I'd settle for 75th percentile to force insurance carriers to actually negotiate and not deliberately keep pruning their provider networks by offering terrible rates.

You can’t have all the doctors paid at the 75th percentile. That’s like saying you want everyone’s children to be above average. It doesn’t make mathematical sense.

At some point someone actually has to set the rate for things. If market mechanisms aren’t working there needs to be another method.

The point here is that sticking customers with out of control surprise bills they have no way of foreseeing or avoiding needs to be removed from the list of options.

75th percentile would be for when out of network. It would work to reduce ridiculous charge-master surprise bills but still provide a redress mechanism for monopolistic insurance companies playing hardball and cutting reimbursement 60% in one year (see Anthem BC/BS to pathology in multiple states).

The argument here is that by destroying the threat of out of network, the insurance company has literally no incentive to offer rates better than Medicare. That’s a huge unfair advantage to insurance companies.

> The argument here is that by destroying the threat of out of network, the insurance company has literally no incentive to offer rates better than Medicare.

Yup. Works for me.

> That’s a huge unfair advantage to insurance companies.

Not so much. Guess what I think the next part of the plan should be?

Sounds like they “prune” non-competitive providers with likely inflated rates. WAI