Anthem contract clause underscores weak bargaining position of physicians

LETTER — Posted July 5, 2004

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Regarding "Feds turn spotlight on Anthem over 'most-favored-nation' clause" (Article, June 7): After reading the article I can only conclude that the numbers boys are at it again. The language of the Anthem contracts apparently permits the company to continuously reduce reimbursement to give them the lowest price for the services by a provider in a given market.

While limited application of such clauses might be legal and fully in keeping with market principles, it appears that Anthem is trying to impose a pole reversal of the objectives that should be pursued by physicians.

Should the physician really be focusing attention on the vital signs of the patient or the stock ticker value of the insurance company's market fortunes? For surely, in this day of instant communications, every readjustment downward in the price of physician services will likely be reflected by an upward tick in the price of the insurance company's shares.

While physicians have little difficulty accepting the maxim that business is business, they are also profoundly aware that the practice of medicine can and should not be only business.

All of this, of course, raises the larger question of why a situation like this exists. In the article, AMA President Donald J. Palmisano, MD, correctly explains that favored-nation clauses are employed to take advantage of the weak bargaining power of one party in a negotiation. The existing legal and regulatory environment in our nation is such that physicians inevitably will remain the weaker party in negotiations with insurance companies. United can buy Oxford, but I can't discuss with my colleagues how and what to charge for a new minimally invasive technique.

How much longer will we then delude ourselves with the false hope that a business model for medical care will somehow provide adequate care and a caring environment for our patients? There has never been, nor is there likely to be, a successful arrangement for medical care in which the underlying principle is to take advantage of the other party.

Sooner or later, we will all become patients. Isn't it finally time to engage with our current patients to overthrow the tyranny of the insurance companies and their self-serving contracts? In the end, they solely serve the underwriters' profit motive. Anthem's practices are just the latest of many reasons why we need to establish a national system of social protection to eliminate the need for commercial health insurance.

John A. Ameriks, MD, Las Vegas

Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/07/05/edlt0705.htm.

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