Health care system will work better if patients are forced to confront costs

Regarding "Out of network, out of luck: The perils of breaking the tie" (Article, May 16): This article basically points out how insurance companies are trying to force physicians to remain in, or return to, their networks by sending the reimbursement checks to the patient rather than to the out-of-network physician.

I empathize with Jim Palombaro, MD, of Raleigh, N.C., a physician quoted in the article, and agree that this is unfair in the present health care environment. But I disagree with his statement that "you don't need to have the patient in the middle of this."

The main problem with our health care delivery system is that the insurance companies are in the middle of the system when it should be the patient! One of the primary reasons health care costs are soaring is that patients never see the bill and have no economic incentive to be cost-conscious in a system that does not operate under free market economic principles like everything else in our society.

Perhaps we should return to 25 years ago, when the insurance contract was strictly between the insurance company and the patient. Physicians charge their usual and customary fee, and the patient pays the fee. I think that is how the rest of society functions. If a physician gets out of line with their fees, then I suspect patients will figure this out.

Patients must take more responsibility in our new health care delivery system, and they will if we give them the opportunity to do so. Our reimbursement mechanisms have become untenable in the present system because physicians have no market power due to one-sided antitrust laws that need to be changed (that's another topic for another time).

Jeff Terry, MD, Mobile, Ala.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2005/06/13/edlt0613.htm.