Soapbox

Don’t blame doctors for ‘surprise’ bills

A laptop screen shows the HealthCare.gov website, where people can buy health insurance.
A laptop screen shows the HealthCare.gov website, where people can buy health insurance. The Associated Press

Assembly Bill 72 offers a misguided solution to the real, yet misconstrued, problem of “surprise” medical bills.

The legislation is based on biased data that are devoid of hard facts, such as insurance claims paid. Yet advocates use this data to justify an attack on doctors’ income rather than focusing on insurers increasingly shifting costs to patients.

What is more problematic about AB 72, authored by Assemblyman Rob Bonta, an Oakland Democrat, is the lack of precedent. No state has imposed a payment cap on doctors in laws to address this issue. That makes me question why this approach has been chosen and whether this mandate is legal.

The very act of mandating a cap on what a private physician charges a private insurer could represent a restriction on trade and an antitrust violation. It certainly moves doctors closer toward being thought of as a utility subject to regulation, but without government subsidies that utilities enjoy. Physicians’ lack of ability to negotiate fairly and collectively with insurers will have to change.

Under AB 72, insurers will have no incentive to keep high-reimbursement contracts with providers such as the University of California health system. We have seen how insurers and managed care plans seek profits by canceling plans on Obamacare health exchanges, closing offices and limiting provider networks.

If AB 72 becomes law, insurers will drop every contract that reimburses above the mandated cap. Every provider will have their fees fixed without being able to collectively bargain with insurers. Ultimately, patients will be hurt by doctor shortages and insurer cost shifting.

The business of health care is changing in California. It must, as costs and access are still serious issues. But it cannot happen by decree of this bill. It must happen by thoughtful analysis, agreement and negotiation.

Eileen Natuzzi is a public health doctor and surgeon in San Diego County. She can be contacted at esnmd@mac.com.

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