Both state and national level politicians certainly know what side the bread is buttered on, and who’s doing the buttering. There are far more patients than there are physicians, thus the rush to fix the problem they’ve defined as “surprise medical bills.”
Sure, just like I’m surprised when I pay good money for admission to a baseball game and then find out that the beer isn’t free! What? It’s completely unfair!
By framing the issue from the position of the average voter, politicians think the solution to the problem that they’ve defined as “surprise” is to force physicians to take contracted rates that they never bargained for or, and why not, simply go to arbitration.
But wait, will you be “surprised” when you find out that arbitration isn’t free or even discounted? What do you mean, why isn’t it free? Will there be legislation to remedy the surprise arbitration cost problem? Don’t hold your breath.
Physicians can’t change the fact that most politicians are simply second handers who create nothing, but crave power. But at least physicians can make an attempt to define the language used in the out of network situation to gain traction in framing what the issue really is: Insurance companies refuse to contract at reasonable rates. Insurance companies want to cut out the cost of contracting and still force “contracted” rates down physician’s throats. By narrowly contacting, insurance companies can then put their fingers on the scale of what contacted rates in “the community” (supposedly) are.
But, of course, if insurance companies don’t have a contract with someone to accept a lower, contracted rate, why should they be entitled to any rate other than full rates? The one-sided “right” to impose a discount is, in essence, imposing a form of slavery on the non-contracted physicians: it’s taking value from you without paying you an agreed upon value in return.
Perhaps physicians are afraid to talk this way.
So how about this frame: Why should anyone be forced to accept a contracted rate they didn’t contract for? If insurance companies are interested in contracting they should reach out and do it. If they’re not, then either they or the patient should be responsible for the full fee. It’s as simple as that. Just like my ticket to the game doesn’t get me free beer unless I bought some sort of package deal.
If you simply sit back and leave it up to political power, then the situation will become what is attributed to Benjamin Franklin (I know, I know, he probably didn’t actually say it), “democracy is two wolves and a lamb sitting down to the vote on what to have for lunch.”
Unless you frame the issue, you will continue to be on the menu.
Comment or contact me if you’d like to discuss this post.
Mark F. Weiss