The numbers are eye-popping: $25,000 MRIs, $629 for an ER visit that only delivered a Band-Aid, decades-old drugs that double in price overnight. As the late Uwe Reinhardt often said, “It’s the prices, stupid.” Experts increasingly point to the high cost of care in America as the chronic illness of the U.S. system. Health systems in other developed countries pay nowhere near these prices for the same services. It's not just individual pricing that’s a problem: there are inefficiencies in care delivery and additional costs associated with middlemen in the supply chain.
As lawyers in the employee benefits field, we’re all impacted by rising health care costs, and struggling in our various capacities to figure out how to address them. We do this in the context of uncertainty of what our federal health care law will look like. Plan lawyers and union lawyers are trying to figure out how to control costs and protect plan assets, but also have to make sure plans honor fiduciary duties to pay legitimate claims by plan participants. Plaintiffs’ lawyers are bringing suits challenging pricing practices for prescription drugs, as well as the activities of PBMs --- and working with plans in innovative anti-trust actions. Defense lawyers litigate these cases, and must also advise their clients about how to navigate the shoals of fiduciary and other forms of liability. Meanwhile, from the big picture perspective, questions remain about what can be done at the state level to control health care costs, especially in light of ERISA preemption following Gobeille.
Catha Worthman, Feinberg Jackson Worthman & Wasow, LLP, Oakland, CA
- Phyllis Borzi, Former Assistant Secretary of EBSA and Health Policy Guru, Washington, DC
- Michael Kolber, Manatt, Phelps, & Phillips LLP, New York, NY
- Tiffany Santos, Trucker Huss APC, San Francisco, CA
- David Miller, SEIU-United Healthcare Workers West, San Francisco, CA
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