When the Montefiore Health System took over St. Luke’s Cornwall hospital, it brought benefits, as those on both sides were happy to feature, and some complications.
One of those is on display now in the contract impasse between Montifiore and Aetna insurance which could have a detrimental effect on local patients. Unless the two sides settle by the time the contract expires on Sept. 8, local patients covered by Aetna, including that company’s Medicare health plans, could be facing much higher bills as local doctors and hospitals become officially out-of-network providers.
Patients who do not want or cannot afford such higher payments would have two other choices. They could get different insurance, if they could find it and afford it, which would pay the doctors, clinics and hospitals they use. Or they could find other doctors, clinics or hospitals elsewhere which still have a contract with Aetna.
Neither side wants to cause such anxiety and disruption, lending pressure on them to settle. For now, however, they do not sound like two sides with much of a desire to find common ground.
Aetna says that Montefiore is greedy, trying to increase what it says are “already substantial profit margins.” That sounds convincing. Why should a hospital make a big profit from people most often not in a position to bargain or shop around?
But the other side is just as compelling.
The rates Aetna proposes would “not appropriately pay for the care we provide,” Montefiore says, so patients would have to pay even more than they do now or find new doctors.
See. Both sides only care about the patients, or so they would have you believe. But there are nations where that is the case, those with a single-payer system. So while there is always a lot to talk about when it comes to health care, this local impasse provides a clear example of the built-in limitations in the way we provide and pay for this essential commodity, limitations that do not help patients.
Any report of health care outcomes, from low weight births to obesity to patient satisfaction, routinely ranks the United States last when compared to other industrial nations with one exception — cost. We pay much more per person than do people in those other countries because we are the only one that relies on a pay-for-service model. While most others have that available, they do not rely on it for the majority of their citizens’ health care needs.
Yet it is hard to have a meaningful, fact-based discussion, something we need as New York considers a statewide single-payer plan, when so much information is so distorted. Just last week Trish Regan on the Fox Business Network lambasted Denmark as a socialist nightmare, comparable to Venezuela. She got almost everything wrong, especially when it comes to health care. Danes pay less and are healthier. Those who watch only Fox will never know.
In the meantime, local patients watch and worry and hope that this local business clash, something that does not take place in other civilized nations, gets settled before it affects their health care.