NY Times Favors State Calculation of “Usual & Customary” Charges – Pacific Research Institute

NY Times Favors State Calculation of “Usual & Customary” Charges

My confidence always rises when the New York Times editorializes from the opposite side of an issue than I occupy. How pleased I was, then, when the editorial board cheered NY attorney-general Andrew Cuomo’s “settlement” (of course, I prefer “shakedown”) of Ingenix, a UnitedHealth Group subsidiary that compiles proprietary databases, which contain estimates of “usual & customary” fees that physicians charge. Ingenix sells these data to health plans, which use the estimated “usual & customary” charges to decide appropriate payments for out-of-network physicians.

A year ago, Mr. Cuomo decided to carry organized medicine’s water by accusing Ingenix of low-balling these estimates, to the detriment of physicians. As I’ve written, the incentive to do so certainly exists. I’ve also noted that organized medicine (and Mr. Cuomo) have attacked the symptom, but not the cause, of malformed physicians’ fees.

Ingenix has caved in, and will abandon this line of business. Some of its settlement will go to seed-funding for an independent, non-profit competitor to create and provide similar databases.

The NY Times’ editorial board (which undoubtedly has better contacts with Mr. Cuomo’s office than I do) informs us that the non-profit competitor might be part of a “university-level school of public health”.

This really set off my alarm bells, because it lays the groundwork for government to fix all medical prices, not just those for Medicare or Medicaid.

Don’t you just know that most public-health scholars would kill or die to have the exclusive power to set prices for a government-monopoly health care “system”, either in the Empire State or the United States.

And whom will the doctors sue for their fees, when the state is both judge and defendant?

Nothing contained in this blog is to be construed as necessarily reflecting the views of the Pacific Research Institute or as an attempt to thwart or aid the passage of any legislation.

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