One Story That Shows How Insane Private Healthcare Really Is

On April 1, the contract between Blue Cross Blue Shield and the Piedmont hospital system, which has over 100 locations around Georgia, expired, meaning those locations were now considered out-of-network for anyone with BCBS insurance. According to Piedmont, about 500,000 people with BCBS had seen a Piedmont provider in the last 18 months. That means hundreds of thousands of people lost their doctor—and would you go to your doctor if you suddenly had to fork over a ton more cash out of pocket?

One of the major sticking points in the contract negotiations is how (and how much) BCBC reimburses hospitals for procedures. Piedmont’s website says it “will not agree to anything with Anthem Blue Cross that does not fairly compensate and recognize how integral physicians are to [their] mission.” As health insurance expert (and friend of mine) Tim Faust pointed out on Twitter, Piedmont likely shares some of the blame here, as hospital groups have pressured prices upwards for years—and though for-profit hospitals are much worse on this, non-profit hospitals like Piedmont are hardly saints when it comes to pricing. But according to Piedmont, BCBS had offered a zero percent increase in physician payments over three years, which wouldn’t be in line with inflation or the rising cost of living.

About 600,000 state employees, including employees of the University of Georgia, are affected by this stalemate. Now, Gov. Nathan Deal has announced that Georgia will absorb all out-of-network costs for state employees and their families for the next 30 days. This is good news for those employees, who would otherwise have had to pay the much higher out-of-pocket costs associated with visiting out-of-network providers.

But it is ridiculous that Georgia is now just going to hand over money to BCBS, for however long the contract negotiations last (or, worse, for only the next 30 days), because of the insane way American healthcare is structured. Nothing about the actual cost of providing healthcare at Piedmont changed overnight from March 31 to April 1. Checkups didn’t suddenly cost twice as much. Bandages, as far as I know, cost the same. Yet the hospital now has to charge people more, because the insurer won’t reimburse as much, because they’re not in network. It’s an incredibly complicated system that makes no sense.

Anyway, wouldn’t it be great if, say, the government was already paying for everyone’s healthcare, and able to negotiate payment rates with hospitals on that basis, and didn’t have to fork over a bunch of money to an insurance company because of a contract dispute? Wouldn’t it be great if insurance companies were put out of business forever? Just a thought.