Children’s Hospital – Blue Cross dispute spills into public view

Theoretically, the supporters of taking health care away from 22 million Americans — as the Congressional Budget Office predicts the U.S. Senate health insurance bill will — shouldn’t be too bothered by today’s full-page ads in the Star Tribune that warn a dispute between an insurer and Children’s Hospital threatens health care for kids.

Blue Cross Blue Shield’s contract negotiations with the hospital are stalled, the Star Tribune reports. If an agreement can’t be reached by July 5, care at the hospital would be considered out-of-network, with all the additional expenses for patients that entails.

The higher rates will force many of the patients to switch doctors or hospitals. Children’s Minnesota says it has identified more than 6,000 children whose needs are especially acute and who the hospital believes could not get the same level of care elsewhere.

Although Blue Cross says it’s working to make sure those patients get an in-network doctor, Children’s Minnesota pediatrics chief Dr. Gigi Chawla said at a news conference Monday that it was “simply implausible” that other hospital systems could provide the same level of care.

Blue Cross, meanwhile, said that Children’s Minnesota provided it with a list of about 3,700 eligible Blue Cross members with complex medical cases whose care should remain in-network; the insurer has agreed to approve continued treatment for each eligible Blue Cross member on that list.

Let’s ask the question that nobody seems to ask when the very idea of health care access is under assault: Who cares?

“The care we deliver saves lives,” the hospital says on a new website devoted to the contract dispute, standtallforsmall.org. “Blue Cross’ actions in this dispute threaten to price very sick children out of lifesaving care they need.”

So?

This dispute will get resolved somehow; they usually do. But it will be interesting nonetheless to see whether appeals to our humanity, if not morality, applies any pressure to a system — political and economic — that increasingly is willing to bet that it won’t.

Related: Amid health care debate, mother’s photo of Boston Children’s Hospital bill goes viral (Boston Globe)

  • MrE85

    Most of us agree, in theory, that people should have access to health care. If we are decent people, we put the health and well-being of our kids first.

    Where we disagree is how to pay for it. That’s really what most “health care” debates are all about. Who pays?

    We all care about kids health. We don’t all agree who should pay for it.

    • When you support the elimination of Medicaid, you’re not having a debate over how to pay for it.

      Like I suggested: This is a far deeper debate. This is a debate over whether we think there is a societal responsibility to provide it.

      //We all care about kids health. We don’t all agree who should pay for it.

      This is, simply, a myth.

      • MrE85

        You’re right, I wasn’t speaking on behalf of the White House or Congressional leadership. I meant decent, moral people.

        Unfortunately, I don’t think many Americans are even aware of what is happening. If it can’t be explained to them in simple, bumper sticker terms, they tune out.

        Anyone who has read one of Speaker Ryan’s “budgets” would have known this was coming, if the lunatics ever took over the asylum.

        They did.

        • Ralphy

          Health care, or lack of, is going to further the migration from rural America. When rural hospitals and clinics start closing, these small towns will lose a major employer and the economic power of all those workers and the area’s residents will have to drive 100 miles for care. And the death spiral of small America continues.

          • If and when that happens, maybe a few of those folks might not vote against their own self-interests.

          • Ralphy

            If only we could fit the story onto a bumper sticker…

          • “Don’t vote against your own self-interests!”

            Nah, too long and vague…

          • Ralphy

            “Pre-existing condition” is too long and too vague…

          • MrE85

            “Please kill us, Washington DC”

          • Ralphy

            I’m pro-death and I vote.

          • MrE85

            You win!

          • Ralphy

            I stole that from my all-time favorite bumper sticker:
            I’m pro-accordion and I vote!

            Saw that one maybe 8 years ago.

          • Rob

            Must have been Myron Floren’s car.

          • Rob

            “You get what you don’t pay for”

          • Barton

            “If and when that happens, maybe a few of those folks might not vote against their own self-interests.”

            Oh, I doubt that.

          • Yeah…but one can hope.

