>> c-span, where history unfolds daily. in 1979, c-span was created as a public service by america's cable television companies and today, we continue to bring you unfiltered coverage of congress. the white house, the supreme court, and public policy events around the country. you by yourought to cable or satellite provider. >> we have a segment called your money and we take a look at programs and initiatives by the federal government. a new look at policies by hospitals. scussion from new york is robin gelburd of fair health. she serves as their president. good morning. before you start, what is fair health, and tell us about it?

fair health is a national independent not-for-profit organization created in 2009 to bring transparency and integrity to health insurance information for all stakeholders. we support researchers, government, consumers, industry, employers using data products and custom analytics and free consumer tools to really feel that curtain on the health insurance industry. we are supported by those that bring up -- that find value in our product and allows us to make free tools available to all consumers across the country. experience, if a person wants to find out how much certain procedures will cost them our hospital, how transparent is that process? beginning january 1, somewhat more transparent. we have been bringing cost information to consumers sense early in 2010. it's a journey that the whole

country is on. carereally -- health pricing right now is in the public spotlight. i think january 1, as you know, the federal government imposing obligation on all hospitals to make their standard pricing available for procedures and services they offer in an online format, and to update that annually. but that's the beginning of that journey. a broad variety of information available to consumers and really try to contextualize it. i think it is sending a signal that consumers deserve this information and it is incumbent on all of us to really help them to travel on this journey. expand on what is required by hospitals now and what is different before that. guest: right now, it's required they include pricing for every single service and procedure ony offer to consumers based non-negotiated prices. their standard pricing meeting that which is not subject to a

specific negotiation with an insurance company. there is no specific format that is required, that's one of the challenges of the new regulation. for consumers to really make their way through these lists of services and procedures, it's a bit difficult to make apple have apples comparisons. i think the federal government is really signaling to hospitals that everyone now can start iterating in creating new ways in which to make it more usable, more user-friendly and that is health as aair backstop, because consumers can take the information they see all these individual hospital websites and begin to start formulating questions by going to an independent database such as ours. if you think about it, think of it as a windshield it's really foggy. what these regulations do is allow the defroster to be pressed, to start having that

mist dissolved. once you see through the windshield, it doesn't mean you can find your way. you still need other types of directions and information, signs along the road, if you will. there are other resources in addition to these hospital site that should help consumers. beginning of this journey, but it's a journey that has been long in coming. host: are these services or at least for what it's going to be charged, is this in plain islish, how much a person going to find for a suture or stitcher something like that? guest: there are certain standard procedure codes that use more technical language i think consumers will be scratching their heads a bit, but they should not be frustrated. they should take those elements that are on these sites and moved to more consumer friendly sites and begin to start preparing that information against the information that is contextualize, that is offered

in a consumer friendly way and my guess is the feedback the hospitals and the federal government will be getting will give some direction on how we could be further shape. again, because it's not standardized, nor is it energized in where a hospital website these listings can be found, so consumers may be really sort of walking through the woods, if you will, looking for trail markers to see where they can find these hospital lists and again, i think it's chiseled and chiseled because there will be confusion, there will be questions asked. but at least now, those questions can be asked at the beginning and so hopefully, we will be seeing much more clarity , even though this is the beginning of transparency, the goal is really to get to clarity. if you have questions about the larger issues of transparency and hospital pricing, and you want to ask questions of our guest, call

eastern and central, call (202) 748-8000, call (202) 748-8001 four mountain in central. information available before this, could someone go to a hospital and say give me these prices for these services? guest: some states already required hospitals to lift some of their pricing data list some of their pricing and they do it voluntarily. federal governments are not meant to supplant those requirements, they are meant to embellish what already is in existence. without something listed, consumers were able to call their hospitals for their ability to get that information easily probably changed from hospital to hospital. host: we saw some of his reaction from the hospital and health association of pennsylvania, i want to review some of the initial reaction when you think about it. they said this when it came to

this new policy, most times, hospitals are paid less than charge rates from the second point they made was while insurers negotiate hospital payments rates that are lower, sometimes much lower than charges, they also add that medicare also pays hospitals less than charge rates. what do you think about those assessments and factor those into what you see doing this day today. what that, just saying, and it's true, there are a lot of hospitals and negotiate specific arrangements with individual plans, and those arrangements vary from plan to plan. with this regulation is meant to do, and by posting charge masters, there's a population of uninsured for one that are not subject to any of those negotiated arrangements. there's also the out-of-network situation, so those negotiated arrangements really speak to hospitals and health systems that have agreed to participate in the plans network. many times, those services can be accessed out-of-network, they

can be accessed out-of-network intentionally because consumers seeking a particular service or has been recommended to a facility and it's important for them to go there. but often times, it is unintentionally out-of-network and when you think about these regulations and this movement toward transparency, you have to look at it in the broader context, because right now, in addition to this regulation, there are over 20 states right now who are trying to design statutes that address the surprise out-of-network situation or the bills i consumers receive for emergency services, which they often can't plan for by virtue of the fact that it is an emergency. everyone recognizes that it is consumers for unintentional out-of-network services such as services that may be ordered by an anesthesiologist or pathologist that might be providing services in an in network hospital.

