To the Editor:

Re “Four Key Things You Should Know About Health Care” (Op-Ed, nytimes.com, Sept. 12):

Ezekiel J. Emanuel and Victor R. Fuchs argue that price transparency won’t lower health care costs. Fortunately, they’re wrong, largely because they missed several avenues for how transparency will help.

Transparency should lower prices through four critical paths: better informed patients; better informed employers able to help their workers shop for value; improved ability for employers to discipline middlemen; and public pressure on high-cost providers.

Employers — actually, employees, since all the health care spending comes out of their wages — are paying rates far above hospitals’ marginal costs for providing services.

Drug importation is no longer a pipe dream. Now it’s a pipe bomb.

The Department of Health and Human Services (HHS) recently floated a proposal, dubbed the Safe Importation Action Plan, to allow Americans to use Canada as their personal pharmacy. In Canada, the government dictates the market through price controls, but any drug importation scheme should give Americans pause.

Remember, the Food and Drug Administration (FDA) has stated over and over again that our government cannot vouch for the safety and efficacy of Canadian medicines. Pushing this policy through would needlessly threaten patient health and well-being. And here’s a key fact that’s being ignored: It’s infeasible. Canada simply doesn’t have enough drugs to share with United States.

The so-called Safe Importation Action Plan offers two paths forward for drug importation. First, states, wholesalers or pharmacists could submit plans for demonstration projects for HHS to review outlining how they would import Health Canada-approved drugs, Second, manufacturers could import versions of existing FDA-approved drugs into the United States.

Surprise out-of-network billing and related patients’ costs are increasing among inpatient admissions and emergency department visits to in-network hospitals, according to a study published in JAMA Internal Medicine. Stanford University researchers found that from 2010 through 2016, 39% of 13.6 million trips to the ED at an in-network hospital by privately insured patients resulted in an out-of-network bill. That figure increased during the study period from about a third of ED visits nationwide in 2010 to 42.8% in 2016. [This shows the ineffectiveness of patchwork legislative solutions since Obamacare contained provisions to stop surprise bills when it passed in 2010.]

As advocates of free markets and members of the business community, we can debate which proposals to prevent surprise billing are more appropriate, but if we enshrine current rates with an arbitration scheme, or if we fail to advance solutions on surprise billing, we only play into the hands of single-payer advocates. It’s time to end secret pricing and save our health care market from the corrupt practice of surprise billing once and for all.

Last year, the Trump rule on short-term health plans went into effect, which not only allowed plans to last 364 days, it lets people renew them for up to 36 months. “Sabotage!” the health care experts cried. They said this new rule would allow junk insurance that would rip consumers off and would force Obamacare premiums through the roof. But the results so far strongly suggest that the “experts” had it exactly wrong when they predicted doom and gloom by giving consumers more choice. States that opened their markets up to new choices and more competition are seeing smaller rate hikes than those that decided to “protect” their consumers by forcing them into government-mandated Obamacare plans.

Health insurance enrollment has declined among people who do not qualify for financial help under Obamacare, new federal data show.  The data released by the Centers for Medicare and Medicaid Services on Monday show that enrollment declined by 1.2 million people, or 24%, between 2017 and 2018 among people with incomes too high to qualify for Obamacare subsidies and who therefore face the full brunt of premium cost increases. In contrast, in the same period, enrollment ticked up among those with subsidized coverage by 300,000 people.

Obamacare wasn’t supposed to give free health insurance to everybody. The Affordable Care Act’s authors expected the poor would enroll in Medicaid, while those with higher incomes would buy coverage through the new insurance exchanges, with subsidies that decrease as income rises. It isn’t working that way. A study published this week by the National Bureau of Economic Research shows that ObamaCare has turned out to be a giant welfare program, with millions of working- and middle-class Americans improperly receiving Medicaid—a reflection of the unpopularity of the exchange policies and incompetence of government oversight.

The 2019 Milliman Medical Index, which measures healthcare costs for individuals and families receiving coverage from an employer-sponsored preferred provider plan, found that health care costs have reached $28,386 for a family, an increase of 3.8% from the year prior. Health care costs for the average American adult are at $6,348. Milliman looks at five components of health care costs, including inpatient and outpatient care, pharmacy, professional, and other services.

The central unanswered question in the U.S. health system is how to discipline costs. The choice is between reliance on regulatory controls put in place by the federal government or injection of stronger financial incentives for consumers into the markets for medical services and insurance. Currently, the U.S. has a mixed public-private system with pricing controls applied to payments made by public insurance, and markets that function poorly because they are hobbled by misaligned incentives, some of which are caused by government policy. The result is widespread inefficiency. Credible estimates put the amount of wasted spending at about one-third of total costs.

A panel of federal appeals court judges on Tuesday sounded likely to uphold a lower-court ruling that a central provision of the Affordable Care Act — the requirement that most people have health insurance — is unconstitutional. But it was harder to discern how the court might come down on a much bigger question: whether the rest of the sprawling health law must fall if the insurance mandate does.