When insurers get into the doctoring business

[Greenbeard]

Bloomberg had a good article over the weekend on a couple trends that are starting to intersect.

The first isn't new: independent physicians and practices have been disappearing for a long time as they willingly get absorbed into larger, hospital-led health systems (Hospital Acquisitions of Physician Practices Continue]). For the larger systems, those practices are an important source of patients and market share. For the formerly independent practices, giving up their autonomy can give them access to higher prices, more resources and capital, and some stability.

The other is the fallout from COVID: health care, which is usually about as recession-proof as an industry gets, was slammed last year (Health-Care Workers See Steep Job Losses From Coronavirus), particularly primary care practices (Primary-care practices fear they may not survive the pandemic). There's lots of expectation, or fear, that these pressures will accelerate the first trend, sending what remains of the nation's independent practices into the arms of well heeled buyers.

But big hospital-led health systems aren't the only potential buyers. UnitedHealth Group, which of course owns the nation's largest health insurer, has a health care delivery arm, OptumHealth. As a sign of things to come, it announced recently that it will acquire the largest independent physician group in Massachusetts. Those 700 docs are a drop in the bucket of the 10,000 that Optum intends to add nationwide this year. As the article notes, United already has more doctors than the largest health systems in the country--over 5% of American physicians, even before this year's plan to expand by 20%.

UnitedHealth Chases 10,000 More Doctors for Biggest U.S. Network

Atrius Health, the largest independent doctors’ group in Massachusetts, faced financial trouble heading into 2020. Covid-19 made it worse. . .Independent doctors were in decline before Covid, as high administrative costs and weak negotiating leverage favored tie-ups with big health systems. Then, the pandemic pushed up expenses for protective gear and dented revenue as patient visits dropped off. The combination could steer more practices into the arms of deep-pocketed suitors. Physician practices that need capital often find big hospital systems to be eager buyers, and Boston has plenty. Atrius, though, has agreed to be acquired by another health-care powerhouse: UnitedHealth Group Inc.’s OptumHealth unit.

The health-care conglomerate that owns the biggest U.S. medical insurer, UnitedHealthcare, has assembled one of the country’s largest collections of doctors -- more than 53,000, or about 5% of U.S. physicians. UnitedHealth wants to add at least 10,000 this year, and if regulators clear the proposed deal, Atrius’s 700 doctors and primary-care providers will be among them.

Across the industry, insurers are expanding their reach into care delivery. Cigna Corp. recently agreed to purchase telemedicine provider MDLive. Humana Corp. bought a South Florida physician network this week in its latest expansion of primary care. CVS Health Corp., which acquired insurer Aetna in 2018, is adding hundreds of HealthHUB clinics at retail stores.

Yet more than any of its rivals, UnitedHealth has bet on owning medical providers, including outpatient surgery centers, urgent care clinics and primary care practices that span 44 states. UnitedHealth says it’s essential to the company’s mission to create a “next generation health system” that offers better care at lower costs.

 

[Neomalthusian]

Really interesting. Your impressions of the pros and cons?

 

[calamity]

Bloomberg had a good article over the weekend on a couple trends that are starting to intersect.

The first isn't new: independent physicians and practices have been disappearing for a long time as they willingly get absorbed into larger, hospital-led health systems (Hospital Acquisitions of Physician Practices Continue]). For the larger systems, those practices are an important source of patients and market share. For the formerly independent practices, giving up their autonomy can give them access to higher prices, more resources and capital, and some stability.

The other is the fallout from COVID: health care, which is usually about as recession-proof as an industry gets, was slammed last year (Health-Care Workers See Steep Job Losses From Coronavirus), particularly primary care practices (Primary-care practices fear they may not survive the pandemic). There's lots of expectation, or fear, that these pressures will accelerate the first trend, sending what remains of the nation's independent practices into the arms of well heeled buyers.

