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November 26, 2013 12:53 PM The Long Struggle Between Insurers and Providers

By Ed Kilgore

As Jonathan Cohn notes today at TNR, the next big conservative campaign to rile up Americans about the Affordable Care Act involves those who find they cannot “keep their own doctor” under ACA-compliant health plans.

If this sounds familiar, Cohn comments, it’s because the struggle between insurance companies and health providers over networks that must accept set rates for medical services long predates the Affordable Care Act, and the “choose you own doctor” battle cry has long been a provider tactic to push back against managed care plans. So ACA is an almost incidental factor in the coming war of words on this subject.

It’s a war that does, unfortunately, need to continue until we secure better ways of correlating provider compensation with health care quality and results. As Cohn says:

Totally lost in this debate is the fact that many experts believe our health care system pays the providers of medical care way too much money. That’s particularly true of hospitals, whose obtuse and frequently unjustified prices were the subject of Steve Brill’s celebrated Time magazine article earlier this year. Sometimes high prices correlate with high quality, but sometimes they don’t. And particularly when it comes to more routine care, a community hospital is not just adequate but maybe even preferable to a teaching hospital that specializes in the hardest-to-treat cases.

That’s certainly the view of the Washington Monthly, which had its own celebrated issue recently on the ways in which provider cartels snare government subsidies and their own reimbursement rates. The big political point to remember is that arguments over Obamacare will often be confused with arguments over health care policy that would be and should be happening in any event. So it’s important to keep them sorted out.

UPDATE: Matt Yglesias pokes fun at the very idea of expecting permanent control of provider access, with or without Obamacare.

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.

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