The difficulty of controlling the explosive costs of medicine by half-steps came clear this morning in the Oregon House Health Policy & Public Affairs Committee, which was hearing testimony on a simple – one page! – bill that on its surface would seem to provide for modest cost reduction and avoidance of fraud. And maybe it would. But as an insurance company lobbyist (yeah, that’s right) pointed out, the matter is more difficult than that.
The measure is Senate Bill 651, sponsored by Senator Ted Ferrioli, R-John Day, and co-sponsored with 14 other senators (of both parties) and two representatives. Its summary states its point clearly: It requires insurers to “make check for payment for health care services payable jointly to provider of health care services and enrollee if provider has not contracted with enrollee’s health benefit plan to provide health care services.”
At present, checks from insurers cut to pay for medical services often are made out to the patient; the idea is that the patient will then sign it over to the doctor or other provider, such as an imaging clinic. Many do. Quite a few others do not, instead either holding the check for a long time – what’s the incentive to hurry? – or in quite a few cases, cashing it and never paying the provider. Thereby, in the end, driving up the cost of business, and so the cost of medical care.
The bill, which is backed by a number of medical providers (notably clinics), would make the check jointly payable so it could be sent straight from the insurer to the provider. Which seems to, maybe does, make good general sense.
But as so often in these things, there’s a catch.
We’ll admit to being less than poised for acceptance as we watched the Blue Cross lobbyist open his stack of papers and sounding every inch the insurance company guy, eager to protect that bottom line. But his point was sound:
Insurers like his engage in negotiations over cost of services with medical providers, and reach agreements with some of them, resulting in lowered costs, and not with others. Those negotiations can have a real impact on the overall cost over medical care.
By requiring insurers to directly pay providers, whether they’ve negotiated a deal or not, the bill would undercut those negotiations – render them all but irrelevant, from the providers’ standpoint – and maybe drive costs back up.
The point seemed to impact on the committee, which almost looked a touch deflated – damn, another idea for containing health costs that doesn’t quite do it.
The committee’s chair, Representative Diane Rosenbaum, D-Portland, did refer during the discussion (the committee did not formally act on SB 651 today) to her efforts to develop certificate of need legislation, to curb medical-related spending that isn’t needed. A larger point seemed to emerge there: In the area of medicine, small half-measures simply don’t seem to do the job, however well-intended they may be. You have to look toward more global approaches.
It’s a blob of mercury. A thumb won’t contain it; you need something larger.Share on Facebook