Surprise! Congress screwed up healthcare again

And private equity is making it even worse

A few years ago, Congress tried to address America’s healthcare crisis by passing the No Surprises Act. This was well-intended legislation designed to end the scourge of “surprise” medical billing. Prior to this law, patients who unknowingly received care from an out-of-network physician would often be stuck with crippling bills through no fault of their own. The No Surprises Act solved that problem, but unfortunately, as government intervention often does, it created a brand new one in the process that further exacerbated healthcare costs.

Instead of sending surprise bills to families, insurers and out-of-network providers now resolve disagreements through the Independent Dispute Resolution (IDR) process, in which a third-party arbitrator chooses one side’s proposed payment. This was supposed to be a rarely used resolution enforcement mechanism, but it is now being exploited by sophisticated financial actors as part of a lucrative business model. Rather than serving as an occasional referee between insurers and providers, the IDR system has now exploded into a multibillion-dollar industry that rewards volume, encourages gaming, and ultimately leaves employers and families (not to mention taxpayers) paying the bill.

New reporting from the Wall Street Journal found that nearly $15 billion was paid out through the IDR system in 2025. The New York Times found that providers filed 1.2 million arbitration cases in just the first half of 2025, even though regulators originally projected roughly 17,000 disputes annually. Providers prevailed in roughly 88% of cases, with arbitrators collecting nearly $885 million in fees between 2022 and 2024 alone. In 2025, these arbitrators raked in a whopping $1.3 billion in fees.

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