The following appeared in the "Letters to the Editor" of the Providence Journal.

Competition is the answer to Blue Cross ills

01:00 AM EDT on Wednesday, May 12, 2004


As a physician, I've been reading the saga of Blue Cross & Blue Shield of Rhode Island with interest every morning.

I and many of my colleagues are struggling to stay in business because of low insurance-reimbursement rates. Although Blue Cross states that it has increased its reimbursement rates 100 percent in the past four years, that has not been seen in most offices. Office-visit codes used in most physician billing have not increased appreciably in the five years that I've been practicing in Rhode Island. Blue Cross payments for office visits are significantly less than those paid by the federal Medicare program, and by Blue Cross in Connecticut and Massachusetts -- for the same quality and amount of work.

The answer is not in more regulation but, rather, in modifying regulations to encourage other insurers to offer policies in Rhode Island. Emily Harding, in her Jan. 22 Commentary piece ("R.I. health czars botched insurance"), clearly delineates a key problem: General Laws 23-17.13 and 23-17.12-1 require insurance companies to be responsible for quality of care and malpractice -- even if they are not HMOs.

Many health-insurance companies have left Rhode Island, which has made it difficult for small businesses to obtain affordable health coverage. Fortis, Mutual of Omaha, John Alden and other companies have stopped doing business here, leaving the citizens of Rhode Island with few choices.

Yes, Blue Cross needs to be cleaned up. I doubt anyone would care how much its former president, Ronald Battista, or its board of directors was compensated if physicians and hospitals were paid appropriately and premiums were reasonable.

Creating legislation to restrict insurers is not the answer. Creating legislation to allow more competition among new and existing insurers in Rhode Island would increase the insurance choices available and reduce the overall costs. I urge our elected officials to move in this direction.