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The problem for consumers up to now has been that the negotiated prices were unknown, or impractical to raise in court due to evidentiary rules. The general rule is that witnesses must testify to facts within their personal knowledge. Notably, if a consumer contests a medical debt collection lawsuit, someone from the hospital must testify that the price charged is reasonable and customary-an assertion that, with regard to chargemasters, involves shading the truth and is vulnerable to cross-examination.

If Democrats get their wish-a landslide victory leading to a Joe Biden presidency, as well as a Democratic Senate and House-they will face an immediate challenge to getting things done. No matter the size of that landslide, the Republican response will be undeterred: a united opposition, akin to a parliamentary minority party, blocking what they can and delegitimizing what they cannot. It will be little different from their approach in the aftermath of the 2008 Democratic landslide. That formula led to huge GOP gains in the 2010 midterm election, and, after Barack Obama's big reelection victory in 2012, even more gains in the 2014 midterms.