Buying health care should be more like buying a watch.

“If I go to a watch store and say, ‘How much is that watch I really want?’ and they say it’s $5,000, I can say, ‘I’d never pay that much for a watch.’ But health care is different.”

Elisabeth Rosenthal, editor-in-chief of Kaiser Health News and a trained doctor, is explaining one of the flaws in the U.S. health care system. If she bought the watch, she’d not only have known the price up front — she’d have agreed to pay it. That isn’t always the case in health care.

“Consumers accept practices in health care that they would not tolerate in any other area,” she said.

Rosenthal was in Omaha this week, invited by Nebraska Attorney General Doug Peterson to speak about health care costs.

Conversations about rising costs and lack of transparency within the health care system — and Rosenthal’s book on the topic — helped spur Peterson to organize a regional conference for attorneys general to explore states’ roles in combating costs and ensuring quality care.

While health care policy typically is viewed as a federal issue, Peterson said he’s not confident that it can be fixed in Washington, D.C.

Rosenthal said there’s tremendous power at the state level to hold the health care system more accountable in terms of its business practices.

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“States can certainly challenge the status quo,” said Rosenthal, a former New York Times reporter who worked as an emergency room doctor. “Big health system reform may be made in Washington, but a lot of how health care is delivered and billed and charged is in the hands of states.”

Colorado, for instance, recently adopted a law capping the price of insulin for insured patients at $100 a month, a response to spiking costs for a medication many diabetics need to survive.

A growing number of states also are adopting surprise billing laws.

State Sen. Adam Morfeld of Lincoln this year introduced a bill intended to address the steep tabs patients can receive when they go to a hospital in their insurance network but receive treatment from a professional outside their network. That bill remains in committee.

Peterson said he hopes the conference, which continues Friday in Omaha, will engage states’ attorneys in talking about solutions and in considering stronger consumer protections.

Rosenthal is the author of the 2017 book “An American Sickness: How Healthcare Became Big Business and How You Can Take It Back.” She spoke ahead of the conference about what states and individuals can do — and in some cases, have begun doing — to combat high costs. Her responses have been edited for brevity and clarity.

How are we starting to see these concerns about cost and transparency addressed?

We’re seeing a lot of bipartisan support for surprise billing laws. When I buy something on my credit card, I know I’m buying it, and I’ve agreed to pay for it. But when I’m a patient with a broken jaw or a heart attack and I go to an in-network hospital, I have no agency, and I never agreed to pay an out-of-network person. And anyway, my jaw is broken and I’m having a heart attack, so I’m not in a good position to refuse.

We’re somehow stuck in this position where we don’t consent to pay for things in advance, the prices are crazy high, and yet we’re expected to pay, and if we don’t pay we’re sent to collections, and that’s just not fair.

If you could change just one thing about the health care system, what would it be?

Can I pick three? I’d like everyone to get bills that are in plain English and transparent so they know what they’re paying for.

I’d like drug prices to be lower so people can afford their medicines.

Next up would be a standard for collections, so that medical bills are not sent to collections the way unpaid credit card bills are sent. That forces people to destroy their credit rating over a medical bill that they never consented to. That’s the threat that gets people to pay outrageous bills — the collectors are calling. I think that has to end.

Whose responsibility will it be to make those changes?

Different players have the ability to do different things. That’s part of the point of my book: I feel everyone can do something.

Attorneys general have been very successful and very aggressive in looking at drug prices. They’ve proven with certain generic drugs that different generic drug makers were conspiring to raise prices. But we see a whole lot of other drugmakers raising prices in tandem. When we talk about anti-competitive behavior, it may be that three drug makers all raising their prices in tandem is kind of anti-competitive, even if it may not fit our current notion of antitrust law.

We’re also seeing states trying importation laws for drugs.

(Florida Gov. Ron DeSantis this week signed a law that eventually could give Floridians access to cheaper prescription drugs from Canada and other countries, if the federal government signs off. DeSantis has said President Donald Trump approves of the initiative.)

Maybe we’ll see those bills pop up in a lot of other states, and that would bring down prices, too.

In terms of individual patients, I think it’s really important that they start rising up and acting like consumers and asking questions. So your doctor says you need these blood tests. I now say to my doctor, “OK, but they have to go to an in-network lab. You can’t just send them to your hospital lab, which is out of my network and is going to be billed literally 10 times as much.”

We have to feel OK saying to our physician, “You think I need a knee X-ray. Tell me why and how it’s going to change my care.” And tell me which radiology center in the city will do it for a reasonable price.

The first time I said that to my doctor, he said, “I don’t know which ones are cheaper.” But that’s your job, to refer me to the cheaper ones and say to the ones that are charging $1,000, “I’m not going to send you patients anymore because you’re ripping them off.”

I’m just saying you should use the market levers you have even though they feel inadequate and hard at the moment. It sends a really strong signal to the system that we’re not going to take this anymore.

When they give you the financial consent form that says I agree to pay for anything my insurer doesn’t cover, I tell people to write in — and I did on my husband’s financial consent form a few weeks ago — “so long as it’s in my insurance network.” And then hold your ground.

If you get an estimate from the hospital, hold them to that. You wouldn’t say to your contractor, “Oh, it’s three times as much for the kitchen. I’m just going to pay it.”

I know these things are hard. The ultimate solution is our state representatives and our state attorneys general should help create and enforce laws so we don’t have to go it alone.

The U.S. Senate is discussing a proposed surprise bill law. What would you like to see in such a measure?

The initial one was in New York, and that said the hospital and the insurer have to work out how much you have to pay. But the onus is still on the patient when you receive that surprise bill, to protest it and to send it back to the hospital and the insurer.

A better surprise bill law would say, if I go to an in-network hospital, everyone who touches me is either going to be in-network or considered so.

Are there any new issues that have jumped out in the last year or so?

I’ve seen more physician contracts where if they move their practice they can’t take their patients with them. That’s really not fair for patients.

Some things have gotten better. I was really encouraged there are surprise billing laws now.

I’m grateful the attorneys from so many states are looking at generic drug price hikes.

It was a good thing that the Centers for Medicare & Medicaid Services required hospitals to post their price lists. I actually asked for that in the book.

The next step is to put everything in English and in a usable form. We’ve got to know what the real price is.

We’ve got such a long ways to go, but I feel encouraged that there are all these debates going on, that states’ attorneys are taking them up and state legislatures are taking them up.

I hope a long-term solution will be a big focus of U.S. politics in the next two to four years. But in the meantime, there’s a lot that can be done.

Julie Anderson is a medical reporter for The World-Herald. She covers health care and health care trends and developments, including hospitals, research and treatments. Follow her on Twitter @JulieAnderson41. Phone: 402-444-1066.

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