Philadelphia Personal Injury Attorney Blog | Pomerantz Perlberger & Lewis LLP

In a statement that outlines five basic principles and attendant proposals for reforming the health care system, the American Health Insurance Plans (AHIP) proposed a set of reforms that it claims could reduce health care costs by $145 billion per year.

The Good

On the good side, are the following:

Proposal 1: Access to information that compares the effectiveness and cost of treatments

Proposal 2: Encourage widespread adoption of tools such as electronic health records, personal health records, secure e-visits, and e-prescribing.

Proposal 5: Enhanced disease management, care coordination, and prevention programs.

All three of these proposals will likely lead to better quality care at a lower price for patients. By streamlining information and promoting preventive care, the medical system can move forward in making everyone healthier for lower costs. In particular, though, it is the insurance companies themselves, with their use of deductibles for even routine care in many cases, that are the main obstacle to the implementation of Proposal 5.

The Bad

On the other hand, I feel that this is a bad idea:

Proposal 4: Build health care reform around quality improvement by rewarding safety, value, and effectiveness.

What could possibly be wrong with that, you may ask? It seems like doctors ought to be paid for providing safe, effective care. However, what insurance companies mean when they say this is that doctors should be rewarded for costing less in providing standardized, unremarkable care at a low cost. As part of the insurance company's rationale in pay-for-performance policies, insurance companies make doctors justify every deviation from standard practices, practices which often do not acknowledge the full diversity of cases that are nominally the same. The source for categorizing injuries and describing treatments would most likely be the insurance companies' own databases, which they currently use to attempt to low-ball settlements on soft-tissue injuries and have been found to be inaccurate in court cases in Colorado, Kentucky, and other states. Among other things, this kind of centralized medicine database makes patients even more vulnerable to pharmaceutical force-outs, in which a pharmaceutical company can sell an insurance company on a new treatment, which then gets written into the standard guidelines without adequate review.

The Ugly

This proposal is definitely an ugly one:

Proposal 3: Replace the current medical liability system with a dispute resolution process consisting of an objective, independent administrative process to provide quick and fair resolution to disputes while promoting evidence-based medicine.

Whenever a big corporation starts talking about "objectivity" and "independent" processes, you can guarantee they're looking for something they can manipulate. In this case, they are referring to substituting the independent courts with an arbitration system for medical malpractice, something like what is used for the resolution of credit card debt disputes, in which credit card companies win over 99 percent of the time. From 2003 to 2007, the National Arbitration Forum never ruled against a credit card company suing a California customer, and there are reports of judges forced to quit for deciding in favor of the customer.

For a Few Dollars More

With record profits coming in from higher premiums and lower payouts, it looks like health insurance companies are afraid that national health care reform will dry up their cash cow, and they are hoping to substitute their own reform proposals for ones that act in your favor.

If you are going up against an insurance company, you cannot face it alone. You need the help of a lawyer. If you have suffered as a result of a doctor's error, contact the experienced medical malpractice attorneys at Pomerantz, Perlberger, and Lewis, LLP today for a free consultation and case evaluation.