But big hospital-led health systems aren't the only potential buyers. UnitedHealth Group, which of course owns the nation's largest health insurer, has a health care delivery arm, OptumHealth. As a sign of things to come, it announced recently that it will acquire the largest independent physician group in Massachusetts. Those 700 docs are a drop in the bucket of the 10,000 that Optum intends to add nationwide this year. As the article notes, United already has more doctors than the largest health systems in the country--over 5% of American physicians, even before this year's plan to expand by 20%.

UnitedHealth Chases 10,000 More Doctors for Biggest U.S. Network

Yes, this is an ongoing problem. Americans are dying sooner now because of it.

 

[Greenbeard]

Really interesting. Your impressions of the pros and cons?

I'm sure there are advantages to the finances and operations of the practices themselves--and if it's a choice between acquisition by Optum or going under, that's a no-brainer. But my quaint preference tends to be for local/regional ownership and control. I have a soft spot for for local non-profit health plans (e.g., ‘Locally Grown’ Insurance Companies Help Fortify Washington State Market | Debate Politics) and, if there has to be consolidation, on mission-driven clinically integrated local/regional health systems. But those local systems use their pricing power as much as any national behemoth, so disruption can be good.

And there's certainly a prominent school of thought that integrating the insurance business and the health care business (like the Kaiser model) is ultimately the way to go. We've seen plenty of providers moving in that direction by buying or launching health plans, though it hasn't been a panacea (How should provider-led health plans evolve? | McKinsey), so it's not shocking to see insurers reciprocating. And there's some indication United is interested in exploring the potential there:

UnitedHealth’s Recipe for Lower Costs: Send Patients to Its Own Doctors

UnitedHealth Group Inc., the country’s largest health insurer, is selling a new plan that directs patients to see the company’s own doctors, a wager that some people will give up access to a greater range of physicians in exchange for lower premiums.

The company’s Optum division, the source of half its profits, has spent years buying medical practices and now employs, manages or contracts with almost 50,000 doctors, according to a recent securities filing. That’s equivalent to roughly 5% of the practicing physician workforce in the U.S.

The new coverage plan, called Harmony, relies on Optum doctors and a small number of outside providers. A tighter, more coordinated network can save customers money and improve patients’ care, UnitedHealth says. Harmony’s premiums are about 20% lower than its own comparable HMO plans.

To the extent this trend is disrupting the status quo (e.g., in markets in California dominated by Sutter), this could be good. For a while at least.

Physicians, Hospitals Meet Their New Competitor: Insurer-Owned Clinics

Some of the largest health insurers are capitalizing on recent massive deals by steering patients toward clinics they now own, controlling both delivery and payment for health care.

The trend creates worries for rival doctor groups and hospital companies that have invested deeply in buying up physician practices, which now increasingly compete against offerings from insurers.

UnitedHealth Group Inc.’s insurance unit is offering a plan in the Los Angeles area built around doctors who work for its Optum arm, which has acquired a sprawling network of doctor practices, surgery centers and urgent-care clinics. The company says it is working to offer similar designs in other markets, though they might also involve non-Optum doctors.

It does make you wonder if someday the white whale will no longer be single-payer health care, but an 'American NHS'-style proposal to move physician practices and hospitals from private ownership to public operation.

 

[Razoo]

Top 10 reasons to support single-payer on Medicare’s birthday - CitizenVox

To celebrate Medicare’s anniversary, I thought I would share my top 10 reasons, out of literally thousands of others, to support a single-payer health care system: 10. Under single-payer, say goodbye to medical bankruptcies in the United States. According to Physicians for a National Health...

citizenvox.org

 

[Razoo]

10 reasons, out of literally thousands of others, to support a single-payer health care system:

10. Under single-payer, say goodbye to medical bankruptcies in the United States.

According to Physicians for a National Health Program and U.S. Sen. Elizabeth Warren (D-Mass.), more than 62 percent of the more than 2.2 million personal bankruptcies in the United States are due to medical expenses.

This problem does not just touch those with health insurance. Many of those who need to file for bankruptcy due to medical costs had health insurance coverage. Single-payer health care would provide health care for all and ensure that no one goes bankrupt due to illness.