therefore, if you take the consumer out of the equation and hold them harmless to what they would otherwise pay if you were in network, now the question is how you reimburse the provider or hospital for that service? those conversations are happening in parallel to the listing of these charge masters. hospitals often do receive less than what is on their charge master, either for medicare or from a plan, but that really does not address the question of the uninsured or out of network situation. our guest is with us from fair health, fair health.org, we have calls lined up for you. comes fromne, oklahoma city. this is joe, you're on with our guest. her -- gond call ahead. we've had a debate over health care for decades and decades and at the end of the day, the american people which is 350 million strong roughly

have really been on the extreme short end of the stick. companiesmaceutical have literally just gouged us down to the last penny. and for-profit insurance companies have basically collected all sorts of premiums and made massive profits and at the end of the day, we are really just being smashed by the health care system. my question for your guest is what i hear people come on, i can respect their opinions and their information, i understand the idea of transparency but my question is because you never know who funds these people, they sometimes will have a nice name like fair health, but quite often, the funding for companies like this in organizations like this are coming from the very our greed caree system. my question for the guest is do you support a national health

system where we finally rang 330 million people into one big risk pool, everyone pays a little extra in tax and we actually have health care that is accessible, not people going oh my gosh, if i go to the doctor, i don't know i'll be able to make rent this month? guest: thank you for that question. we talked about when fair health was created in 2009, but let me give you a little more background on that i think it will help answer the question that the caller was asking. we were created because there were a number of questions and complaints that were raised in new york state to the attorney general's office about conflicts of interest that were perceived to be in data used to help support decision-making of the insurance industry. there were concerns that the data being used were really being generated by a company

wholly owned by the insurance industry. so whether the data were in fact flawed or not really wasn't the issue. the investigation then ended because everyone agreed that even without appearance of a conflict of interest there would be a lack of trust in the kinds of information being talked beingin the data circulated, so fair health was specifically created to be independent, neutral, unbiased support all stakeholders in the health care system, because it was recognized that this is a very fragile ecosystem with a lot of interdependencies, if you about anut it, think aspen forest where all the roots are connected in the ground, is not one single tree. our mandate was to disseminate information that could be trusted, that allow everyone, whether it's a consumer, physician, hospital executive, the plan, negative and researcher, a government official to exhale. we don't take a position, we are unbiased and what policy should be adopted.

our goal is to provide fewer ingredients for sound decision-making. so the people can use the data that we offer to understand. we have over 27 billion health care claims in our repository and the largest in the country, that's commercial data. figure that oceans of claims. our goal is to take people out on that glass bottom boat and let them look into the ocean and let them determine what they are seeing and to rearrange or suggest policies are ways in which the ecosystem could be better. i agree with you, and support to be able trust the information that is advancing different types of policies and that is where we are poised to help. from oakland, michigan, this is christina. caller: i'm a retired rn who worked in an operating room and believe me, different doctors use different things in different things are charged for different light.

my problem with the whole idea of posting prices is health care is not like buying a microwave or buying a tv. you know what features you would like and it's all what you choose. health care is quite different. you can post a price for a hip surgery but it depends on whether you have a heartier problem, so more care is going to be needed or if you have diabetes, or if you have a complication that arises. there is no way to price this type of things. so the consumer visits and all sounds wonderful, and again, health care and you are finding out what's wrong with you. whatave no way to judge things are going to cost so you can make a better decision because somebody put the price list, is not the same as every other thing we buy. thank you very much for listening. is such an excellent

point, and you are right, health care is here in usual which is how we found ourselves in the situation we are in today, it incorporates a lot of different factors, pricing is just one element. a big condition, what the patient's condition is as well is also critical to what the ultimate cost should be. you are right that there are so many different ingredients to what makes of a procedure and the cost of that procedure. i think what we are learning is a recognition that in the past, when insurance models really required more or less out-of-pocket costs on the part of the consumer, they factored in the chorus line in the back while the employers in the plans and the health systems would make the different arrangements about with those prices should be, but now with high deductible changingans and reimbursement models, in effect, the consumer has been plucked from that chorus line and is now in fact the star of their own insurance play in their own health care play.

