Some health networks drop elite hospitals - Is anyone surprised?

Boston Globe: Health insurers are starting to sell policies that largely bar consumers from receiving medical care at popular but expensive hospitals such as Massachusetts General and Brigham and Women’s — a once radical idea that is gaining traction as a way to control soaring health care costs.

Governor Deval Patrick and Senate President Therese Murray have included such restricted provider networks in their recent legislative proposals to control rising insurance rates. And the state this month began offering limited-network plans to 300,000 state employees, retirees, and their families, promising 20 percent discounts on premiums if they are willing to give up access to some of the Boston area’s most renowned hospitals.

Dolores Mitchell, executive director of the agency that oversees health insurance for state employees, said she wants “to send a message to the more expensive [provider] organizations that, ‘Hey, we’re not going to just sit still and do nothing’ ’’ as medical costs climb year after year.

But even as state officials promote the idea, there are obstacles to its wide adoption. Some of the state’s largest insurers have contracts with powerful teaching hospitals and doctors’ groups that could make it difficult to exclude them. And Massachusetts consumers and employers have long cherished choosing from a broad range of providers.

OK, lets do a little common sense examination of this bit of news.

First, Massachusetts has mandatory health insurance now.  In time it will be a national requirement.  That said, health insurance cost are growing MUCH FASTER than other cost.  So it's really expensive to buy insurance.  Solution, cut out the expensive providers.  That makes a fair bit of sense at least insofar as sending a message to providers that they either control their cost or risk being taken out of the game.  While there are certainly issues with this notion, the fundamental requirement to control COST not just require that everyone has insurance, a payment issue having nothing to do with cost, might actually have some impact on medical care cost.

But reading a bit further we find that the large medical care providers, you remember those, the ones that are more expensive than community providers, have provisions in their insurance reimbursement agreements that limit insurers ability to exclude them.  In simple terms, they are big enough and powerful enough that they can require that equally big and powerful insurers pay them MORE for equivalent procedures than community providers!

Want to know one reason our medical care cost are high and results poor?  Go back and read the previous paragraph again.

As I've noted before, the issue with medical care in the United States is less one of who pays than it is one of cost.  Our care is simply to expensive for what we get.  That's just common sense.  One can only hope that provisions such as those proposed might have some effect on health card cost.