http://a257.g.akamaitech.net/7/257/2422/14mar20010800/edocket.access.gpo.gov/cfr_2001/janqtr/pdf/16cfr4.17.pdf

Lawyers stick together. The doctor must insist on an attempt to disqualify the biased FTC lawyer. His defense attorney will never consider this tactic, except under threat of legal malpractice claim by the doctor.

The biased FTC lawyer is the source of his income. Why on earth would the defense attorney want to do anything that would even upset him? Perhaps, they are even friends.

This was an example of where the HMO system worked. When I was diagnosed I was a young pup making probably $22K a year. If I hadn’t been covered I would have almost certainly declared bankruptcy and the doctors would have gotten nothing. That time was also probably the height of the HMOs.

Since then I’ve seen every year the HMO out of pocket costs for the patient get higher and higher, the costs for the businesses for managed care plans get higher and higher and more employers dumping managed care plans because they cannot afford them.

Today my employer plan is a standard catastrophic plan and I pay all med costs up to a stop loss of $5K a year. (using preferred providers) There are preferred providers in the traditional plan but very few in my area, and we don’t use them for standard medical services (checkups, etc.) only for major surgical and such. Which effectively means in every year since going out from under the HMO and to the traditional plan I’ve paid 100% of all medical costs. Yet my payroll deductions for the traditional plan are so much lower than under the HMO that my yearly grand total out of pocket medical costs for services plus premiums are lower after employer contributions.

I have directly experienced the best and the worst of the managed health care providers and clearly, if for me, an ex cancer patient, a traditional plan not using preferred providers is today cheaper than a managed plan using preferred providers, then managed care is in my opinion, effectively dead. Most likely most employers and employees under an existing employer paid HMO have not yet run the numbers and realized today that they would get a better financial deal under a traditional plan.

Now, we all presumably know that the only incentive a 3rd party payer has to get a physican group to even consider signing a contract with them is the referrals they would get for being on the preferred provider list. What I am guessing though, is that if a physicians group were to take the revolutionary step of simply not contracting with any 3rd party payer at all for any listing as a preferred provider, and instead take the money they are spending on a billing coordinator to fight with insurance companies all day long and instead spend it on a patient analyst who could help patients to analyse their total medical costs and come up with payment plans on a non-managed insurance plan, that these groups might find themselves making no less money than dealing with the preferred provider system. I wonder if the day of the preferred provider contracts is drawing to a close.

There is no question that today, if I was diagnosed with cancer, I would pay $5K instead of $1.5K for treatment. But so what? The total cost would probably be more like $300K, the HMO would write off 50% and I probably would end up paying more like $3-$4K in nickle and dime charges under the HMO anyhow.

I realize what the FTC is doing with the physicians groups is wrong. But, nobody is holding a gun to anyone’s head and telling them they have to become a doctor. The doctors can simply ignore any contract overtures by any 3rd party payers and be done with it. In my area there’s already a large number of doctors that don’t take medicaid patients, the usual statement they make is “we are not accepting new medicaid patients” and there’s also some doctors that are not on any preferred provider lists on any insurance company, they will only bill your insurance company their rate, and you pay the difference. So my take on it is that the FTC sees all this coming and is fighting a losing battle to hold on to what they got. I’m just glad for now I’m not anywhere near old enough to have to depend on Medicade, it sure looks like the makings of a giant crash and burn for that program.