no lines and they're being asked to add live as they walk in to these health care institutions are doctors offices without knowing what the cost will be. you are totally correct that that should be embellished with quality information on other factors. and that is why there are lot of reimbursement models that are now recognizing that and are adjusting it based on different , comorbidities, the condition of the patient because hospitals and physicians should not be penalized because someone presents in a more complex way even though they may be getting let's say in the replacement. if they have diabetes or hypertension there will be additional costs to someone who is presenting a more simple matter. beginning of this journey. it should be appended with information about quality, that frequency, about the patient's condition. omega starting point and i think consumers are really hungry for

some directions they can start that constructive conversation and begin to plan for what these costs may be. host: why is there such a wide range of prices when it comes to a single procedure? that's a very common question you can imagine with 27 billion claims we see tremendous disparities and we organize our data into a 493 different discrete geographic markets. really trying to capture the medical heartbeat of those markets. there is a lot of diversity. byetimes it's explained different communities and the cost of employment. even have moral communities where you are trying to attract physicians and facilities to open and there may be premiums there. technologies that one facility has versus another, whether it's a pet scan or other types of technologies that might bleed into that. some may be just market wins and conditions. , thoseleast now disparities are going to be made

quite plain. we've already been doing that on our website, but now we are down to the hospital level. opportunity is an for people ask questions and ask what hospital versus another why are you charging x versus y for this procedure and there may be very legitimate reasons or unfortunately, maybe also because of the lack of the apples to apples comparison they are not even looking at exactly the same thing. but at least again, there's a starting point for these conversations. what is the ability of the consumer to find on the pricing scale of they have to go to the emergency room rather than another hospital visit? concern with a big emergency services. if it's, you're not going to be shopping for lowest-cost, of course. and that's why there are so many states right now and some states already, new york and connecticut already protect consumers against bills for

emergency services that might be out of network. based on those two states, there are conversations going on all around the country and in fact, there is also national legislation that has now been introduced by a bipartisan team of senators and the house is taking up this issue as well. this is truly a purple issue, protecting consumers against bills for emergency services or surprise out of network bills that they really were not in a position to know beforehand. host: from maryland, hello. you are on. caller: i have a couple of comments here. my first point is people really understand how insurance works. insurance is supposed to make you -- it's not supposed to make you bankrupt. at the same time, if you are going to the er one time a year,

i'm sure you will be paying and people to $2000 say that interest doesn't work for them. it's very important to understand how it works and you can pick up a plan with a $6,500 high deductible, is not going to work for you but it will make sure that you don't go bankrupt if something big happens. thank you. that is such an excellent point that you raised. we commissioned a national consumer survey about people's understanding of insurance that level of insurers and in fact over 75% of respondents say they wish they had been given a course either in high school or in college that explained the basics, the fundamentals of health insurance. is they feel like they are being pushed into that world blind and now particularly with

individuals 26 years old and older not to come off of their it'sts plans, again, really a challenge to understand what this principle are. what ise meantime offer equivalent to health insurance 101 on her website, because we don't presume any knowledge on the part of the consumer. it's a very complex area and people don't understand basic terms like premium, co-pay, and deductible. mentioned, high direct will help plans are becoming quite common right now and people don't really understand the implications of that plan design. it's critical to really understand, take that insurance card and really try to understand what are the elements that are governing that level of insurance, because medical bankruptcy is not unusual and people are really having financial challenges again, explains the launch of these regulations. once peoplegelburd, can go online and find out the

price for the various services that are received, what other costs have to be considered that maybe will not be on that charge master that is listed online? guest: interestingly, the requirement is that all services and procedures offered by the institution be listed, but that can be a challenge for consumers , which is why we have really tried to go out of our way to explain to consumers the concept of episodes of care or bundled payments, because what we have --rned in our research is a if a consumer is going to have a procedure, let's say carpal tunnel surgery, they are thinking of the surgery cost, they are not necessarily thinking of the attendant anesthesia or radiology or others or of attendant costs that may be associated with it in a three-dimensional type of view. that is where consumers have to be assisted to help them understand all the different components and while all of them are required to be on the hospital site, they may be

presented in a very disjointed way. there are free resources startble for consumers to really nurturing that awareness of the fact that it is not just one service they should really be thinking about all the other ancillary costs so they can appropriately prepare for their procedure. by thet is a requirement federal government, what is the penalty of this information is not available? i'm not aware of penalties, i have not seen them articulated. i think that there is a sense that the hospital will move to compliance with this and we are already seeing that happen right away. and as i said through state activity and just voluntary activity on the part of hospitals, a lot has are decidedly down this path. it will be adjusting to see to what extent there is a need and what the level of those penalties will be. host: call (202) 748-8000 for

eastern and central time zones and call (202) 748-8001 for mountain pacific time zones. kate in new york city is next. good morning, go ahead. the word that i really take objection to with the use of the term consumer. there is noney and determine what their coverages until they have been through a major health incident. -- my husband had stage for large diffuse andhodgkin's lymphoma thankfully, i was employed and had an employer policy that was somewhat decent at the time, although it continued -- the benefits continually were

