I was asked to look at a few bills about primary care that were presented this week for hearing in the legislature. One of these bills allows physicians to charge administrative or operational fees to support their overhead. Another allows physicians to charge optional fees for non-covered services. Another keeps insurers from requiring physicians to do referral co-ordination, which usually means lots of administrative time to get preauthorization — and seeks to outlaw lots of required preauthorization, which functions as an unfunded mandate for physicians. Still another would require new insurance contracts to be renewed every twenty-four months and require insurance companies to negotiate in good faith, understanding that insurance contracts often lock physicians in for years and are very difficult for physicians to terminate. Still another requires insurance companies to provide physicians with a complete fee schedule, so they learn what they are actually going to get paid. And one more adjusts timeline for physician credentialing, so health plans can’t keep new physicians dangling for months, uncredentialled and thus unable to bill for the services they provide.
As I read these bills, I was stuck by an overwhelming sense of sadness, thinking about how out of whack the world has become, out of whack in a way that makes these bills important and even necessary.
Doctors don’t take insurance because we like insurance companies. We take insurance because we want to help and support our patients, who have insurance and want to use that insurance to access health care. But that kindness, that compassion and concern for others, has allowed insurance companies to exploit physicians and physician practices every six ways of Sunday. Physicians don’t set their own prices – insurance companies do. Restaurants set their own prices. Gasoline companies set their own prices. Doggy day care sets its own prices. Supermarkets – well, you get the drift. Physicians are offered the choice between not taking insurance at all, not serving many of the people who are our neighbors — or taking insurance and living under the domination of insurance companies that are interested in only their own profit.
Here’s how the financial numbers on this play out. Health insurance costs $9000 per person per year. Health insurance companies retain 15-20 percent of that – or $1350 to $1800 per person per year. Most primary care practices generate the equivalent of $300 to $360 per person per year, or $25 to $30 per person per month — less than the cost of cellphone or streaming services. Those practices pay 30 to 40 percent of that, or $90 to $120 a month, to cover the cost of billing insurance companies alone! So primary care practices only get to keep and try to operate on $180 to $270 per person per year, or $15 to $22.50 per person per month. Which is crazy. Undoable. Impossible. And why many physicians just quit, move to other states, start to work for hospitals, or go into IT.
I’m told that the major opposition to these bills comes from insurance companies. But I hope that the legislature will find a way to free physicians from their grip. Yes, it may make health care cost a little more. But at least we’ll still have doctors and nurses to care for people, instead of bots.
When was the last time an insurance company executive answered the phone at 3 am to talk to the mom of a three-year-old with a fever?
I just hope and pray that no one will ever do to supermarkets, gas stations, restaurants and doggy day care what insurance companies have done to physicians. Because I, for one, occasionally like to go out to eat.
One more note. I learned today that my colleague Dr. Amy Acton is running for governor in Ohio and is the presumptive Democratic nominee in that race. I met Amy briefly about eleven years ago, when I was finishing my stint as Director of RIDOH and she was beginning hers as Director of the Ohio Department of Health. She was bright, thoughtful, and incredibly compassionate — and was courageous during the pandemic, when people kept threatening her life and her family because she told them how to protect themselves, using the best public health science available at the time. It looks like she will be running against Vivek Ramaswamy, the tech billionaire who ran for President in the last election primaries.
A doctor who was the calm voice of public health vs a tech billionaire. I don’t live in Ohio. But if I did, there’s no question who I’d choose. Let’s hope Ohio, like the US, finds its moral footing, and goes back to choosing people over profit again. Go Amy!!!
You can find Michael Fine’s commentaries and short stories on
https://michaelfinemd.substack.com/and on http://www.michaelfinemd.com
