Balance the power of health plans with antitrust relief for physicians

LETTER — Posted Oct. 24, 2005

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Regarding "Unhealthy mergers: The wrong trend" (Editorial, Sept. 5): Your editorial concerning health plan mergers underlines the problem with the American physician community when it comes to their current perilous financial situation. The editorial points out the danger to patients and physicians from recent mergers and acquisitions involving Wellpoint and United.

Yet the response of the AMA is a letter to Attorney General Gonzales, and the editorial ends with wishful thinking about an end being put to this growth spurt. It is unrealistic to think that letters, public relations campaigns and lobbying will stop these health plan giants. And no real alternatives are proposed.

My suggestion is that either health plans be limited to no more than 15% of the covered lives in a geographic area or that the physicians in that area, those who are self-employed or salaried in small groups, be allowed to form cooperatives that would be allowed to bargain with the health plans concerning payments for services. I doubt that the former can be achieved, so I favor the latter alternative. In each geographic area, there would be several cooperatives. Each cooperative would be balanced in terms of physician specialty and office location. Each cooperative's membership could not exceed in percent of all physicians in that area the percent of covered lives for largest health plan.

Of course, this solution would require a change in the current antitrust rules and regulations. Those who benefit from the current situation, namely large health plans, the large employers, trial lawyers, lobbyists and politicians, will oppose such a change. Frankly, we cannot match them in financial and lobbying power.

Physicians must start a discussion among ourselves as to how we can convince a large majority of the American public that it is in their interest, as well as ours, for us to be given cooperative bargaining power. Without it, we will gradually be forced to join large physician corporations to have negotiating parity with large health plans. Physicians must come to realize that we must be prepared to act together to preserve our practices. It is the responsibility of the AMA and the medical societies to provide some real leadership.

Richard DiGioia, MD, Washington, D.C.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2005/10/24/edlt1024.htm.

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