I am reposting this diary as I posted it rather late in the evening and I think a lot of people missed this latest AHIP-o-critical spin. And I fixed (and added to) the poll. Also. ;o)
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America's Health Insurance Plans released a white paper today entitled The Value of Provider Networks and the Role of Out-of-Network Charges In Rising Health Care Costs: A Survey of Charges Billed by Out-of-Network Physicians.
The 20-page PDF can be found here.
I suggest, that if one reads this document as unacknowledged snark, one serve a heady yet humble Côtes du Rhône-Villages.
If one prefers to read it as outright comedic farce, a lively and inexpensive Montepulciano d'Abruzzo might be more in order.
If one reads it seriously and agrees with its basic premise, then I suggest a 1986 Chateau Haut-Brion. It's a helluva wine and you can likely afford it.
Protecting consumers from runaway charges billed by some out‐of‐network physicians is an important policy issue at a time of major economic challenges and a national debate surrounding health care reforms. This report provides a snapshot, state‐by‐state, of exorbitant charges billed by out‐of‐network physicians in the 30 largest states by population.
It is designed to illustrate the value of provider networks and a growing problem faced by consumers who want affordable, meaningful access to out‐of‐network providers. [italics theirs.]
That's right. One of the reasons health care is becoming so gosh darned expensive is people having the temerity to use out-of-network physicians for their health care needs!
Their exorbitant charges are, as they rightly state a few paragraphs later, because they are at a "non-negotiated rate".
But then they allude to doctor's gouging (no pun intended) their out-of-network patients:
Some out‐of‐network providers are charging exorbitant prices – several hundred or even
over a thousand percent of the Medicare reimbursement for the same service in the same area. Recent examples: $4,500 for an office visit when Medicare would have paid $134; $14,400 for removal of a gallbladder when Medicare would have paid $656; and $40,000 for a total hip replacement when Medicare would have paid $1,558.
Wait a minute. Are they really going to compare rates charged by physicians to the Medicare reimbursement schedule? Are they kidding??
Didn't they release a report along with AHA, Premera Blue Cross and Blue Cross/Blue Shield last December stating that low Medicare reimbursement rates created a "hidden tax" on consumers because providers had to cost shift to private payers?
Why yes, yes they did.
They then go into a state by state "analysis" (in actuality, a snapshot) of exorbitant out-of-network fees compared to these Medicare reimbursement rates.
They do not compare these rates to in-network private insurance contracted rates.
They do not say what their "reasonable and customary charge" would have been in each case (which is a multiple of Medicare payment rates) with those out-of-network doctors.
They also, oddly, fail to show any direct correlation between these fees, which are either not covered or are capped by private insurers and, thus, paid out of pocket by the patient, and the horrific rise in health care costs.
If the solution to the health care cost crisis is for everybody to pay the Medicare prix fixe then why aren't all AHIP member plans doing just that? That would reduce their costs significantly and allow them to drastically reduce the premiums that they charge to their members!
Problem solved!!
The answer, obviously, is because no providers (physicians OR hospitals) would contract with them for reimbursement substantially less than cost!
The implication in this 20 page Chick tract is that these "out-of network" doctors are thieves. Maybe some of them are, I have no idea.
But by basing their argument on the false premise that all hospitals and all doctors are equal in terms of skill and outcomes it's damn thin gruel.
Patients should not have a choice about which doctor performs their surgery - especially if they are choosing to pay the difference out of pocket? Isn't patient choice what they're screaming about if we get a government plan?
If a doctor is really, really good at what they do should they not be able to charge more for their skill/experience/outcomes? I thought the American dream was based on being able to get ahead through your own hard work, skill, and talent.
Why does AHIP hate America?
[ed.note - I mentioned in the comments, which should probably have been included in the diary, that I felt it was a big mistake for Obama (and Congress) to decide ab initio that we had to build on the system that was there instead of scrapping what we had and starting from scratch.]