This video explains the problem and the solution very well.

9. If it’s good enough for the royal baby, George Alexander Louis, it’s good enough for the United States.

Here’s my previous blog on this topic.

8. Single-payer would cover everyone.

I believe health care is a right – not a privilege reserved for the wealthy. Regardless of how much you have in your wallet, you would have access to doctors and hospitals under a single-payer system. In the wealthiest nation in the history of humanity, it is the least we can do.

7. If members of Congress tried to shut down the government to defund single-payer, they would be defunding health care coverage for themselves and their families.

Unless members of Congress and their families participate directly in a particular health care system, they can hold it hostage for political gain. Case in point: 60 members of Congress recently sent a letter to their leadership requesting that House Speaker John Boehner (R-Ohio) shut down the government if the administration doesn’t “defund” Obamacare. If those representatives and their families received their health care through a single-payer system, they would be less inclined to defund it.

6. It works well in other countries.

Dozens of other industrialized countries can’t all be wrong. Their people live longer, their child mortality rate is lower and they have unrestricted access to maternity care. This is an example of where we could learn something from studying how other countries provide health care.

5. Transitioning to a single-payer system would save billions of dollars.

If the United States was able to move away from its private health insurance system, we could save more than $400 billion a year in administrative costs. Further savings could be obtained by adopting European-style drug pricing and provider payments.

4. Single-payer is simple to administer

H.R. 676, model single-payer legislation, is 30 pages long. It does not need to be thousands of pages long accompanied by a mountain of regulations. A few key principles: Universal coverage, publicly funded and publicly administered, is easy to implement.

3. Single-payer will increase business competitiveness.

If you remove the more than $1 trillion dollars that private employers pay for health care every year, it would greatly improve the playing field for American business. It is often stated that GM must add $1,500 to $2,000 to the sticker price of a car due to health care costs that car companies in other countries do not have to bear (i.e. Germany and Japan). Having the government be responsible for health care would improve business efficiency, productivity and employment.

2. You wouldn’t lose your health care if you lose your job.

Every American would have health care no matter what their employment status. Now when people lose their jobs, they also find themselves without health insurance. That’s the last thing someone needs who is trying to figure out how to meet the basic necessities of life.

1. Say goodbye to private insurance company abuse.

Private insurance companies have generally made their money by only insuring the healthy and denying claims for the sick. Moving toward single-payer would eliminate the perverse incentives inherent in the private insurance system and turn the focus back to helping heal the sick instead of maximizing profit.

 

[Razoo]

50% of bankruptcies are connected to healthcare = people with insurance

 

[Razoo]

After the passage of health care reform, ALEC’s top priority has been to challenge the law by encouraging members to introduce bills that would prohibit the law’s insurance mandate.

ALEC’s Health and Human Services task force is led by representatives of PhRMA and Johnson & Johnson, and representatives of Bayer and GlaxoSmithKlein sit on ALEC’s board.

The group’s model bill, the “Freedom of Choice in Health Care Act,” has been introduced in forty-four states, and ALEC even released a “State Legislators Guide to Repealing ObamaCare” discussing a variety of model legislation including bills to partially privatize Medicaid and SCHIP.

The legislative guide utilizes ideas and information from pro-corporate groups like the Heritage Foundation, the Goldwater Institute, the James Madison Institute, the Cato Institute, the National Center for Policy Analysis and the National Federation of Independent Business.22

ALEC: The Voice of Corporate Special Interests in State Legislatures | Right Wing Watch

When state legislators across the nation introduce similar or identical bills designed to boost corporate power and profits, reduce workers rights, limit

www.rightwingwatch.org

 

[aociswundumho]

After the passage of health care reform, ALEC’s top priority has been to challenge the law by encouraging members to introduce bills that would prohibit the law’s insurance mandate.

I've always been puzzled as to why so many progressives supported the idea of forcing Americans to buy a product from a greedy corporation.

 

[Razoo]

Maybe not all are progressives .............

