when they are sick or injured. The U.S. health care system also is not designed to help patients with the huge dollar-and-cents choices they may need to make, creating the overpowering distress that is known, at least in cancer care, as “financial toxicity” for vulnerable people and their loved ones.

For individuals, fighting back against medical bills can be a lonely, daunting, and exhausting ordeal.

But by reading this far in this newsletter, you already may have a big head start in the battle: That’s because you know this important fact:

 Prices in health care are not fixed. They are negotiable. They can be — and are — discussed, argued, and contested. Just as it is important never to ignore your health and serious illness, don’t hide from medical bills. Don’t just ignore them and hope they will magically go away.

Ways to take action

As Elisabeth Rosenthal — a onetime doctor and longtime reporter (the New York Times) and editor (Kaiser Health News Service) — has argued in an excellent book and many news articles (this is from one of them, a series she wrote on the Medium site):

“So, you ended up in the hospital. You got treated, and you’re home now, dreading the day when you get that bill — or, let’s be honest, bills — in the mail. Every day millions of Americans seek medical care … but what happens after you’ve gone to the doctor? What happens when you start receiving your medical bills? At this moment, because of the way economic incentives motivate our health care system, those bills will often be BIG and it behooves us all to empower ourselves and fight back. (I know it’s HARD to act like a consumer when you’ve been ill and are happy to be cured. But that’s the situation we’re in, sadly.) [There] are some steps that you can take to try to lower the cost of your care. Take them!! They will save you money and send a message to the business of medicine that we care about unreasonable, implausible costs and are prepared to take action to change things.”

She suggests steps like these (and I’m pleased to quote them, at length, again from Medium):

• If you receive an outrageous bill from a hospital, a testing center, or a medical office, don’t wait — negotiate! Make an offer… Prices are so inflated that often even low-level clerks are authorized to approve major discounts. If you haven’t met your deductible and are paying out of pocket, make an offer. I’ve heard from patients who’ve had bills for a $3,000 emergency visit for a broken ankle and a $25,000 hospital stay more than halved on the spot. If a hospital has to refer your payment to a debt collector, it will likely lose way more than half anyway.
• When a hospital bill arrives in the mail, request complete itemization. An itemized bill is your right… Many hospitals will use umbrella headings like “pharmaceuticals,” “room,” and “surgical supplies” on their bills to try to fudge full disclosure of costs. You want to know exactly which medicines and implants were used by the surgeons in the OR, for example, and the charge for each. In hospitals these days, every pill, every piece of surgical equipment, every splint is bar-coded; the hospital knows exactly how much will be charged for each item. The hospital may resist answering your inquiries and tell you that privacy regulations governing health care — such as those under the Health Insurance Portability and Accountability Act of 1996 (HIPA A) — prevent such revelations. That’s wrong. Some hospitals say they don’t discuss billing with uninsured patients “as a matter of policy.” But that’s not their choice. An itemized bill is your right.
• Check the bill against the notes you made while you were in the hospital. Errors are highly likely… Make sure you received the services for which you are being charged. In an age of automated billing, errors are highly likely. One study found that over 90% of hospital bills contained mistakes, and others have detected errors in 50% of bills or more. The sooner we all start scrutinizing these statements and demanding some answers, the quicker this nonsense will stop. Hospitals will be forced to account for their billing practices.
• Protest bills in writing to create a record … Protests via e-mail or letter are harder to outsource than phoned complaints, which can be easily referred to an operator in a distant call center. Send a copy of your letter to a reporter at your local newspaper and the state insurance commissioner or consumer protection bureau. If your protest is about a doctor’s charge, send a copy to his national specialty society (for example, the American Society of Plastic Surgeons or the American Academy of Orthopaedic Surgeons). These societies care about professional reputation and can sanction doctors for outrageous charges.
• [If hospitalized,] avoid a private room. Hospitals have built a huge oversupply of private rooms, though insurers frequently won’t cover their cost. If you are assigned to a private room, make it clear that you did not request it and would be happy to occupy a room with another patient. Otherwise, you might be hit up to pay the “private room supplement” by your insurer.
• Be clear on the terms of your stay in the hospital: Are you being admitted or held on “observation status”? Do not be afraid to ask point-blank. The answer will have big implications for your wallet. Hospitals can keep you for up to three days (two midnights) on observation status. Though you will be in a hospital bed, you will be considered an outpatient and be responsible for outpatient co-payments and deductibles, which are generally far higher than those for an inpatient stay. If you are on Medicare, the government insurer will not count days on observation status toward its required three days of hospitalization required for coverage of a stay in a rehabilitation center or nursing home after discharge. Ask why you cannot be fully admitted. If there’s not a good answer, insist on going the inpatient route.
• Identify every unfamiliar person who appears at your bedside. If you’re feeling well enough, ask what he or she is doing, and who sent him or her. If you’re too ill, ask a companion to serve as gatekeeper and guard. Write it all down. Beware the nice doctor who stands at the foot of your bed each day and asks if everything’s going OK. That pleasantry may constitute a $700 consultation. There’s an epidemic of drive-by doctoring on helpless inpatients. These medical personnel turn up whether you need or want them, with the intent of charging for their services. Remember that you can say no. Everything done to you or for you in the hospital will be billed at exorbitant rates.
• Refuse unnecessary equipment. If the hospital tries to send you home with equipment you don’t need, refuse it, even if it’s “covered by your insurance.” This is a particular concern if you’ve had an orthopedic procedure. Avoid $300 bills for slings you could buy for $10 at a pharmacy, $1,000 knee braces, and $2,500 wheelchairs, all billed to insurance and cluttering up your front closet.

