Attorney-General Cuomo's Attack on Health Plans is Unprovoked & Frivolous

There's nothing new about state attorneys-general going on fishing expeditions (at taxpayers' expense) to find fertilizer for their trial lawyer buddies, but New York AG Andrew M. Cuomo threatens to outdo even his predecessor, current Governor Elliot Spitzer, with today's challenge to health plans' ranking doctors by quality indicators.

Not that insurers are actually doing any ranking yet, but they intend to, and that's enough to put Mr. Cuomo in motion, demanding that they disclose their plans to him within 48 hours.  His fear? That plans won't actually rank doctors by quality, but simply promote those who cost less.

Meanwhile, across the state line, Connecticut doctors' lawsuit against plans' rankings claims "defamation", although (as in New York) no rankings have yet been published!  Of course, doctors are quite happy to see the health plans ranked on promptness of payment, but (as so often happens in American health care), what's good for the goose ain't good for the gander.

What are they worried about anyway? People do not trust their health plans, which rank below tobacco companies in HarrisInteractive polls.  Unless health plans do something to turn around their plummetting status, nobody will pay attention to their rankings.  If plans try to force them on us, we will rebel, like we turned on HMOs at the turn of the millenium.  On the other hand, people do invest doctors with high prestige.  There is nothing (except a natural instinct for collusion) that prevents the medical profession from ranking its own members.

In any case, this urge to rank doctors like singers on American Idol is overblown: if we were free to choose doctors and "rank" them by paying them freely negotiated rates, most of us would rely on word of mouth from friends and colleagues in our neighborhoods.  Nevertheless, if health plans rank doctors, or doctors rank health plans, or nurses rank hospitals, or patient advocacy groups rank drug-makers, or wheelchair manufacturers rank tire-makers, who am I (or anyone else), to forbid it?

Which brings us back to Mr. Cuomo. New York ranks dead last in health ownership, according to the recently published U.S.Index of Health Ownership.  The Empire State "suffers from government-health care programs that are out of control, a grossly over-regulated private insurance market, and almost completely uncompetitive provider markets" according the Index' insightful author (me).  None of this is due to health plans' ranking doctors or not.  When it comes to improving health care in New York, the AG and other politicians in Albany have much bigger fish to fry.