Kevin Drum read Elisabeth Rosenthal’s An American Sickness and has this summary. EmCare is a company that will run your Emergency Room for you – and isn’t in-network with anyone’s insurance plan, apparently. Over to you, Kevin:
Hospitals know perfectly well that patients expect doctors at in-network hospitals to also be in-network. That’s why hospitals negotiate with insurers in the first place: to get a place in the insurer’s network so they can attract the insurer’s customers.
Likewise, if they contract with a third-party firm to run a part of their hospital, they know perfectly well what will happen if the third-party hasn’t negotiated with the same set of insurers: their patients will get outrageous out-of-network bills.
Unlike patients, hospitals are sophisticated actors. They know enough to ask whether or not EmCare’s doctors belong to their networks. Obviously they did ask, and just as obviously the answer was no. But they signed up with EmCare anyway.
But when you need an ER, do you have the time & inclination to check whether the local ER is in-network? Are you smart enough to ask that specific question?
I know I’m not.
Here’s the thing – I doubt whoever is running EmCare will consider themselves immoral or unethical. To them, this is simply finding a lovely loophole through which to make money, and since they’re businessmen, they’re completely moral. Much like the for-profit prison companies who lobby for longer prison sentences in order to fill their prisons, it’s not the role of companies to look to the greater good. They provide services and make a profit – and if that profit can be increased, their morality is improved just as much.
Now, I’m not yammering for government to step in just yet. It’s not yet clear to me that the interests & skills of government would be appropriate to this situation – especially the Federal Government just at the moment. I might be more interested in a Board of Medical Business Ethics that has a realistic view of the situation and makes rules based on a just understanding. That’s just a rough idea, though, and might not work.
But my point is that the intrusion of private sector sensibilities into the health sector has led to what sounds like a really awful situation. Just called me Broken Record Hue.
And all this based on my reading of a review of a book. I suppose I should read it.