Resources for the cost-conscious

Consumer Reports has information online on how to deal with medical bills, as does AARP, the nation’s largest advocacy group for older Americans, and California Healthline, a nonprofit news site focused on health care issues and the Golden State.

The Kaiser Health News Service, which Rosenthal heads, reports regularly on excesses in medical billing and how dubious charges often get resolved when journalists inquire about them. The site’s coverage also has expanded to include podcasts, including recent sessions on charitable ways to deal with medical debt and legal ways to combat this menace.

Common themes emerge from people (professionals) who deal a lot with the misery of inexplicable medical prices and bills. To get relief, some human characteristics may be helpful: Stay polite, firm, focused, and organized when dealing with medical providers, especially hospitals. Those who get angry, belligerent, or abusive don’t get the results they want.

It is important, always, to determine ways to stand out from the volume of patients with questions, complaints, or issues, maybe by building a rapport with anyone you can get to discuss your case. It can be vital to get your issue escalated, from a clerk to a supervisor, to a department head, to a director, to a vice president. Each person at her level may have just a little authority to help you, but it increases if your concerns can get bumped up.

This may mean asking around to see if family, friends, or work colleagues can refer you to a helpful insider. It would be great to have a knowledgeable hospital executive take up your concern. Do not, however, underestimate how much health workers at all levels know and can share with you. Your primary care physician may be willing to check in with specialists if you convince her their charges may be crushing to you. Nurses, internally, can have a lot of sway. These days they, for example, consult in complicated lawsuits because they can look at records or bills with a discernment that can challenge, say, the efforts of a disinterested doctor. You may know people who work in medical offices who are steeped in billing codes, pricing, and other practical information that could be invaluable to you.

Charitable care

The law requires hospitals to treat patients with medical emergencies without regard for their finances. Obamacare, especially with its expansion of Medicaid coverage for the poor, sought to reduce the tragic reality of ERs being for too many patients their principal provider of primary medical care and to assist with the financial burden of that treatment.

With the ACA and other measures, the federal government also has sought to increase the pressure on hospitals to provide more charitable care and to let patients know about its availability. This is a fair tradeoff for those institutions who reap big tax benefits by claiming to be not-for-profit. (Of the 5,200 non-federal hospitals in this country, 3,000 of them in 2019 were non-profits, with 1,300 of them for-profit, and 1,000 operated by state and local governments. The non-profits include some of the biggest and best known hospitals and chains).

But when it comes to determining how charitable care is administered and what treatment and patients are qualifying, the federal government leaves that up to states and hospitals. The rules vary greatly. And hospitals, in notices posted in their facilities on their web sites, may claim to be ready to help, while their actual practices may differ.

Patients need to ask for charitable assistance and then be ready to provide major disclosures and documents about their finances to demonstrate their need. (They may, for example, seek to show they fall at or below the federal proverty level, defined as an income of $26,200 annually in a family of four). As U.S. News and World Report described who might benefit with charitable care, quoting Jenifer Bosco, staff attorney at the National Consumer Law Center:

“Patients will find that these programs run the gamut depending on the medical institution and the state in which it’s located, which may have its own regulations. ‘There’s not anything within IRS rules that says how much financial assistance needs to be provided and who qualifies for financial assistance, so the hospitals have a lot of leeway to make those decisions,’ Bosco says. You may find everything from fairly generous policies offering assistance to families who earn five or six times the federal poverty guidelines – an annually adjusted measure of income and family size – or you may find that your facility offers the bare minimum. Some may offer sliding scales, wiping away more debt for lower-income patients, while others may standardize the relief offered.

“Nonprofit medical centers are required to make the financial assistance policy, application form and a plain language summary of the policy widely available on their websites, so you should be able to find more information about your hospital online.”

