Editor’s note: This commentary is by David Weissgold, a physician in a community-based, small, independent vitreoretinal practice in South Burlington.
In his commentary, Dr. John Brumsted claims the UVM Health Network “is bringing care where it is needed and reducing duplication to ensure it is more affordable.”
Unfortunately, “reducing duplication,” which in this case seems to be code words for reducing competition, makes nothing more affordable, and only increases prices, as studies in health care have shown time and again. In closing, Brumsted stated, “The plain truth is that we must innovate to preserve access to high quality, affordable health care delivered as close to home as possible.”
The plain truth?
The plain truth is that there are hazards lurking in the current push for increasing consolidation that is ongoing in our medical marketplace. There are myriad studies and well-researched investigative reports, just in recent years, that demonstrate that costs are higher in health care markets when there is no competition. It’s not a hard concept to grasp: Relative monopoly drives up prices. Lack of competition denies large organizations the impetus they need to rein in administrative and other costs. Such large, monopolistic organizations – in health care and all other market sectors – are left with no urgency to control costs, to keep unnecessary spending in check, or to improve the patient experience for customers with no other options. These large systems see their budgets grow, year after year, and eventually they become “too big to fail.”
In April, Health Affairs published a study in which researchers from Harvard, Princeton and elsewhere explained that they had determined, through careful study and data analysis, that health care insurance premiums were highest in U.S. communities with the greatest degrees of “consolidation” of providers. Just weeks ago, commentators in Forbes Magazine concurred, reminding us that consolidation has been an unintended negative consequence from the Affordable Care Act. Also in recent weeks, in a New York Times opinion piece, “That Beloved Hospital? It’s Driving Up Health Care Costs,” Dr. Elizabeth Rosenthal, editor-in-chief of Kaiser Health News, explains much of the same, referencing reports from the Rand Corporation and Yale and other universities.
In 2016, MVP Healthcare, one of only two commercial insurers offering products to consumers on Vermont’s open market, told Vermont’s Senate and House joint Health Care Reform Oversight Committee that our local university medical center was the single most expensive one in their entire network. Really? Care is worth more here than it is in Buffalo, Rochester, Syracuse and Albany? What’s different about our community than these others? One thing: the high degree of consolidation and utter lack of competition in ours.
For more on the value of having independent providers around, see Dr. Bob Kocher’s piece in the Wall Street Journal, in 2016 title “How I Was Wrong About ObamaCare.” There he frankly admits that “… published research … has indicated that savings and quality improvement are generated much more often by independent primary-care doctors than by large hospital-centric health systems.” Notably, Kocher was the only physician on the Obama administration’s National Economic Council advising the White House on health care policy.
We are fortunate to have a great local tertiary care medical center in the University of Vermont Medical Center, staffed by outstanding, caring, hard-working physicians, nurses, technicians, and so many others who give of themselves for all of us. But the road we’re on, one where consolidation is barreling ever closer towards Vermont having one behemoth single provider, is beyond worrisome. Vermonters deserve choices in health care and we, as a state, ought to prioritize making sure that Vermonters have them. It has been proven time and again in published studies that consolidation/monopoly in health care literally costs us all.