reduced over time. one thing that was of particular concern to me was watching the annual cap and the lifetime caps come down before obamacare. i think that most citizens in this country do not understand that obamacare eliminated those caps. have ifrisk that they they have a band-aid policy that is going to pay $100,000, $200,000, and they don't realize they think they're looking at $1 million worth of treatment. --ot caught with a hospital i had a world-renowned oncologist reading my husband, thankfully, and i did this correctly and saved his life. i ultimately did not with the second incident that i went through with them. but i did get caught the first time with his need for a port, because he had to receive

extremely strong chemotherapy and he had to have a port. the only surgeon available in the hospital for that port in and to remove that port was not -- was out of network. so i got hit with a $10,000 aarge to put the port in $10,000 charge to take the port out. but as my husband's advocate, fighting as hard as i could to save his life, the last thing in the world i was at that time was a consumer. professional,s a i can tell you if you come to me with a set of facts, i cannot tell you, given the complexities that i may encounter in your case, what the cost is ultimately going to be. i appreciate your story and telling us your perspective. your husband was very

lucky to have you as his advocate. one of the main drivers of the creation of their health really behind the organization was a woman, a cancer survivor who had breast cancer and had challenges mounting for her because she was also receiving care from multiple clinicians, many of whom were out of network and it was dizzying for her as she was really trying to just care for her own condition and really take care of her family at the same time. it was that story that was presented to the attorney general's office among others, but that was a leading voice and in fact, this particular individual became a board member of fair health because of her particular journey and the challenges she faced. careally agree why health is so different, not only from the earlier caller says they are so much complexity to health care and is not like toasters or tv's, it's also because it is so

personal and so stressful, dealing with life-and-death situations. the last thing you want to compound the situation with the financial complexity and those principles. i think while we are all not patientsd, we are all or family members or advocate on behalf of patients. is pertinent to arm ourselves much information as possible try to keep the focus where it on the care and well-being of the particular patient in the club -- in a clinical setting. caller, from south carolina. couple questions and comments. i would like you to address free care, when people come to the er, they basically get free care. it's not always for something lotto an emergency

targets for headaches or finger infection or things like that ends up getting put on people do have insurance and we have these very high cost which we do about that, i think people need to have skin in the game, they have to pay something because the people i've seen come back day after day after day to an er forgetting their prescriptions refilled. it's crazy. the other thing is it seems like we are heading towards catastrophic care like you mentioned earlier. people should just have insurance for catastrophic care and the only way this thing will work. what the caller is mentioning is what i indicated earlier about those interdependencies in the health care system.

there is cost shifting under tug here andet -- it unravels there. the emergency room has been used for far more than true emergencies, which is why we're seeing in billing of claims right now a true revolution going on in place of service. what we are seeing is the emergence of a new set of health centersues, urgent care , and military centers, retail clinics, telehealth to really start allowing in a sense the air to come out of the balloon of that pressure in the emergency room because there are a lot of nonemergency conditions resenting there. convenience,use of there may be office hours are not available to some and so i think that is starting to shift a bit and we are seeing a decrease in emergency room utilization and a movement towards urgent care settings and some of these other outposts to

really take the pressure off because you are right, if you go there for something that's nonemergency, emergency room's because they are open 24 hours have sophisticated equipment and technologies, it's inexpensive operation to run. and therefore, if someone is unable to pay and does not have insurance, those costs do have to get absorbed somewhere. it will be fascinating to track the shift, the serve revolution going on in these new venues. because i think that is starting to change. host: robin gelburd of fair health, she serves >> c-span's washington journal live every day with news and policy issues that impact you. coming up, a discussion of the green new deal and energy and environmental issues.

then we talk about the latest on the government shutdown with christina marcos. be sure to watch washington journal. here is some of our live coverage tuesday. the house returns to look at a handful of bills. president trump addresses the nation on what he calls the humanitarian and national security crisis at the southern border. a conversation on how governments incorporate relations into foreign policy. then the impact of the new congress. the senate gavels and at 3:00 p.m.. there is more coverage on c-span

3. the lobbying group for the natural gas and oil industries. elected members of the housealk about democrats priorities. then for spending bills covering financial services, transportation, agriculture, and the epa. >> sunday on q&a, james grant. i think the trouble lies not so much as an wall street. wall street is what it is. it is mostly american history.

i think what we are to be more on our guard about on he two shins and the federal government that are validly benign in their intentions. the federal reserve, the department of the treasury. the securities exchange commission. these are set up as benefactors. >> next a discussion on nuclear security and arms control policy. the brookings institution hosted the projects of strategic's arms reductions treaty which establishes limits on the u.s. and russia. this is 90 minutes.