 

[Greenbeard]

Top 10 reasons to support single-payer on Medicare’s birthday - CitizenVox

To celebrate Medicare’s anniversary, I thought I would share my top 10 reasons, out of literally thousands of others, to support a single-payer health care system: 10. Under single-payer, say goodbye to medical bankruptcies in the United States. According to Physicians for a National Health...

citizenvox.org

After the passage of health care reform, ALEC’s top priority has been to challenge the law by encouraging members to introduce bills that would prohibit the law’s insurance mandate.

ALEC’s Health and Human Services task force is led by representatives of PhRMA and Johnson & Johnson, and representatives of Bayer and GlaxoSmithKlein sit on ALEC’s board.

The group’s model bill, the “Freedom of Choice in Health Care Act,” has been introduced in forty-four states, and ALEC even released a “State Legislators Guide to Repealing ObamaCare” discussing a variety of model legislation including bills to partially privatize Medicaid and SCHIP.

The legislative guide utilizes ideas and information from pro-corporate groups like the Heritage Foundation, the Goldwater Institute, the James Madison Institute, the Cato Institute, the National Center for Policy Analysis and the National Federation of Independent Business.22

ALEC: The Voice of Corporate Special Interests in State Legislatures | Right Wing Watch

When state legislators across the nation introduce similar or identical bills designed to boost corporate power and profits, reduce workers rights, limit

www.rightwingwatch.org

What do these decade-old articles have to do with this topic?

 

[jaeger19]

Bloomberg had a good article over the weekend on a couple trends that are starting to intersect.

The first isn't new: independent physicians and practices have been disappearing for a long time as they willingly get absorbed into larger, hospital-led health systems (Hospital Acquisitions of Physician Practices Continue]). For the larger systems, those practices are an important source of patients and market share. For the formerly independent practices, giving up their autonomy can give them access to higher prices, more resources and capital, and some stability.

The other is the fallout from COVID: health care, which is usually about as recession-proof as an industry gets, was slammed last year (Health-Care Workers See Steep Job Losses From Coronavirus), particularly primary care practices (Primary-care practices fear they may not survive the pandemic). There's lots of expectation, or fear, that these pressures will accelerate the first trend, sending what remains of the nation's independent practices into the arms of well heeled buyers.

But big hospital-led health systems aren't the only potential buyers. UnitedHealth Group, which of course owns the nation's largest health insurer, has a health care delivery arm, OptumHealth. As a sign of things to come, it announced recently that it will acquire the largest independent physician group in Massachusetts. Those 700 docs are a drop in the bucket of the 10,000 that Optum intends to add nationwide this year. As the article notes, United already has more doctors than the largest health systems in the country--over 5% of American physicians, even before this year's plan to expand by 20%.

UnitedHealth Chases 10,000 More Doctors for Biggest U.S. Network

Its the consequences of high demand.. with declining reimbursement. Something is giving and its patient care.

 

[Deuce]

I've always been puzzled as to why so many progressives supported the idea of forcing Americans to buy a product from a greedy corporation.

Progressives want single-payer.

Are you...confused as to what that means?

 

[aociswundumho]

Progressives want single-payer.

Perhaps, but in the meantime they support forcing Americans to buy health insurance from the same companies they believe to be the major problem with healthcare in the US.

Is there anything sweeter to a big, greedy corporation than a law which forces people to buy what they're selling?

 

[Mircea]

The first isn't new: independent physicians and practices have been disappearing for a long time as they willingly get absorbed into larger, hospital-led health systems (Hospital Acquisitions of Physician Practices Continue]).

Not willingly.

Your lack of knowledge of the history of healthcare in the US is not impressive.

The long-standing feud between the American Hospital Association (AHA) and American Medical Association (AMA) was based on 2 key issues:

1) Sliding scale fees

The AMA insisted doctors charge sliding scale fees --meaning the patients ability to pay -- while the AHA insisted on charging all patients the same fees.

AMA-member hospitals applied the same principle (unfortunately only 18% of hospitals were AMA members while 80% of hospitals were AHA members).