Even if they successfully negotiate reduced prices and payments from hospitals, patients may be barraged still with bills (from other providers) and mailings, which they can’t ignore. Hospitals themselves may not go out of their way to inform patients about charitable care, hitting them with huge charges, instead. They also may be unforgiving about charity patients making payments, pursuing them zealously with collection agencies and lawsuits no matter if the sums they owe may be reduced or small. 

In the meantime, not-for-profit hospitals infuriate their critics annually when they report the billions of dollars in tax breaks they take under the Internal Revenue Service’s allowance for their “community benefit.” The institutions, especially the more affluent, critics say, are far too miserly in allocating charitable care and reaping too great a tax benefit for what they dole out.
 
Insurers and your costs

Within the U.S. health care system, the pursuit of profits can create unhappiness among major players. Patients should not hesitate to take advantage of others’ natural frictions. Your insurance company may not be helpful to you in dealing directly with brutal medical costs. Insurers know they will make their profits, no matter, and they have not raced to assist patients in cost containment.

But insurers can help provide a lot of baseline information about prices. They may require you to get their approval in advance for procedures and warn you about costs by explaining what (how little) they will cover (look closely at that dreaded “explanation of benefits” document you get after the flurry of bills start to fly). If in doubt, it can pay to consult with your insurer, especially before getting medical services. Don’t hesitate, too, to appeal insurer decisions on medical care coverage.

Patients also may not know that insurers and providers, especially hospitals, can have testy relationships with each other as they jostle daily about money. The recent federal disclosure requirements have spotlighted, for example, how insurers and providers tussle about prices. These may fluctuate, for example, depending on an insurer’s strength in a market or in negotiating with a hospital or health system, including on how many cases might get sent for treatment. Insurers do take heat on their rates if, for example, they want the lucrative business of big companies, which themselves must keep shareholders happy by keeping profits up and costs (like health care for employees) lower. Playing insurers, hospitals, and employers off each other may be one strategy for patients, particularly if they get the sense that any of the parties may be more sympathetic to their cause and unhappy with the others.

If the disputed sums get large enough, and this occurs all too often, overwhelmed patients may seek expert help, contracting, for example, with medical billing advocates. Or they also may need to retain accounting or legal counsel to help them with financial crises associated with health care costs.

Hospitals and hospital groups, even during the pandemic, have kept up their aggressive, even Draconian collection of medical debt. It persists as a financial nightmare for patients and their loved ones, with a 2018 study from academic researchers finding that 66.5% of all bankruptcies were tied to medical issues — because of high costs for care or time out of work. An estimated 530,000 families turn to bankruptcy each year because of medical issues and bills, the research found.

The pathetic part of this hounding of patients can be seen, of course, in charitable efforts to assist those burdened with medical debt. Hospitals and providers do so poorly in collections that financial institutions bundle the debt and sell it for pennies on the dollar, with a notable charity (which works with churches and many other Samaritans) buying billions of dollars in these unpaid obligations and legally dismissing them, pronto.

Patients may want to remind hospitals and other medical providers of this as they try to do the right thing and negotiate reasonable payments of their medical bills.

Patients aren’t alone in confronting tough questions about medical costs, especially hospital prices. Governmental bodies and employers also have big concerns.

RAND researchers have identified three ways policy makers have sought to address this rising issue:

• Regulating hospital prices, tying them to rates already established, say, by Medicare
• Improving price transparency (for example, by requiring, as the federal government recently did, posting of prices for various procedures and supplies)
• And increasing competition among hospitals (for example, by discouraging mergers of big institutions or the acquisition by major hospitals of smaller facilities)

The researchers’ complex economic modeling sought to put some dollars-and-cents estimates on the effects of these options.

They found for price regulation that “Setting prices for all commercial payers could reduce hospital spending by $61.9 billion to $236.6 billion,” if their rates could be set at 100% to 150% of what Medicare pays. This change would lead to a “1.7% to 6.5% reduction in national health spending.” Efforts to increase information and transparency on hospital prices could cut “hospital spending by $8.7 billion to $26.6 billion.” As for decreasing hospital market concentration, such steps “would reduce hospital spending by $6.2 billion to $68.9 billion.”

Sounds nifty, right? The researchers hastened to add that none of  these options would be easy to put in place. They all have uncertainties and potential major downsides. It is unclear, for example, how they boost or diminish the safety, quality, and accessibility of health care and hospitals’ ability to invest in improvements and innovations.

These approaches also might require vexatious amounts of political will and lawmaking — huge obstacles considering the opponents who cannot wrap their minds around two key notions: that in the wealthiest nation in the world, health care is a right and not a privilege, and that government really does have a role in health care.