          • Rob

            Heard a very sobering story yesterday on All Things Considered about the impact that the Healthcare for None, Tax Cuts for Those Who Don’t Need Them Act would have on rural hospitals.

            My sister (one of the few Iowans who didn’t vote for T.Rump) and brother-in-law live in a small Iowa town, and I worry about the impact of Medicaid cuts on the hospital there. The closest hospital not in danger of closing due to such cuts is about an hour away.

          • That was a good story. Basically the era of rural hospitals is over.

          • AL287

            And the small towns that had them will eventually disappear swept up in the flood of tax cuts from which none of them will benefit.

    • Rob

      I would suggest that anyone who doesn’t see healthcare as a basic human right doesn’t care about kids’ health. And yes, that would require those who can afford to pay more in taxes to fund universal healthcare, to pay more.

      • jon

        Pay more?
        Right now the US spends more public funds on healthcare per capita than total funds spent on health care in the UK, and we have worse outcomes.

        Universal health care shouldn’t cost more, it should cost less over all.

        A more apt comparison might be the netherlands where they still have for profit insurance, and hospitals, and spend the same amount in public funds per capita as the US and far far less in private funds, and still get better outcomes…

        Something is sucking up money in the US that isn’t happening in the rest of the world… and fixing that is how we fix health care… and it starts with negotiating prices better, which the government programs in the US aren’t allowed to do.

        I work for a medical device company, and the best deal we give on our products is to the VA, and once they got a deal every one else wanted the same deal… when the VA negotiated with us it brought down prices everywhere in a few years, because no one wanted to pay more than our best price…

        • Rob

          I don’t contest the facts regarding healthcare expenditures being less overall in places that have universal healthcare; I’m aware of them. My only point is that in order to establish and fund such a system, it’s likely to cost some taxpayers more than others. Hence, those who can afford to pay more in taxes, will most likely end up paying more in taxes.

          • >>Hence, those who can afford to pay more in taxes, will most likely end up paying more in taxes<<

            As one of those who would most likely pay more in taxes for a Universal system, I say, "Bring it on!"

          • Ralphy

            When one nets out the personal increase in taxes with the reduction in health insurance cost and whatever subsidy their employer provides, if any, I suspect most people would find their net cost of living (healthy and well) would go down.

          • I try to explain this concept to people and usually get blank stares…

        • I love the people who have their health insurance through their employer yet are whining that their taxes will go up under a Universal Healthcare system…have they ever actually looked at their paychecks to see how much they already pay in premiums and how much their employers are kicking in?

          It’s mind boggling.

          • jon

            Yeah, but employers love paying for health care costs because it keeps employees locked in to their jobs.

            Of course that is what the GOP fears… people not working because they don’t have to, which would drive wages up and make companies less profitable for investors and executives.

            And there is some truth to it, paying $10k a year for health insurance will keep me from retiring early, I ran the numbers on my retirement account a while back… health care is the difference between retiring at 45 and retiring at 60.

            Of course changing the system isn’t all bad, driving up wages might bring people back to work and actually boost the economy by forcing some actual trickling down… but until the elected officials see it that way… not much to come from it.

          • >>Of course that is what the GOP fears… people not working because they don’t have to, which would drive wages up and make companies less profitable for investors and executives.<<

            People would still work and employers wouldn't have to subsidize health insurance to the tune of $18k+ / year.

            I can see more people starting their own small businesses, contracting, or
            freelancing, more if they didn't have to worry about staying in a particular job "for the healthcare" (Golden handcuffs anyone?)

          • jon

            You’ll get no rational argument from me.

            But it’s a fear… it doesn’t need to be rational.
            The idea is when people aren’t working it’s bad… idle hands and all…
            And works makes GDP go higher… (except that increasingly we see productivity going up while hours worked remains level… because automation…)
            And change is bad. (which is just a human fear in general)

            These are all of the underlying messages from the GOP.
            And the employers enjoy having the control in the employer/employee relationship… so they’ll keep the status quo for as long as they can.

