Abdul El-Sayed — Abdul Breaks Down the Conflict between Blue Cross Blue Shield and Michigan Medicine

Hey friends, Abdul here. I wanted to explain some of what you've been hearing about this conflict between Blue Cross Blue Shield of Michigan and Michigan Medicine. It might end up that by July 250,000 Michiganders will be without health care, having to find new doctors, in large part because the University of Michigan and Blue Cross Blue Shield cannot agree on reimbursement rates. I want to break this down and explain why it's happening and what it tells us about what we need for the future. It's happening because we've seen massive mergers and acquisitions and consolidation in the health care space. Health care systems buying each other up and then negotiating deals with insurers, Blue Cross Blue Shield of Michigan. Now, the University of Michigan, of course, is a health care system run by a university. These kinds of health care systems, academic medical centers, are often subsidized by NIH grants. But, with the Trump administration and the general gutting of NIH grants, the University of Michigan has had to figure out how to get the level of reimbursement that they can get for the medical care that they provide up to make up for the loss in grant funding. Now, for a long time, Michigan Medicine was willing to take lower reimbursements because, of course, they had NIH grants running. Now, that's not the case. And so, they've required Blue Cross Blue Shield to pony up and reimburse them at a rate that is actually consistent with the quality and the health care that they offer. But, Blue Cross Blue Shield has decided, like all insurance companies, that their bottom line is more important than the sustainability of the business that they run. So, now there's a game of chicken Michigan Medicine and Blue Cross Blue Shield. There's a couple of pieces to this story that I really want to highlight. Number one, NIH grants really, really matter. They helped to subsidize the health care in regions like ours all over the country. And when you cut them, there are downstream implications for the health care people get. Number two, Blue Cross Blue Shield, like all other insurance companies, they're focused on their bottom line. They're not that interested in whether or not 250,000 people lose their health care, they're interested in making sure that they can make money off of health care. And so, for them, this is just a matter of doing business, even though for the rest of us, it's a matter of whether or not we're going to be able to get the health care that we need when we need it. And then, there's the question of mergers and acquisitions, consolidation more generally. The larger our health care systems become, the more important the implications of these sweetheart negotiations by which reimbursement rates get decided. And in this particular case, you're talking about 250,000 people who rely on their health care from Michigan Medicine and are insured by Blue Cross Blue Shield. And they're liable to lose their health care. And as these mergers and acquisitions continue and health care systems get bigger, the stakes of these negotiations between health insurers and health care providers just get bigger and the costs, should they not be able to make a deal, get that much more profound. So, how do we fix it? Well, number one, I don't believe we need private health insurance companies to have this much power in our system. I believe in Medicare for all to guarantee every single person cradle-to-grave coverage without premiums, co-pays, and deductibles. What that would mean is that no matter who you are, you can get health care where you need it without having to worry about whether or not there's a war between your health insurer and your health care provider. But number two, we need the Federal Trade Commission to step up and start enforcing against the mergers and acquisitions that have created these high-stakes negotiations and to require, in situations like this, that when they cannot come to a negotiation deal, I think the federal government has to be able to step in and force it to happen. We've seen these kinds of march-in opportunities in other industries that are critical to the public good, like being able to provide health care, which I'd argue is critical to the public good. So, I'm daring the Trump administration or the state to march in and require these two to figure out their stuff to make sure that 250,000 people don't lose their health insurance by this July. And so, if you're listening, FTC, if you're listening, CMS, if you're listening, state of Michigan, this might be the opportunity to step up and force these two parties who are more focused on their bottom line than they are focused on their patients to come to the table, negotiate in good faith, and make sure people get the health care that