Yesterday, I was reading the Greenville Hospital System (GHS) medical staff newsletter. One of the articles was excitedly explaining how GHS had struck an EXCLUSIVE contract with Blue Choice Medicaid. This means that the 14,000 members of Blue Choice Medicaid in the Upstate area will only be able to receive their medical care from GHS physicians. The article was presented as very exciting, positive news, but I saw it as an illustration of what is happening to health care in the United States as it moves away from individual centered health care to corporation based health care.
The deal between Blue Choice Medicaid and GHS, despite all of the claims about improving quality is really about money. It has been done for the purpose of both GHS and Blue Choice making more money. Of course, contractual deals between businesses have been done as long as business has been around. This makes sense, if you are talking about Walmart buying a large volume of shirts from a manufacturer so that they can sell them cheaper to entice the consumer to come into Walmart and buy the shirts. I think it is a different matter both morally and functionally to do this in healthcare. In order for the deal between GHS and Blue Choice to work, a population of patients has to be bought and then their behavior as well as the behavior of their doctors controlled in order to produce “savings.” This would maybe be okay if the patients were free to move in and out of the Blue Choice Medicaid plan, but whether you are talking about Blue Choice Medicaid plan or any other insurance plan, the patients do not have the freedom to move and out of their insurance plan. As a consumer, I have the choice to buy a shirt at Walmart or Belks or wherever. However, as a patient I am locked into the insurance plan that my employer chooses or in the case of Medicaid, the plan the state chooses for me. I have no control over the deals that have been struck by these insurance plans. If I am insured by Blue Choice Medicaid and my doctor is not part of the GHS network, I will be forced to either change doctors to one of the GHS doctors or go without insurance coverage, which few can afford.
This process has been going on for quite some time and it has been accelerated by the Affordable Care Act (Obamacare). Once insurance began paying a majority of the health care costs, patients and doctors were no longer viewed as individuals, but now lives to be purchased and members/providers whose behavior was negotiated and controlled. Obamacare brought Accountable Care Organizations into existance and this is driving much of what is happening now. Under Obamacare, much of the money will be distributed to hospitals, who will then determine how the money will be spent for the healthcare of the populations under their control. This is why hospitals have been very aggressive at buying physician practices and coalescing numerous hospitals into their networks. The more healthcare a GHS can provide, the more of the money they can keep for themselves.
On the surface, GHS trying to provide a wide range of services themselves is not a problem. However, it becomes a problem, when they establish themselves as a monopoly that drives out of business any doctors unwilling to be owned by a system and thus controlled by the system. It becomes a problem when patient’s choices are limited because their doctor is not part of the system or their doctor is limited on who he/she can refer to based on whether they are part of the system. It is a problem if the patient’s choices are challenged because the choice does not fit the patient behavior guidelines of the system. It is problematic, when vastly different individuals with unique needs, preferences and biologies are all treated as one monolithic patient population.
As a doctor, I will never be owned by the system. As a patient, I fear the kind of health care system being created is not in MY best interest.