  • Gary F

    Maybe you should change hospitals. Yes, not near as easy as going to a different barber or auto mechanic, but as difficult as it is, take you business elsewhere.

    The word gets out that people are leaving Childrens, that may change their attitude.

    • Ralphy

      Your comment assumes that the Blue Cross offer is equitable and that Childrens is being unreasonable and deserves to be punished.
      I’m interested how you got there.

      • Gary F

        It brings them back to the table. Somewhere there has to be an agreed on amount.

        What the story lacks is what is Allina/Fairview/Mayo getting paid by BCBS?

        • Gary F

          Children’s offers premium service, that’s what got them the great reputation. Is it better than Allina? Fairview? Mayo? I don’t know.

          What are those hospitals getting paid by BCBS? Its not covering costs either way.

          Sure, they can accept lower reimbursement, then expect more average service, like their competitors.

          • Veronica

            Dude. What?

            Do you have kids? Have you ever had to bring a severely dehydrated 2 year old boy to the ED for an IV? Or have your 3 year old have his tonsils out? Providing kind, capable care to kids does take a different set of skills. How is that bad? What parent would choose mediocre care for their kid?

            And again, as I pointed out above, it’s not that simple. Allina doesn’t have any of their own NICUs anymore.

          • Gary F

            At some point you are not going to get premium care if everyone has to work for 50% reimbursement. Children’s provides premium care and wants 25% more, and still under their costs.

            Just wait until single payer government run systems, “the rich” will get premium care, and everyone else will get just “OK” or crappy service.

          • jon

            What do you think the healthcare industry is like right now?

          • Ralphy

            On what basis do you stake the // …”OK” or crappy service claim?

          • Veronica

            What is this premium care you keep talking about? Explain, please.

          • >>Just wait until single payer government run systems, “the rich” will get premium care, and everyone else will get just “OK” or crappy service.<<

            Pretty sure that happens right now, except for the "everyone else" part seeing as there are still millions of uninsured folks out there.

            I think a move to get EVERYONE a baseline of "ok" service instead of "none" would be a good thing…

          • Rob

            Is this really you, or is it Mitch McConnell?

        • Veronica

          Fairview had the same fight with BCBS last year.

        • Ralphy

          It brings them back to the table by holding patient’s lives hostage.

    • These sorts of insurer contract negotiations are the case at every hospital these days as we saw earlier in Duluth and also at Fairview. You can’t outrun them.

    • Veronica

      It’s not that simple.

      There are at least 8 facilities where, if a baby is born and needs to go to the NICU, parents aren’t given any choice–their babies go to Children’s. Allina’s NICUs are ALL run by Children’s.

      Mom may be in network, but what a nightmare if a medically fragile baby ends up in a place that is out of network.

    • John O.

      One aspect to keep in mind is the specialized pediatric care they provide. Obviously, there are other possibilities (Amplatz Children’s at the U comes to mind).

      Our (now) 25-year-old son had to have specialized surgery when he was about 1 1/2 years old. They were the only provider who could do it back then. I suspect this may still be true today.

      • Gary F

        And they may not offer as many specialized programs if they are not reimbursed.

        • Ralphy

          I am confused. Are saying that their offering specialized programs is a bad thing?
          If one needs a specialized procedure, and no hospital offers it because the insurance company dropped coverage as part of negotiations with the hospital, then what?

    • John O.

      Good luck if you have a loved one with a rare condition or disease.

      My wife isn’t a bleeping ’62 Buick and I’m getting real tired of people looking at her as a drag on society instead of a person who WORKED HER ASS OFF FOR A LOT OF YEARS, PAID HER TAXES AND PREMIUMS AND THROUGH NO FAULT OF HER OWN ENDED UP WITH A WRETCHED DISEASE THAT NOW FORCES HER TO GOTO MAYO BECAUSE IT’S THE ONLY PLACE LEFT THAT CAN TREAT HER!