2) Doctor independence

The AMA fought to have doctors remain independent of hospitals.

The AHA seeks total control of all doctors, meaning every doctor is employed by a hospital or they cannot practice.

If you don't see how the AHA policy is harmful to you, then it's because you're not listening.

Hospitals have reputations in the community/region. Hospitals with poor reputations end up closing (like around here it was Holmes, and Saint Luke West and Saint Francis and Saint George and Provident which all ended up closing).

A hospital may have generally a good reputation, but one of its units may not.

Mothers may tell other mothers to avoid these hospitals for child-birth and go to another. Some people might tell you not to have your cardiac procedure or orthopedic procedure at certain hospitals because of their very bad reputation.

As an independent creature, your doctor can best advise you on which hospitals to use for your surgical procedure or medical treatment and which ones to avoid.

However, as an employee of a hospital, your doctor is contractually prohibited from recommending or suggesting any hospital other than his employer-hospital.

So, your doctor is rolling his/her eyes and giving you funny looks trying to get you to understand that your newborn infant should have their heart-valve replaced at any hospital except that one lest the infant should die or suffer serious complications, because he is barred from coming right out and saying it.

For the larger systems, those practices are an important source of patients and market share. For the formerly independent practices, giving up their autonomy can give them access to higher prices, more resources and capital, and some stability.

Way back when, insurance companies did not offer health insurance, but hospitals did.

During the Great Depression, the States attempted to coerce hospitals into complying with State insurance regulations and laws in order to drum up revenues, so the AHA embarked on the Great Bribery & Corruption Tour and got all the States to enact "enabling laws" -- so-called because they enabled hospitals to offer insurance without complying with insurance laws and regulations.

Those same laws also allow hospitals to operate as legal monopolies.

The AHA swore up and down that the free medical care provided to low-income families would offset the negative consequences of monopoly power.

So.....how much free medical care have the hospitals in your area provided over the last 80 years?

No one knows.....because the AHA who wrote the legislation made damn sure there was never any requirement to report the amount of free medical care provided to any government office or agency.

When you hear hospitals screaming poor patients don't pay.....well, the hospitals promised to provide free medical care to low-income patients, so what's the problem?

[

 

[Mircea]

QUOTE="Greenbeard, post: 1073618083, member: 22081"]But big hospital-led health systems aren't the only potential buyers. UnitedHealth Group, which of course owns the nation's largest health insurer, has a health care delivery arm, OptumHealth. As a sign of things to come, it announced recently that it will acquire the largest independent physician group in Massachusetts. Those 700 docs are a drop in the bucket of the 10,000 that Optum intends to add nationwide this year. As the article notes, United already has more doctors than the largest health systems in the country--over 5% of American physicians, even before this year's plan to expand by 20%.[/QUOTE]

That was always the plan. The AHA wants total control of everything.

After the Supreme Court denied a writ of certiorari for In re: Inland Steel in 1949, the flood gates opened and insurance companies started offering health insurance.....with a twist....a good twist.

Here were your options 1949 to 1954:

Purchase a life insurance catastrophic coverage plan from a bona fide insurance company:

1) You pay premiums for 10 years only then you never pay another dime for the rest of your life.
2) You, your spouse (and minor children) are covered until the day you die.
3) When you die, whatever money you haven't spent on healthcare out of the policy that remains goes to your named beneficiaries.

Or.....

Purchase a policy from the AHA Blue Cross:

1) You pay premiums every month until the day you die.
2) When you die, you get nothing.

Which one of those do you think Americans were jumping on?

Not the Blue Cross. By 1952, the Blue Cross had lost 50% of its market share and was teetering on bankruptcy.

They ran to Congress and got Congress to change the IRS Tax Code to ban the practice of coupling life insurance with health insurance.

"Premiums paid by an employer on policies of group life insurance without cash surrender value covering the lives of his employees, or on policies of group health or accident insurance...do not constitute salary if such premiums are deductible by the employer under Section 23(a) of the IRS Code."

