ObamaCare Clusterfuck: How the insurance companies will bend the cost curve
The same way they're doing now: By denying care. See this fascinating case in the LA Times:
In a rare case, a Los Angeles jury awarded $3.8 million in compensatory damages to a Porter Ranch doctor who contended insurance giant Anthem Blue Cross retaliated against him for being a strong patient advocate.
See, there's your problem. Jury trials.
The jury found that Anthem, the state's largest for-profit health insurer, violated Nordella's right to "fair procedure," and the company did so with "malice, oppression or fraud." That latter finding prompted the hearing Friday in Los Angeles County Superior Court to determine punitive damages.
Nordella said he was turned away because he had challenged the denial of hundreds of patient claims over the years when he was previously included in Anthem's network. He said he often protested Anthem's conclusion that care wasn't medically necessary and would not be covered. Nordella went so far as to meet with top Anthem officials in 2001.
Anthem "held this grudge and continued to lie and deceive," Nordella said in an interview.
Shocker, I know.
Doctors and health insurers have battled over reimbursements and the denial of claims in court for years. But legal experts said cases like Nordella's usually never reach trial or result in multimillion-dollar verdicts.
"I was surprised by the size of the verdict, and it's really the first case I'm aware of in years," said Carol Lucas, a healthcare lawyer in Los Angeles who represents doctors and medical groups. "Insurance companies will likely look at what happened here to Anthem, and they will make sure they can justify any exclusions from their networks."
No, they won't. They'll double down. They'll think the only problem with Nardella is that they didn't throw him out soon enough.
This case comes as health insurers, in a bid to hold down costs, are increasingly dropping doctors and hospitals and promoting smaller networks. Insurers typically try to negotiate lower rates with the fewer providers left in the network, who get higher patient volume in return.
Nordella said many doctors are unwilling to challenge powerful insurance companies because their incomes are so dependent on being in these provider networks. "Physicians are so afraid to come forward," he said, "and I hope this changes that."
I hope so too, and I'm sure some will. But I would bet ObamaCare triggers a great consolidation and rationalization of the networks. If the cost curve is going to be bent, yet health insurance companies are to maintain the same level of profits, then something's got to give, and it's going to be patient care. Sure, we could wait around for electronic medical records or those guys at Dartmouth to come up with something. Or, we could throw the doctors who want to give care out of the network. Which do you think is going to happen?