I just finished my third year as a panelist on a healthcare policy day for a local leadership training group. I continue to be impressed that they bring me back. Each year I’m teamed with an insurance professional, hospital administrator, payor or pharma executive. The panels view of the the healthcare market, the problems and solutions couldn’t be farther apart. The debates are lively and the audience of 40+ people come from all backgrounds and political philosophies.

I represent the independent medical doctor and their unique challenges in American healthcare.  As insurance companies merge, hospitals get ever larger and piles of regulations come out of Washington DC, it’s the small family doctor that is getting squeezed.  The consequences of less and less competition for healthcare services comes more concentrated power. With more buying power comes higher prices.  Basic economics.

The boogie man in healthcare in the 1990’s was the evil insurance companies and their HMO’s. Today, the hospitals have taken up the mantle of Goliath and they are merging and buying their way to market dominance, city by city.  As the hospital grows, their ability to dictate every higher prices from insurance companies grows as well.  Through the Affordable Care Act, insurance companies have been turned into highly regulated utilities similar to your local electric or gas company. The government dictates who the insurance company must take, what they can rate their policies on and how much of the premiums have to be spent on services.  In highly regulated markets, the bigger survive because they can afford the layers and layers of systems and people to manage the complexity. The losers are independent doctor groups and in the case of banking and finance, the local community banks. (more…)