By: Alex Wawro
Posted: 4/9/08
If you have health insurance you ought to know what "balance billing" is. Balance billing and the ongoing attempts to outlaw it directly determine how much you pay for medical services.Typically, if you have medical insurance (say, Kaiser Permanente), your provider will pay any medical fees above your standard co-payment. If Kaiser, however, only pays a standard allotment of $500 for a service a physician would normally charge $750 for (say, an emergency cardiac bypass), the doctor or hospital might send the patient a bill for the missing $250.
What this means for the average consumer is that not only do they have to pay their co-payment, they may receive a second bill for the remaining amount the insurance chose not to pay. Governor Arnold Schwarzenegger supports a bill that would outlaw balance billing.
The less money you have to pay the better, right?
Wrong. The legislation is blatantly unjust; worse, it undermines the foundation of free enterprise that our economy is built upon.
Think about it - when you sign up with an HMO like Kaiser, you agree to pay a standard fee monthly in exchange for a guarantee of financial aid if you need serious medical care.
In return, Kaiser receives monthly income and negotiates flat rates for services with a pool of physicians; those physicians give up the right to charge their own price in exchange for guaranteed business from Kaiser customers.
But if you, as a Kaiser customer, are brought to the ER for emergency surgery, there are no guarantees that the surgeon working is a Kaiser-approved doctor. If that surgeon saves your life, should he or she be forced to accept whatever percentage of the standard rate Kaiser chooses to pay him or her for the service? He does not receive the benefits of being a member of the Kaiser family; why should he be forced to abide by their restrictions?
Essentially, passing this bill destroys the basis of our capitalist economy in favor of a more socialist system in which the government regulates our freedom to spend and charge what we think is fair. By eliminating the practice of balance billing, Schwarzenegger forces all doctors to accept whatever healthcare providers think is fair payment.
Even worse, it makes the entire system of licensed physicians meaningless. A doctor who agrees to accept Kaiser's rates does so in exchange for receiving more business from the company. In essence, what he loses in individual sales he more than makes up for in volume.
If all physicians are limited to collecting only what Kaiser chooses to pay, why bother contracting with doctors in the first place?
Kaiser can pay a doctor whatever they believe they can get away with, and the physician has no choice but to take what he is given.
By removing a practitioner's ability to charge what he thinks is adequate for his services the government is sullying the principles on which this country was founded.
Though this legislation seems to benefit the consumer, in the end only the corporation wins.
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