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Future of Cost Shifting Depends on the Little Guy
I once thought that healthcare cost-shifting behavior would die a quick death as employers developed more sophisticated ways to value quality. I'm no longer so sure.
When one customer says I'll only pay half of what everyone else pays (with no ability to negotiate), you either reject it and don't take him as a customer; or you accept it, and shift the burden you have to achieve positive margins onto higher paying customers. While the hospitals share some blame with their high cost structure, the government with their money-losing reimbursement structure is the main culprit. Healthcare will look very different as hospitals adjust to the ever-declining reimbursement rates of the future.
Cost shifting is just an excuse for hospitals to gouge vulnerable small employers and individuals. Health plans also take advantage of this segment by preventing formation of health insurance purchasing groups. As James Carville explained a dog's unusual trait "they do it because they can!"