The Medical Establishment Took The Treasury’s Keys

According to Uwe E. Reinhardt, an economics professor at Princeton, about half a century ago, organized medicine and the hospital industry in this country struck a deal with Congress.

In retrospect, it was as audacious as it was incredible: Congress was asked to surrender to these industries the keys to the United States Treasury.

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Direct Care Is Actually Affordable. Direct Care Is Actually Care. Something The ACA Wishes.

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When Blue Shield of California was designing the new health plans it would offer individuals under the Affordable Care Act (ACA), the insurer made a simple request to doctors and hospital in its network — lower your prices or get left behind. The insurer asked providers to accept reimbursement rates as much as 30 percent lower than what Blue Shield previously paid through plans sold on the individual market. Keep in mind that billing through a third-party-payer is about to multiply tenfold in complexity (from ~15,000 to +155,000 billing codes with ICD-10), meaning that getting paid will require more work for fee-for-service docs. In fact, providers are attending training seminars, paid for out of pocket, to learn how to deal with this billing beast.

Some providers got on board with Blue Shield, but not all of them.

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