Unraveling Health Care – Part 1


By Michael Douglas Carlin


For many years Republicans have been threatening to repeal Obamacare aka The Affordable Care Act. One of the campaign promises of President Trump was that he would repeal and replace this health care bill. He said that this would be easy and that Americans would get something better at a fraction of the cost. Every effort to make good on these promises has been stalled and the effort appears to be impossible to achieve. Keep in mind that Republicans now control the House, the Senate, and the Presidency so if a Congressional Bill was created that did what all of these elected leaders had been promising it would sail into law.


The flaws in the Affordable Care Act are beginning to show. Rates in many states have risen to record numbers and many insurers have pulled out of these markets limiting the choices. 75% of the insurance market is controlled by five or fewer companies in 34 states and in Alabama one company controls 90% of the market. Why are we at this impasse and what can we do to unravel the roadblock?


None of the answers are easy. Lobbyists in D.C. continue to fund candidates on both sides of the aisle. Many of them represent powerful special interests that have their agendas that polarize and prevent a comprehensive solution.


Where did we go so wrong? Could it be the federal policy led us to this important intersection? The Federal Government pays more to hospitals than private practitioners.[1] By paying more to institutions, private practices have been folding into hospitals at a record rate providing fewer options and skyrocketing prices. Patients in rural areas are more affected than those in bigger cities. The hospital in Bozeman Montana puts non-compete language into their contracts to limit competition once a private practice is folded in. Here is an example of their non-compete clause: “Under the terms of this agreement, the Radiologists are forbidden from participating in joint venture operations for the technical component of any imaging joint venture, within a 50-mile radius of Bozeman, MT, and/or Gallatin County unless the Hospital participates and/or gives written permission for the Radiologists to participate in such venture.”[2]


In Los Angeles, there was a bitter feud between UCLA and Cedars that persisted for many years. Recently the hatchet was buried and a collaboration was born right here in Century City. The California Rehabilitation Institute was the end of competition and the beginning of cooperation. Now both medical organizations are expanding with satellite operations similar to the Bozeman Deaconess Hospital that recently opened in Belgrade and Big Sky.


One doctor in the Bozeman Deaconess Hospital family comments, ‘We have created a medical ecology based on overprescription and overconsumption on the part of both physicians and patients.’[3] Dr. Blair Erb merged his own private practice, “I feel defeated. We’ll try to retain as much professional independence as possible but the fact of the matter is, we’ll have a new master.”[4]


“Erb sees a big irony — that a flood of cardiologists feel forced to work for hospitals because of shrinking Medicare reimbursements, yet because Medicare pays hospitals more, the federal government will end up paying higher costs instead of saving money.”[5]


That is really the essence of the problem. Costs are out of control. A suit filed in U.S. District Court gives us some insights. The complaint sites lack of competition and a “decade long kickback scheme” and claims that BDH has a “monopoly on radiology services in Bozeman, Montana.” AMI was and is a sham joint venture created for the sole purpose of exchanging

cash for referrals, and maintaining BDH’s monopoly on radiology services in the Bozeman market.[6] The Hippocratic Oath to “first do no harm” makes non-compete language in our health care system unethical and there are challenges being brought in this suit that claims BDH created an illegal monopoly. In Bozeman costs are rising because of lack of competition.


So what does this mean for the future of health care? It is a tangled mess that needs desperately to be unraveled. This will certainly keep attorneys, in Century City and beyond, busy for the next decade as there seems to be no relief in sight. If you have comments on this article or would like to provide your own stories on health care, please send them along with supporting documents to MichaelDouglasCarlin@gmail.com


Century City News, Michael Douglas Carlin, Bozeman Hospital, Hippocratic Oath, Blair Erb, California Rehabilitation Institute,

[1] https://www.bozemandailychronicle.com/news/economy/there-s-a-doctor-in-the-house/article_92303900-a266-11e0-9f10-001cc4c002e0.html


[2] Non-compete language in Radiology Services Agreement with BDH.

[3] http://www.modernhealthcare.com/article/20130223/MAGAZINE/302239995


[4] http://freelancemd.com/blog/2011/3/5/the-disappearing-independent-physician.html


[5] https://www.bozemandailychronicle.com/news/economy/there-s-a-doctor-in-the-house/article_92303900-a266-11e0-9f10-001cc4c002e0.html



[6] Case 2:15-cv-00080-SEH Document 1 Filed 12/11/15



For more detail – http://centurycity.news/unraveling-health-care-part-p1035-181.htm




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