There is a lot to
dislike about exchanges and their rollout, but here is something to like. Providers complaining about pay.
The exchange is
first and foremost a marketplace, it’s a means of communicating preferences
between buyers and sellers of health care.
Buyers who choose low cost, limited networks are sending a message that
the services of high cost providers are not worth the price. What happens next?
One way providers
could respond is to lower prices.
Another way is to make their case to the public justifying high prices
and explaining why they are worth it.
Both of those are good things, as they'd force providers to think about
costs and benefits.
Another way to
respond is to lobby the government for preferential treatment as described by
the WSJ. To the extent providers are
arguing for more money because that's what they're used to getting, the door
should be slammed in their face. But if
a provider wants to argue that their service is so critical and so unique that
a service area is being deprived of critical care if they're excluded from a
network, than they've got a point.
There are two kinds
of facilities that might claim that:
those with high cost/low utilization services such as a burn unit, which
serve only a tiny fraction of the population but are critical for them, or
rural providers where they may be the only show in town. Those cases are unique and may indeed warrant
special treatment. But that treatment
can't be a simple mandate in their favor, it has to include obligations
acknowledging that such providers are in effect monopolies.
That's another
conversation that has to happen, a recognition that there are areas of health
care where because of monopolies, competition makes no sense. In those areas the only answer is public
oversight, as intensive and invasive as is applied to other utility
providers. And we should accept the
possibility that for some services, the community really doesn't need a local
provider and prefers the burden of having to travel further to receive such
care.
All of these
conversations about costs and benefits, monopolies and oversight are way
overdue, ignoring them has turned health care into a runaway train. Whatever the rollout problems, if the ACA
makes those conversations happen I'd mark it a success.
