Jim’s Take

Yes, Sometimes Government Does Need to Get Involved

Yes, Sometimes Government Does Need to Get Involved

Most of you know that I believe, generally, that anytime government “fixes” something, the outcome ends up being worse that it was before.  The old saw about “the cure is worse than the illness” comes to mind.  Or perhaps “The Reverse Midas Touch.”

But in life there are no absolutes, and with health care there are some things that government ought to zero in on.

I’m speaking specifically about “surprise medical bills” and mega-conglomeration.

Surprise Medical Bills

These usually occur when there is an emergency and the ambulance – which always goes to the nearest hospital – dumps the sick or injured person in a non-network hospital.

The hospital, of course, delivers care to the patient.  It’s the law.

But then they are free to charge the health plan whatever they charge for non-network use.  And that is often a usurious rate.  The employee is often then billed for the out of network excess, which can be tens of thousands of dollars.

That seems to be less of a problem in Massachusetts than other states, at least the part about the employee being charged a balance bill.  However, that usurious charge is paid by your plan.  And that raises premiums or costs for everyone.

It’s an example of hospitals being able to use an unplanned, unavoidable occurrence to squeeze dollars out of people and employers.  The size of the ER charge for out of network emergency visits ought to be legislated.  There aren’t any market forces that I can see that would solve the problem, at least not without over-enriching lawyers.

Runaway Conglomeration

Hospitals are on a merger binge.  It’s out of control.  Left to Partners Health Care, there would only be ONE care-providing organization in the state.

Invariably, the networks “justify” this by babbling about “economies of scale.”

Sorry, but there’s only one word for that: BS.

The Robert Woods Johnson Foundation did a study in which they demonstrated that hospital mergers resulted in, on average, an increase in costs. My memory tells me it was a 9% increase, but whatever it was, it certainly wasn’t an “economy of scale.”

My preferred term is restraint of trade.  It is hospitals creating, at best, oligopolies, and, at worst, monopolies.  Even the Wall Street Journal wrote about this September 18, 2018.

The all-powerful conglomeration of health care providers becomes so overwhelming in scope that they can dictate to carriers that their doctors/facilities/labs/etc. ALL be included in the carrier’s network.  Or the carrier gets blocked out of the network – something NO CARRIER will tolerate.

The networks already dictate that carriers can’t “steer” patients to a specific doctor or other provider.  This means that your people are denied the ability to buy what is best and what is cheapest for them, the end user.

Only government can seemingly stop monopolization.  Market forces can’t effectively do it.  Government can.

But for some reason our spineless, fawning politicians (but I repeat myself) are cowed by the health care providers.

One Saving Grace

However, luckily, that is showing some minor evolution of attitude.  In fact, there is only one force besides government that has an impact on monopolists: their own covetous greed.  Eventually it becomes so overwhelming that even politicians can’t be frightened off anymore.

Thank Heaven for that one saving grace.

Another Saving Grace

There is one other answer for many employers: What networks won’t do and politicians are afraid to do, you are free to do and can do.

You can retain an independent, expert adviser firm to guide your employees.  To help them find the best doctor.  To help them find the most affordable provider.  To help them achieve the best possible outcome for the most reasonable price.

That advisor ISN’T Business Benefits.  That’s NOT our job.  Our job is to screen for the best and then to help you find those advisers and make sure they work for YOU, not for the health providers.