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Yes, the Health Care Industry Is Conspiring to Steal Your Money

Here are two news stories from this weekend that belong together. First, the Los Angeles Times found that insurance networks on the California exchange are getting narrower. From the LA Times:

The state’s largest health insurers are sticking with their often-criticized narrow networks of doctors, and in some cases they are cutting the number of physicians even more, according to a Times analysis of company data. And the state’s insurance exchange, Covered California, still has no comprehensive directory to help consumers match doctors with health plans. […]

Even as California’s enrollment grows, many patients continue to complain about being offered fewer choices of doctors and having no easy way to find the ones that are available.

Then, the New York Times has an article about how “in network” hospitals emergency rooms are employing large numbers of out of network doctors to effectively steal money from people who narrow network insurance. From the NYT:

Patients have no choice about which physician they see when they go to an emergency room, even if they have the presence of mind to visit a hospital that is in their insurance network. In the piles of forms that patients sign in those chaotic first moments is often an acknowledgment that they understand some providers may be out of network. […]

When emergency medicine emerged as a specialty in the 1980s, almost all E.R. doctors were hospital employees who typically did not bill separately for their services. Today, 65 percent of hospitals contract out that function. And some emergency medicine staffing groups — many serve a large number of hospitals, either nationally or locally — opt out of all insurance plans.

We are expected to tolerate “consumer driven” insurance policies with high deductibles and narrow networks because in certain circumstances they can get people to shop around for a better deal or turn down necessary care. Exploiting these rules to increase profits in emergency rooms when shopping around is impossible, though, is akin to criminal extortion; and if we had non-corrupt politicians those involved would be subject to RICO-like investigations. They are preying on people in extreme distress to coerce them into signing contracts that come with unreasonable charges.

As always, it is worth stating this problem is easily solvable. First World countries without government-run single payer insurance should at least have an all-payer system which sets a reasonable limit on what a health care service can charge. For example, we could cap charges at say 150 percent of what Medicare plays.

Photo by Truthout.org under Creative Commons license

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Jon Walker

Jon Walker

Jonathan Walker grew up in New Jersey. He graduated from Wesleyan University in 2006. He is an expert on politics, health care and drug policy. He is also the author of After Legalization and Cobalt Slave, and a Futurist writer at http://pendinghorizon.com

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