Source: Public Law 83-591, August 16, 1954; Internal Revenue Code of 1954, Section 106. For more information see the 1986 Internal Revenue Code.

After the American Hospital Association and your State and federal government disenfranchised Millions of Americans by letting employers lord over health plan coverage, you got screwed again:

"Introduced by various House and Senate sponsors and subject to extensive hearings, the basic framework of part A began to reflect accommodations between the sponsors, the Administration and the American Hospital Association (AHA). It ranged all the way from principles of institutional reimbursement, which has been pretty thoroughly already worked out in a general way for their own purposes between Blue Cross and the Hospital Association over a period of several years The American Hospital Association has already nominated the Blue Cross organization for its membership, although some member hospitals will undoubtedly elect out of this arrangement. We have proceeded very far in the development of working arrangements with Blue Cross, although no formal approval as a fiscal intermediary has yet been given them."

Source: Report to Social Security Administration Staff on the Implementation of the Social Security Amendments of 1965, Robert M. Ball Commissioner, November 15, 1965

 

[Greenbeard]

Not willingly.

Your lack of knowledge of the history of healthcare in the US is not impressive.

The long-standing feud between the American Hospital Association (AHA) and American Medical Association (AMA) was based on 2 key issues:

1) Sliding scale fees

The AMA insisted doctors charge sliding scale fees --meaning the patients ability to pay -- while the AHA insisted on charging all patients the same fees.

AMA-member hospitals applied the same principle (unfortunately only 18% of hospitals were AMA members while 80% of hospitals were AHA members).

2) Doctor independence

The AMA fought to have doctors remain independent of hospitals.

The AHA seeks total control of all doctors, meaning every doctor is employed by a hospital or they cannot practice.

If you don't see how the AHA policy is harmful to you, then it's because you're not listening.

Hospitals have reputations in the community/region. Hospitals with poor reputations end up closing (like around here it was Holmes, and Saint Luke West and Saint Francis and Saint George and Provident which all ended up closing).

A hospital may have generally a good reputation, but one of its units may not.

Mothers may tell other mothers to avoid these hospitals for child-birth and go to another. Some people might tell you not to have your cardiac procedure or orthopedic procedure at certain hospitals because of their very bad reputation.

As an independent creature, your doctor can best advise you on which hospitals to use for your surgical procedure or medical treatment and which ones to avoid.

However, as an employee of a hospital, your doctor is contractually prohibited from recommending or suggesting any hospital other than his employer-hospital.

So, your doctor is rolling his/her eyes and giving you funny looks trying to get you to understand that your newborn infant should have their heart-valve replaced at any hospital except that one lest the infant should die or suffer serious complications, because he is barred from coming right out and saying it.



Way back when, insurance companies did not offer health insurance, but hospitals did.

During the Great Depression, the States attempted to coerce hospitals into complying with State insurance regulations and laws in order to drum up revenues, so the AHA embarked on the Great Bribery & Corruption Tour and got all the States to enact "enabling laws" -- so-called because they enabled hospitals to offer insurance without complying with insurance laws and regulations.

Those same laws also allow hospitals to operate as legal monopolies.

The AHA swore up and down that the free medical care provided to low-income families would offset the negative consequences of monopoly power.

So.....how much free medical care have the hospitals in your area provided over the last 80 years?

No one knows.....because the AHA who wrote the legislation made damn sure there was never any requirement to report the amount of free medical care provided to any government office or agency.

When you hear hospitals screaming poor patients don't pay.....well, the hospitals promised to provide free medical care to low-income patients, so what's the problem?

[

 

[bave]

10 reasons, out of literally thousands of others, to support a single-payer health care system:

10. Under single-payer, say goodbye to medical bankruptcies in the United States.



9. If it’s good enough for the royal baby, George Alexander Louis, it’s good enough for the United States.


8. Single-payer would cover everyone.



7. If members of Congress tried to shut down the government to defund single-payer, they would be defunding health care coverage for themselves and their families.