      /endrant

      • MrE85

        I think about you and your wife often these days. As always, I hope only the best for you two. I know it has been rough on you both.

        • John O.

          Things are going well right now. We’re taking advantage of these good days because we both know that there are bad stretches ahead too. One day at a time.

          And thank you.

  • Mike

    Funny how spending less on healthcare is an imperative for budgetary reasons, but the same constraints never apply to the Pentagon. I guess we love our empire more than our lives.

    American Special Ops Forces Have Deployed To 70% Of The World’s Countries in 2017
    https://www.thenation.com/article/american-special-ops-forces-have-deployed-to-70-percent-of-the-worlds-countries-in-2017/

    • Gary F

      And that stellar care that the VA is providing.

      • Ralphy

        The care is pretty good. The system is overwhelmed and under funded.

        • Gary F

          Miss managed, I know someone who works there. She says its a completely different mindset than when she worked for Fairview.

          • >>Miss managed, I know someone who works there.<<

            She works in one part of a clinic that may be "mismanaged" from her singular point of view, but by many accounts, the VA seems to be doing just fine for being underfunded and overwhelmed (as mentioned earlier in the thread).

          • Ralphy

            Miss managed.
            Is that some sort of pageant competition that Donald Trump used to operate?
            ( ;-b

      • >>And that stellar care that the VA is providing.<<

        …"the VA healthcare system has consistently out-performed the non-VA/private sector in quality of care and patient safety."

        …"the VA healthcare system has been a model for accountability."

        https://www.forbes.com/sites/harlankrumholz/2014/05/23/3-things-to-know-before-you-rush-to-judgment-about-va-health-system/#5377e35b55e4

        • Rob

          As my dad, a Korean War vet, could attest.

      • I assume you’re relaying something second hand because most everyone I’ve ever talked to who gets VA care says it’s very good.

      • jon

        My 91 year old grandfather was in town for a wedding last weekend, and was espousing how great he thought the VA care was, his meds are cheaper because of it, and he gets an appointment with a doctor every 6 months.

        His only complaint was he has to schedule the appointments 6 months out and can’t reschedule because they book up fast.

      • Angry Jonny

        My brother in law has been being treated for Leukemia he contracted in Vietnam by handling Agent Orange. The VA has been amazing.

        • KariBemidji

          Same with my dad. Damn Agent Orange. The VA in St. Cloud is letting him get his cancer care in Alexandria (2 miles from his house vs. 60 miles).

      • MrE85

        I may be using that system soon, which has taken care of many of my brothers and sisters quite well.

    • jon

      I kind of get the idea that the GOP is shooting for… Health care spending is a larger portion of the budget than the military (for now) and it’s not appropriated, it’s entitlement spending (meaning people are entitled to health care by meeting some criteria and if they do they get it regardless of if the money is there or not).

      If we are going to balance the budget the spending needs to be predictable, and entitlement spending makes that hard, in theory, in reality 300 million people makes for a pretty decent law of averages… and the spending is largely predictable… failure to actually predict it is a different story.

      Moreover, they don’t seem to actually be worried about balancing the budget, which from a financial perspective would be a great idea, the 4th largest cost for federal spending is interest on the national debt… not a great thing to be piping money into. (well it kinda is, but we’ll be piping money into it for 30 years even after we balance the budget.) just give a tax cut to the wealthy…

      So while I understand why they are targeting what they are targeting for cost reduction, they aren’t planning to use that cost reduction money in a productive manner, and their plan to reduce costs is going to lead to worse outcomes (When in reality we could push for a system like the netherlands has and spend less on health care over all with better outcomes.)

      • Mike

        I think it’s much simpler than you have described. Our political culture is addicted to war, worship of the military, and controlling the planet for the benefit of elites here in the U.S. and, to some extent, other Western countries.

        The U.S. military budget is by far the largest in the world, and our current leaders are intent on spending more. Therefore, everything else must be squeezed. Virtually no mainstream politician is arguing for a reduction in military spending; the only debate is how much increase is “needed”.

