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Saturday, August 16, 2014

My Editorial about Highmark that you can't quite read at Delaware Online

This was printed in today's paper, but somehow (I'm NOT speculating) it is not available in the online edition.

So find out what a Libertarian thinks about State-enforced corporate monopolies:

It isn’t news that Delawareans pay higher health insurance premiums than most Americans, or that many families can’t access A. I. DuPont Children’s Hospital because of a feud between the doctors and insurance bureaucrats.

Some reformers dream of a single-payer health-care system, where taxes cover the costs, patients pay no premiums or co-pays, and the cost of medical care goes magically down.  A bill to enact stand-alone single-payer for Delaware is introduced—and ignored—in the General Assembly every year.

The reformers don’t understand that we already have a two-payer health insurance system in Delaware, and that second payer has no intention of losing its monopoly to the government.

Just over 50% of Delaware’s citizens receive health insurance via the government, through Medicaid, Medicare, Chips, or various military programs.  The remainder sits in the “private insurance market.”

Over 90% of this “market” dominated by a single entity:  Highmark Blue Cross Blue Shield of Delaware.

A 90% market share usually characterized as a monopoly, which generally means fewer choices, poorer service, and higher prices for consumer.

Pennsylvania Judge Patricia McInerny recently characterized Highmark of Delaware’s parent company as a “supposedly ‘non-profit’ corporation,” while ruling that Pennsylvania law was so vague Highmark could legally claim a $432 million profit as “incidental.”

Highmark’s empire includes major (if not monopoly) insurers in Pennsylvania, Delaware, and West Virginia; the nation’s second-largest optometry chain; multiple dental plans; lucrative Medicare processing contracts and supplemental insurance policies; and investment in or ownership of urgent care centers and hospital chains.

Executive Vice President David O’Brien says that Highmark intends “to expand our footprint in the provider world,” meaning that the company plans to purchase hospitals, clinics, and medical practices.

Thus the insurance company paying your doctors could also be their employer.

In West Virginia, Highmark is the only company listed on the health insurance marketplace.  In Delaware it might as well be:  Highmark has acquired roughly 93% of all sign-ups.

In Pennsylvania Highmark purchased a hospital chain and fought a trade war with the University of Pennsylvania Medical Centers.  Among the casualties were thousands of Highmark customers who either lost coverage or had claims denied for visiting a competing hospital.

In Philadelphia, independent optometry shops allege that Highmark gives its subsidiaries preferential treatment in dealing with customers who have Highmark vision plans.

In a 2012 case heard by US District Court Judge Roy Flowers, Highmark admitted having paid varying rates to different providers for exactly the same services.

On entering Delaware, Highmark received $175 million in corporate welfare from our General Assembly.  Our State Insurance Commissioner wanted a gigantic company atop the Delaware market because “small health insurers have struggled to compete with large national insurers who have billions of dollars of capital and resources.”

MedExpress, a chain of urgent care centers in which the Highmark parent company has a $52 million (about 10%) investment stake, followed Highmark into Delaware.  Within months, locally owned competitors were informed that they had sixty days to meet new standards of operating and credentialing (designed by Highmark, and, coincidentally those of MedExpress) or they would cease being reimbursed for services at the standard rate.

One local doctor/owner who attempted to resist these changes alleges that his family’s insurance claims were denied in blanket fashion; thousands of dollars in payments to his clinic were unreasonably delayed, and his employees’ policies were abruptly audited—all in six months. Highmark and the State Insurance Commissioner contend that these acts were coincidence and routine.

The doctor has since sold his business to a national chain that does not accept Medicaid (as he did).

The strangest part of this story is that it doesn’t appear to be news in Delaware.  A recent inquiry to the Insurance Commissioner’s into Highmark’s status by a local citizen required almost two years to generate a one-paragraph dismissal.  None of our legislators or government leaders appear willing to talk about the Highmark monopoly on private health insurance, or the company’s reach into Medicare, vision plans, or dental insurance.

Nobody seems willing to draw the logical conclusion that Highmark’s premiums (already among the highest in the nation) are scheduled to go up another 5% in 2015, despite the parent company’s $4.4 Billion cash surplus, because monopolies foster profit taking, not competition.

One of the reasons I am running for State Representative is to bring this issue out into the open, and force our government to confront the question:  Is what’s good for Highmark really good for Delaware?


  1. How many nations comprise what is known as "the industrialized world." Out of that number of nations, what are the names of the nations (other than the United States) which do not provide "national health" care to every citizen for free (or, more accurately, as a function of the nation's revenue generated through taxes)?

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