The last couple of weeks have been extremely busy, and this resulted in my being unable to get a complete blog post written last week and the week before for the first time since I launched my blog in mid-January of this year. I actually started two posts, which I will complete very soon.
However, I want to pause a moment and think about my “journey” in advocating affordable medical and surgical care, especially in the midst of some potential local controversy in my little world of Iron County, Utah.
The message of how a truly free market in health care can make its costs so much more affordable is certainly a difficult message to get across to many people. From what I have read in writings by doctors I follow on Twitter and on other platforms, I believe one of the main problems is that government meddling in the delivery of health care has become such a norm, especially after Medicare and Medicaid were voted into existence by Congress in 1965, that way too many people have come to expect that if they do not like the way the delivery of medical/surgical care is working, the government will solve the problem. The government tends TO BE THE PROBLEM!
Over the years, government has increased its involvement in the way medical and surgical care is delivered with a plethora of regulation. Of course, the two most recent heavy-handed interventions by government are the Patient Protection and Affordable Care Act (better known as Obamacare) and the Medicare and Chip Reauthorization Act of 2015 (known very unaffectionately as MACRA).
It cannot have escaped anyone’s notice that Obamacare really IS IMPLODING. There are already areas in the country that have been reduced to a choice of only one insurance carrier. One of those areas is mine!
Worse yet, the insurance I have been stuck with the last two years is a monopoly in the state of Utah, and especially in my somewhat rural area. I will call this monopoly out by name because it is important for people to understand how such “health care systems” keep prices high by limiting the facilities and physicians people are able to use.
The culprit in my area, and I am sure many other areas of the country have their own similar culprits, is Intermountain Health Care, which is a “not-for-profit” organization. When I frequently reported on the activities of this much-revered “health care system” in my days working for a couple of weekly papers and one daily paper, I had no idea how Intermountain was operating to CONTROL its competition.
However, I learned that from my orthopaedic surgeon (and eventual employer), Randy G. Delcore, M.D.
One issue with Intermountain is that it is affiliated with a subsidiary insurance company known as SelectHealth. This insurance company has refused to contract with Dr. Delcore’s surgery center, Cedar Orthopaedic Surgery Center, even though the surgery center offers much lower pricing for orthopaedic surgeries than our local hospital does. Therefore surgical patients with SelectHealth are herded to the hospital for orthopaedic surgery procedures where it is guaranteed they will pay more just in deductibles and co-insurance because some of Dr. Delcore’s costs for procedures are well below the average deductible under Obamacare. I have explained in previous posts how hospitals and insurance companies collude to play a game of phony discounts that make people THINK they are getting a good deal, when they are not.
Not only does Intermountain refuse to contract with Dr. Delcore’s surgery center, but it also essentially bribes other insurers and third party administrators to refuse to contract with COSC. This situation is coming to a head even as I write this because the public schools in Utah are self-funded, and yet they have a third-party administrator known as Educators Mutual Insurance that broke off its contract with COSC about four years ago because the TPA was offered a larger “across-the-board” discount for medical and surgical procedures from Intermountain for canceling its contract with COSC than it would get if it continued to renew its contract.
After four years of remaining a physician on contract with EMI, but not being able to offer patients the real savings of procedures at COSC, Dr. Delcore made the very difficult decision to break off his physician contract with EMI. Then EMI did not waste any time in sending emails to those whose insurance it manages that they would have to find another orthopaedic surgeon … and isn’t it so convenient that Intermountain just happens to have two employed orthopaedic surgeons in our area to which patients can be herded?
If this is not monopolistic behavior on the part of Intermountain, I don’t know what is. I feel I can be open about this controversy because I submitted a “letter to the editor” on behalf of Dr. Delcore to our weekly paper, Iron County Today, and it should actually be in today’s edition. So the cat’s out of the bag. I have also been working at mailing out this same letter directed to public school insurance holders who are also Dr. Delcore’s patients. So if you’ve been wondering where I have been, this is what I have been up to while being a little delinquent from my blog, but I feel it is a worthy cause because it is an issue very close to my heart in terms of health care costs.
I don’t know, at this time, how publishing this letter will work out, but I hope we can wake people up to the harm that hospital and insurance company monopolies can cause to patients and society as a whole. I will keep you all posted on what happens next.
Just as little note here – when President Obama was promoting his signature “health care plan,” he praised Intermountain. This alone should tell you something about that company – control issues!
Photo by Daron Pealock, R.N., Nurse/Administrator at COSC- Post Acute Care Unit at Cedar Orthopaedic Surgery Center.