6. It works well in other countries.



5. Transitioning to a single-payer system would save billions of dollars.



4. Single-payer is simple to administer



3. Single-payer will increase business competitiveness.



2. You wouldn’t lose your health care if you lose your job.



1. Say goodbye to private insurance company abuse.

10: This has been largely debunked in that these bankruptcies had unpaid medical bill balances, but cannot show they caused the bankruptcies. For instance, I would wager 99% of them had credit card balances, why not blame the credit card companies? I would wager 80% of them were behind in rent/mortgages, blame the high rent/mortgages. But no, it's healthcare, right?

9: Do you really think the royal family's care is the same as the general public? I will give you a corollary, do you think the POTUS gets the same care as a veteran through the VA? There is a reason why BNH and Walter Reed both have VIP sections, it ain't for the common man.

8: Proven to not be realistic. Go to the single payer flag states and you will see a huge bifurcation in care along wealth lines. Look at why the UK is veering towards private insurance. Further, no one has a right to the goods/services of another.

7: Meh, politics.

6: Politics heavily in this one. For instance, look at the infant mortality rates and how they are calculated. ACOG did a big study on this years ago, the cliff notes were that the WHO scoring metric was massively tilted against the US because of how many terrible ill newborns we save initially, who succumb later, while in many other universal care countries those children simply die at birth. Further, comparing the overall health isn't really tied to healthcare delivery. The US has an obesity epidemic, Denmark does not. Comparing the two via health outcomes isn't a hugely accurate methodology.

5: This is more complicated, but the cliff notes is that adopting EU-ish payment policies would drastically alter the availability and quality of care in the US. One of the reasons why the US is so much more expensive is the quantity of care delivered. Look at hip/knee replacements in the US compared to the UK as a great example. Look at the productivity ratios of US surgeons compared to UK surgeons. It's night and day. The cost savings are illusory because you assume that we would suddenly be able to shift to their cost structure, we wouldn't, the system would outright implode if you tried anything resembling it. A great example? Why does CMS use third party insurance carriers to administer medicare plans? Why are they so popular? The answer? It's a win-win-win for the patient, insurance company, and CMS.

4: That's true, if you trust a federal agency....

3: Probably true, except within the healthcare/biotech/pharma space, which would disintegrate.

2: Meh. If you leave your employment you have many means to acquire health insurance, whether via COBRA or a private purchase.

1: Yes and no. I will give you an example. Go try and find someone who has a serious illness who is on medicare/medicaid and then ask them about their ability to get into top tier facilities/physicians. It doesn't happen. Huge swaths of physicians no longer accept medicare/medicaid any longer because of the paperwork and reimbursement. It is the different between having healthcare coverage, and healthcare.

 

[bave]

Not willingly.

Your lack of knowledge of the history of healthcare in the US is not impressive.

The long-standing feud between the American Hospital Association (AHA) and American Medical Association (AMA) was based on 2 key issues:

The AMA fought to have doctors remain independent of hospitals.

The AHA seeks total control of all doctors, meaning every doctor is employed by a hospital or they cannot practice.

As an independent creature, your doctor can best advise you on which hospitals to use for your surgical procedure or medical treatment and which ones to avoid.

However, as an employee of a hospital, your doctor is contractually prohibited from recommending or suggesting any hospital other than his employer-hospital.

So, your doctor is rolling his/her eyes and giving you funny looks trying to get you to understand that your newborn infant should have their heart-valve replaced at any hospital except that one lest the infant should die or suffer serious complications, because he is barred from coming right out and saying it.

The AMA is a joke, their entire business is administering a code database, which they have a federally provided monopoly on, which generates ~80% of their revenue. They don't give a flying shit about anything other than protecting that monopoly.

Why are physicians flocking to employment models? Because CMS made them. You can't run a 1-4 physician practice anymore because of all of the mandates (ie: EHR) combined with ever declining real reimbursement rate. Instead they go and work for a large institution that has scale, clout, and negotiating power. A physician working for a large hospital network is going to get paid more, to work less, because the feds decided that was the best model.