        • jon

          If the goal is a balanced budget, in order to get there through cuts to the military you’d need to cut military spending by 96%.

          in order to get there you’d need to cut health care by about 50%.

          Now this totally sets up a false equivalency suggesting we can’t cut both.
          And the idea that the goal is to balance the budget…

          But from a strictly financial standpoint, going after health care (Which we know has some terrible inefficiencies, I mean it has to, how else can we spend double most developed countries and get worse outcomes?) is easier than going after the military (Where at least spending 3 times more results in having more aircraft carriers than the rest of the world combined) makes sense.

          Now if we could focus the debate on how to get better outcomes for less money instead of just spending less money… that’d be a marvelous idea… but turns out the people we’d take money away from give some of that money to congressmen for their campaigns… so little is likely to change.

  • Al

    So who do we cheer for in this one? Big Insurance or Big Hospital?

    • wjc

      I would never cheer for Big Insurance. Just sayin’.

      • MrE85

        Heh. I used to work for them, and I agree.

        • wjc

          Me too.

  • Al

    Some think the Twin Cities market isn’t quite big enough to sustain two children’s hospitals. We’ve been talking about it for the past 10 years.

    • Rob

      Amazon will eventually come in and buy up both of the kids’ hospitals.

  • Jack

    Health care is a basic human right. I am so tired of the games being played. This in-network out-of-network business is pure crap. Luckily I had the foresight to check on U of M hospital’s status with our provider before we needed to go there. Would have still used them no matter what. I want the best care we can get.

    Also tired of losing good doctors for the reason that they end up out-of-network based on an employer’s decision to change carriers.

  • Barton

    The emotional blackmail of the contract negotiations is what bothers me in this issue, just as it did when BCBS was negotiating with Fairview and others. I think it also contributes to the ill feelings people have about health care in the US, and specific blame placed on the insurers in many cases.

    Truly, an advertisement trying to place blame on one side or the other is cheap theatrics (maybe not so cheap), and seems to create this false need of panic. They will come to an agreement, it is in the best interests of both parties. So why bring the public into it except to make us angry about health care costs in the US and blame the other party for that?

  • AL287

    I find it very disturbing that all of this contract nonsense is occurring as our fearless leaders are contemplating drastic financial cuts to the Medicaid program.

    My personal opinion is Blue Cross is cutting its losses early in anticipation of government reimbursement rates being cut IF the new bill is passed and signed into law.

    Anytime funding cuts involve healthcare it is the very young, the very old, the medically fragile, the disabled and the mentally ill who get hit the hardest.

    Where are all the anticipated Alzheimer’s patients going to go when LTC is no longer paid for by entitlement funding? Are we just going to have them wandering the streets? Are we going to start impoverishing surviving spouses, forcing them to sell their homes and liquidate their assets to pay the bill?

    I liken slow death by lack of medical care to the “slow codes” where medical personnel take their time in responding to a medical emergency in the hospital.

    We very recently got mental illness covered on an equal basis thanks to Paul Wellstone’s (I sure miss that man!) ceaseless efforts. Mental health coverage under Medicaid will be optional for the states if the Senate bill passes.

    Overturning the ACA and replacing it with Trumpcare is short sighted and foolhardy.

    Those Carrier employees are pretty angry at their “savior” Trump who bent the truth during the first weeks after his election to make himself look saintly and magnanimous.

    I think we are seeing the beginnings of a revolution.

    Clean out the swamp, you say? The swamp is so infested with two-faced liars and cheats you’d have to burn down the Capitol Building to get rid of the stink.

    I think I need to drag out my sliding scale clinic proposal I researched in graduate school. There are a lot of people who are going to need it.

    • Veronica

      Oddly, BCBS is shifting the management of their health care benefits to Magellan on 1/1/18.

    • Jack

      I miss Paul Wellstone too. We really need the voice of reason in a time like this.

  • gus

    BCBS has done the same in my rural community. They care only about profits and that’s how it is.