Supporters of consumer-directed health care have privately told me that I have been too hard on doctors and too accomodating to the health insurers.  This has been in response to my posts on health plans ranking doctors' quality and NY Attorney-General Andrew Cuomo's opposition to it.

I had hoped that Mr. Cuomo's deal with the Empire State's health plans might let me off the hook: I sure don't want to be remembered as the insurers' sweetheart.  Unfortunately, the New York Times has editorialized in favor of the arrangement, and Consumers Union and AARP also support it.  Now, to be fair, support from these august liberal bodies does not necessarily mean that a proposal is wrong, but it's a pretty good signal.  Let's recap: 

Basically, NY's physicians had gotten riled up that health plans' "quality" rankings would recommend physicians to patients based on cost, not quality at all.  This got Mr. Cuomo's attention and he blustered that he would stomp all over health plans who publicly ranked doctors - even though no rankings were actually taking place, and it wasn't clear how such rankings would be illegal.

Many health plans quickly fell into line, submitting to Mr. Cuomo's demand for a standard ranking method that, it appears, is unlikely to offend any doctors.  On the other hand, it's unlikely to divulge any information of value to patients, either.  Albany's legislators quickly agreed to pass a bill incorporating Mr. Cuomo's demands, as well as those of doctors' lobbyists and self-styled "consumer" groups.

There is one positive condition in the agreement: health plans can pool information on doctors so that each plan will not base its rankings on selective data.  However, my understanding of the federal McCarran-Ferguson Act is that it already permits insurers to pool claims information, so Mr. Cuomo's "safe harbor" provision is not very useful.

On the other hand, the agreement is likely to result in a sclerotic, unresponsive, and monolithic physician ranking "system" for New York.  For example, physicians hold an effective veto over the rankings: plans must submit changes to physicians 45 days before making a change, and cannot change a physician's rank if the physician appeals the change.  Perhaps even worse, insurers must submit to a "Ratings Examiner" ("Rx", which is a confusing acronym because it also symbolizes a prescription), who is paid by them but answerable to the attorney-general.

The agreement has room for a lot of "gotchas" if the A.-G. decides to go after the health plans.  Interestingly, the health plans agree not to act against the A.-G. if he does something they think violates the agreement, but the A.-G. reserves the right to act against the health plans, agreement notwithstanding.

Why did the health plans cave in so quickly?  One is forced to consider the possibility that the originally proposed health rankings were the result of the market telling NY's insurers to compete on quality.  (As I noted in previous posts, patients do not trust health plans' rankings today, so for plans to launch significant new investments in publishing rankings must indicate that they think that they have to shape up in order to thrive.)

By buying in to Mr. Cuomo's "standard" they (might) implicitly collude to forestall this competition because they can claim that to do anything more than what the new law demands will risk litigation by the "Cuomortician".

So, despite Mr. Cuomo's antagonistic stance, the result of his interfering in health plans' ranking physician quality is more likely to result in a comfortable life for physicians and health plans alike.......Not what the patient ordered, I'm afraid.