Playing the blame game

Whose fault is it for damaging the U.S. healthcare system?

By Peter J. McDonnell, MD


Our mother possessed the patience of a saint, but that never stopped my five sisters and me, when we were youngsters, from doing our best to test the limits of that patience. And limits there were.

While my mother was very pretty, she had also grown up on a farm and was physically quite strong. It didn’t happen often, but if we started fighting and throwing things and one of my mother’s prized possessions ended up damaged or broken, we all knew there was a reasonable chance she would apply that strength to the bottoms of her little miscreants.

For reasons that escape me at this time in life, my sisters and I often felt it was incumbent upon us to deny the ultimate responsibility for the misbehavior and instead lay the blame at the feet of a sibling.

“She started it,” I might yell, pointing at my sister. “No, he did!” she would exclaim.



‘Just stop it!’

For some reason, my mother never found this blame game very engaging. She wasn’t interested in learning who had incited the latest episode of bad behavior. She just demanded that it stop.

I was reminded of this childhood blame game when reading about congressional hearings on the topic of consolidation in the healthcare industry. Under the leadership of Chairman Robert Goodlatte (R-VA), the House Judiciary Committee has conducted hearings looking for ways to foster competition in the health care marketplace. Members of this committee have expressed concern with the possible anti-competitive implications of consolidation in both the hospital and insurance markets. 

In a September meeting, witnesses representing the various players offered their perspectives. Rick Pollack, president and CEO of the American Hospital Association, defending the dramatic expansion of hospital mergers as a necessary response, cited his grave concern about the recent merger and acquisition deals in the insurance industry that “would eliminate two of the largest national health insurance companies, leaving just three dominant providers of health insurance.” (“She started it!”) 

Au contraire, opined Dan T. Durham, executive vice president of policy and regulatory affairs for the America’s Health Insurance Plans (AHIP). This gentleman asserted that patients would benefit from the consolidation in the insurance industry, which would reduce costs.



‘He did it!’

Durham maintains that the real problem is hospital consolidation, which he interprets as an effort to garner greater market share to the point where insurers wouldn’t have any option but to pay what large hospital groups demand.  According to this view, insurance industry consolidation is not only a good thing in and of itself, but a logical response to the hospitals’ getting together in an effort to increase their pricing power. (“No, he did!”)

In yet a third perspective, Barbara L. McAneny, MD, a trustee of the American Medical Association, declared a pox on both their houses, if you will. This witness criticized both the hospital and insurance groups of anti-competitive activities, and argued that physicians (as well as patients) are at risk as a result. The mergers, she maintained, threatened “the health and safety of American patients.”  (“They both started it!”)

So whose fault is it? Who started this wave of consolidation in the healthcare industry? 

Your chief medical editor is thinking that it might not matter a great deal who started us down this road, but instead the question is whether, at the end of the road, we will reach a place where patients come first and the physician-patient relationship remains special. 

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