Still, politicians have learned that they still must serve constituents over powerful special interests (see sidebar below on “surprise” medical bills) and there are more surprising twists to getting hospital prices better in line with reality.

Hospitals can and do negotiate rates 

A key point that patients may miss about health insurance is that insurers do negotiate prices with providers. That reality alone makes it important for everyone to be covered by insurance.  And expanding coverage, as the Biden Administration wants to do via Obamacare, may offer a check of sorts on provider pricing. With hospitals, the insured can escape the painful, sky-high standard rack rates that are listed on their tough to find and hard to read “charge masters.” The charges are routinely slapped on the uninsured and those who don’t have someone (also including some employers) who might help them find a better price for medical services (see sidebar below). Some insurers, including some who are prodded by big employers, haggle well and patients can benefit significantly.

For tens of millions of Americans, the federal government acts as an uber negotiator, setting prices for medical services paid for under the Medicaid and Medicare programs that cover the aged, kids, and the handicapped, and chronically ill and mentally ill. Doctors and hospitals howl that these rates, set after tough bargaining, are far too low. It is a dirty not-so-secret that hospitals get tax breaks for the “community benefit” they provide with “charitable care,” including gaps in what they get between their standard and Medicare-Medicaid patient rates. Hospitals also engage in so-called cost shifting, charging “regular” patients higher rates to make up for purported losses in serving those on Medicaid and Medicare. The American Hospital Association’s own data says this shortfall amounted to $75.8 billion in 2019.

On the other hand, the “prices paid to hospitals nationally during 2018 by privately insured patients averaged 247% of what Medicare would have paid, with wide variation in prices among states,” RAND experts have found in a recent study. They added that, “If employers and health plans participating in the study had paid hospitals using Medicare’s payment formulas, total payments over the 2016–2018 period would have been reduced by $19.7 billion, a potential savings of 58%.”

Let’s not get too deep into health economics here. But what states and big employers are finding is that the Medicare and Medicaid rates provide a sound starting point in negotiating with hospitals over their prices — and getting them lowered to multiples of what they say are rates too low but with health costs declining still.

State governments are taking action

Maryland, of course, long has run a state system of hospital rate-setting. It has become accepted and has its doubters but is considered successful. But now Montana is gaining attention for its efforts, which may not only be replicated by states but also by employer-insurer consortiums battling hospitals over costs.

As the independent, nonpartisan Kaiser Health News Service reported on the push by onetime Montana official Marilyn Bartlett, and how she pegged hospital prices to a Medicare multiple, wrestled with powerful institutions and their political forces, and saved the state employee health system $30 million over three years:

“Montana’s success became a small sensation, at least in health policy circles. Now, one big question remains — the same one that has deflated the highest hopes of so many health care leaders. Can it be replicated? Many of the country’s employers are desperate to find out. Their costs have risen 50% in just the past decade. Employee spending on health care is also on the rise, growing two times faster than wages. Leading economics researchers point to high hospital prices as a key culprit.”

KHN also reported:

“Since retiring from Montana state government in December 2019, Bartlett said she has spoken at numerous conferences, given hours of free advice, and answered a seemingly endless stream of calls. One of the first calls came from Trish Riley, executive director of the National Academy for State Health Policy (NASHP). Riley hired Bartlett in 2019 to serve as ‘a coach, cheerleader and mentor’ for officials from dozens of states trying to cut costs, including New Jersey, which passed a bill in 2020 overhauling the state’s health coverage for teachers and estimated to save the state $30 million annually. Bartlett is also advising regional business coalitions stretching from Houston to Maine and seeing early signs of progress.

“In Colorado, Bartlett is coaching a group of public employers, including city, county, and state health plans, that have come together to negotiate with hospitals. The group recently notched its first win, signing one hospital to a Medicare-benchmarked contract. In Indiana, Bartlett is advising the Employers’ Forum of Indiana, a coalition that recently pressured insurer Anthem to renegotiate its contract with a notoriously expensive health system. Bartlett is even shaping legislation, including recent failed attempts in the Montana legislature to more broadly control hospital prices and in the U.S. Senate to increase transparency.”

It is always risky to forecast the politics and prospects for government- or employer-based efforts to deal with health care and hospital prices. With the great good will that institutions have won with their work in battling the pandemic, hospitals may be riding as high as ever in statehouses and the nation’s capital. A much-publicized initiative to improve U.S. health care and check its costs, launched by corporate titans — Amazon, Berkshire Hathaway, and JPMorgan Chase — flopped after only a few years of exploratory work. So, we’ll see.

Patients clearly need relief. But here also is hoping that you and yours stay healthy throughout 2021 and beyond, meaning you also will be free from any worry about hospitals and medical bills!