For more than a decade, health systems nationwide have struggled with creating a medical bill that patients find easy to read. But judging from the hundreds of comments from readers who have contacted The Plain Dealer during a year-long look at medical billing issues, an answer has not yet been found. The Healthcare Financial Management Association launched a patient-friendly billing initiative a decade ago. Working with a handful of health systems—including Mayo Clinic in Minnesota and Geisinger Health System in Pennsylvania—the organization developed and tested sample bills. The version that consumers responded to best was a single monthly statement that listed all outstanding charges and payments.