Of course, health plans were eager to defend their territory. "Competition is vigorous among health plans across the country," America's Health Insurance Plans (AHIP) Press Secretary Robert Zirkelbach told HealthLeaders. "They operate in highly competitive markets in which consumers have numerous choices among plan types and insurers."
While stopping short of calling the report erroneous, AHIP pointed out that a former Department of Justice staff economist who analyzed last year's study concluded that AMA's accuracy and reliability could be called into question. "For example, the AMA data exclude some types of self-funded plans, a large and growing portion of the market, and show significantly higher market concentration than data available from NAIC," according to Zirkelbach.
He went one step further stating that in many markets, provider consolidation is a significant factor contributing to rising healthcare costs, citing research indicating that states often cited as examples of high market concentration actually have some of the lowest premiums in the nation.
As an industry observer, I'm left scratching my head as to who's story to believe. Turns out they're both right. Buried deeper in AMA's research about the lack of insurer competition is the fact that small physician practices are really the ones bearing the scars from contract negotiations. But considering the constant downward pressure on Medicare reimbursements, it's a bit unfair to health plans as the ultimate unruly enforcer.
That still doesn't answer the question of who's responsible for painfully high healthcare costs. Judging by what each side has to say, perhaps both should share the blame along with John Q. Public who doesn't take nearly as good enough care of himself as he should.