Pittsburgh Post-Gazette Brian O’Neill column [Pittsburgh Post-Gazette]

Aug. 15--An irate email surprised me the other day.

I've gotten irate missives before, running the gamut from snarky to incensed, but this one stood out because the reader and I seemed to be on the same side. She just didn't like the way I used my Sunday column to lampoon the fight being waged between Highmark and UPMC through TV spots, because she could abide no jokes about that.

This newspaper is "too busy looking the other way" and "ignoring what UPMC is all about" because we're afraid to lose ad revenue, she said.

Accusing the Post-Gazette of not writing enough about UPMC or Highmark is a bit like complaining that the Beach Boys didn't write enough about surfing and cars. But the exact words she sought -- "FEDERAL GOVERNMENTAL INTERVENTION AND ACTION TO STOP MONOPOLISTIC PRACTICES BY UPMC AND HIGHMARK" -- have been missing.

I don't know that this is a federal case, and President Barack Obama never returns my calls anyway. But the day after that email, the PG ran a letter from former Allegheny County Executive Jim Roddey suggesting the state Insurance Department should intervene. It has standing since it allowed Highmark's affiliation with the West Penn Allegheny Health System in April, and before that it let UPMC get into the health insurance business.

It's the state that grants such nonprofit status in the first place, Mr. Roddey noted.

One does wonder what all these accusatory commercials are supposed to accomplish. In Pennsylvania, where the phrase "that's your state government inaction" is too often the operative term, Gov. Tom Corbett has leaned on the warring parties. He said in a press release Wednesday the state is requiring them "to clarify any consumer confusion surrounding Highmark's Community Blue product and services at UPMC."

Others have been more direct. Last month, Attorney General Kathleen Kane said she would not formally object to the Altoona Regional Health System becoming part of the UPMC network, but she pointedly warned the Pittsburgh health giant "to keep the Altoona facility accessible to all members of the public, without qualification." In other words, don't try shutting out Highmark insurance carriers.

On Wednesday, state Sen. Jim Ferlo, D-Highland Park, said that because Highmark and UPMC won't cease running those commercials, he's asked the state insurance commissioner to consider the attack ads as violations of Pennsylvania's Unfair Insurance Practices Act. But that would seem to treat the symptom, not the disease.

Reps. Dan Frankel, D-Squirrel Hill, and Jim Christiana, R-Beaver, are co-sponsoring legislation to require hospitals such as UPMC to contract with "any willing insurer." If a hospital can't reach a deal with an insurer, a contract would be imposed through binding arbitration, Mr. Christiana wrote in a memo to House members last month.

I reached Mr. Frankel at the National Conference of State Legislatures in Atlanta, where he'd participated in a health care summit. He blasted UPMC for the "potential disenfranchisement of millions of people who are Highmark subscribers" and the danger it would further dictate the price of health care.

"They're just not a Fortune 500 company," Mr. Frankel said. "They must be held to a higher level of responsibility."

At the Atlanta conference, he noted that "Western Pennsylvania is ground zero in what is happening in the health care industry." Hospitals buying up doctors' practices and reclassifying them as "outpatient facilities" allows for a higher reimbursement, driving up health care costs, Mr. Frankel said.

The Christiana memo suggests that health care spending could reach 20 percent of the gross domestic product by 2020. That's twice what the rest of the developed world spends on health care, Mr. Frankel said, yet other countries have higher life expectancies. Anything that limits competition will drive up those costs further.

When I asked whether he had the votes to impose the "all willing payers" rule on hospitals, Mr. Frankel hedged some. Philadelphia still has real competition with four viable health care systems, he said, but representatives there should know there's no guarantee that can last forever.

We once had pretty healthy competition in greater Pittsburgh, too. Now we have way less competition and way more noise. That needs to be flipped.

Brian O'Neill: boneill@post-gazette.com or 412-263-1947.

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