Let's keep competition in medicine -- and insurance

A message to all physicians from AMA Chair Edward L. Langston, MD.

By Edward L. Langston, MDis a family physician in private practice in Lafayette, Ind. He served as chair of the AMA Board of Trustees during 2007-08. Posted Nov. 5, 2007.

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Growing up in the rural Midwest, I learned early in life the value of good neighbors. No matter what the trouble, you never were alone, because good neighbors always showed up to help.

The American Medical Association has a long and proud tradition of being a good neighbor to everyone in the House of Medicine, joining forces with other organizations when needed to fight for what is right.

Our recent activities in Nevada, in support of the Nevada State Medical Assn., demonstrate the AMA's commitment to the belief that any one health care insurance company having a stranglehold on any one state's health insurance market is just one instance too many.

AMA Immediate Past President William G. Plested, MD, joined officials of NSMA in late July urging the Nevada commissioner of insurance to block the buyout of Sierra Health Services by United HealthGroup. Our analysis shows that United's buyout, which would combine two of the three health insurers in Las Vegas, would substantially lessen competition and cause significant harm to consumers and health care providers in the Silver State.

The AMA provided extensive information about marketplace concentration in Nevada. In Las Vegas, United would have more than a 90% market share in HMO plans and more than a 60% share in all health insurance plans and an absolute monopoly in the Medicare Advantage market vital to thousands of senior citizens. Additionally, the proposed takeover likely will result in diminished compensation for health care professionals. Nevada already suffers from a chronic shortage of physicians and nurses and has one of the highest rates of uninsured individuals. This takeover will only heighten the current health care crisis in Nevada.

These are more than dry statistics. They vividly paint a picture of market dominance that history clearly proves always works to the detriment of ordinary men, women and children -- employees, health plan participants and their family members. United's own actions tell that story.

United has been fined in numerous states for violations of state laws impacting patient care and physicians as well. For instance, in 2006, Arizona fined United $364,750 for violating state laws dealing with members' rights to appeal denied care. Nebraska levied a $650,000 fine in 2006 for the plan violating 18 state laws more than 800 times. This was the second time United was fined in Nebraska, the first being in 2005.

New York banned United from adding new patients to its HMO plan for repeated defiance of state regulations. Rhode Island fined United earlier this year for violating state laws intended to protect small business employees. Texas fined United $4 million for repeated violations involving delayed physician payments.

United recently entered into an agreement with insurance regulators in 36 states and the District of Columbia whereby the health plan will be required to make tens of millions of dollars in payments, including restitution to insureds and providers, for a wide variety of claims-processing errors. This record-breaking settlement resulted from a nearly three-year, multistate investigation of United by the National Assn. of Insurance Commissioners.

The AMA pointed out the anti-competitiveness of United's proposed Nevada buyout in hearings before the state's insurance commission.

Since then, the AMA and other parties have redoubled their efforts to encourage Nevada state and federal antitrust regulators to examine closely the anticompetitive consequences of this buyout of Sierra by United. Decisions by these regulators should be forthcoming soon.

Surely someone will take notice of United's track record in putting profits ahead of patients, of an ongoing stock option back-dating scandal involving United executives, of failure to comply with state regulations and United's unwillingness to correct systemic errors.

Competition is good medicine. In states where competition thrives, patients, their employers and health care professionals all benefit.

Edward L. Langston, MD is a family physician in private practice in Lafayette, Ind. He served as chair of the AMA Board of Trustees during 2007-08.

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