We have tons of conversation in this country about whether we should have a single payer health system. Sometimes we talk about Medicare for all, sometimes it’s a pure single payer system. In my opinion either one is fine. It’s just a method of paying for our health insurance.
What about a single provider?
There is almost no press on this issue. In Vermont, it’s becoming a bigger and bigger issue. For all intents and purposes we have two providers of health services in the State. We have Fletcher Allen in Northern Vermont and Dartmouth Hitchcock in Central and Southern Vermont. In some specialties, the only provider is one from the large health care system.
You might be asking yourself what’s the big deal about this? Well, as we all know when there’s only one choice of service provider, service often becomes worse. The provider might become arrogant. The provider might decide that it’s OK to have a backlog of months instead of weeks to see a provider.
Both have been true with my recent experience with the Fletcher Allen system. For me, it really doesn’t matter how the bills get paid, it matters how many providers there are and if there is any competition for my business.
We tend to focus on the wrong things.
There has been a concerted effort on the part of large health care systems to starve out the smaller private competitors. My Oncologist tells me that he gets a reimbursement rate that is 40% less for the same services that Fletcher Allen gets in their infusion clinic. I’m told that this is the norm.
When I made a public complaint out of this, I got a message saying that the reason the reimbursement was so much higher was because of indigent patients. I can see it being somewhat higher, but 40%? Really? To me this seems a little high.
The reality is that private providers are being squeezed out.
Private providers of medical services are selling or just abandoning their practices and becoming employees of the large health care systems. I recognize that many of these providers don’t want to be in their own business and are just as happy as employees. At the same time, there are many practitioners that just can’t afford to keep their doors open anymore.
This is not the free enterprise system at work. This is having an unfair reimbursement system. Those who want to be in their own businesses and have their own practices are finding they can’t afford to do so.
The more we allow this practice to continue, the worse our care will get. When there is no competition, you can be sure your service levels will be reduced. I don’t know about you, but I’m not looking forward to the day when we have no choice for medical service.
Next time you get yourself into a conversation about a single payer medical system ask what about a single provider. Isn’t that a bigger problem? What do you think?