Sometimes images just stick with you like the tune that you can’t get out your head. After editing our cover story this month about insurance company mergers by Susan Ladika, the image I can’t get out of mind is a pair of sumo wrestlers going at it. Susan interviewed Tim Greaney, a professor at St. Louis University School of Law, and Greaney compared the current consolidation of both providers and payers to the Japanese wrestlers. The law professor says as one side gets larger, it can counteract the market power of the other side. I wonder if the CEOs of these big-and-getting-bigger provider and payer organizations would agree to settle their disputes in a dohyo instead of at the negotiating table, wearing mawashis instead of expensive suits.
But I’ve also had a nagging feeling that the sumo wrestler analogy is off because, as Susan reports, the insurance mergers are partly a response to the growing role of the government payer. About 1 in 3 Americans now get their health insurance through a public health plan of some kind. CMS actuaries predict that federal, state, and local government dollars will finance nearly half (47%) of national health care spending by 2024 because of the ACA and baby boomers aging into Medicare. The plot thickens, though. An increasing share of those public dollars are managed by private entities. The trend lines for Medicare Advantage and Medicaid managed care plans continue to go up and up.
So maybe it’s not really private payers grappling with private providers, sumo-style, but a complicated cage match of government, employer, and personal funds, managed by private companies, going to larger providers. Let’s just hope the health and well-being of the American people emerges the winner.