Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-28T09:25:00.566Z Has data issue: false hasContentIssue false
  • English
  • Français

For Profit Enterprise in Health Care: Can it Contribute to Health Reform?

Published online by Cambridge University Press:  06 January 2021

Eleanor D. Kinney
Get access Rights & Permissions [Opens in a new window]

Extract

Since the demise of the last major health reform initiative in 1994, health coverage for the American people has deteriorated. Private insurance costs have risen, and coverage under private insurance became less comprehensive, with higher deductibles and copayments. Many new treatments for serious diseases and associated provider compensation have become more and more unaffordable, even for those with health insurance coverage. Recent reports document the challenges for cancer patients faced with the soaring cost of cancer treatment. Public programs, such as Medicare and Medicaid, have picked up some slack and have grown in numbers. But gaps remain. Approximately 16 percent of the U.S. population is uninsured. Annual U.S. spending for health care was $2 trillion in 2005, and is estimated to reach $4 trillion by 2015.

Type
Article
Information
American Journal of Law & Medicine , Volume 36 , Issue 2-3 , June 2010 , pp. 405 - 435
Copyright
Copyright © American Society of Law, Medicine and Ethics and Boston University 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

†

JD, MPH; Hall Render Professor of Law and Co-Director, Williams S. and Christine S. Center for Law and Health, Indiana University School of Law — Indianapolis. JD, 1973, BA, 1969; Duke University, MPH 1979, University of North Carolina School of Public Health.

References

1 See, e.g., Jacob S. Hacker, The Road to Nowhere: The Genesis of President Clinton's Plan for Health Security (1997); Hugh Heclo, The Clinton Health Plan: Historical Perspective, 14(1) Health Aff. 87 (1995); Paul Starr, What Happened to Health Care Reform? Am. Prospect, Dec.1994; Adam Clymer, et al., For Health Care, Time was a Killer, N.Y. TIMES, Aug. 29, 1994, at Al; Adam Clymer, The Health Care Debate: The Overview, National Health Program, President's Grandest Goal, Declared Dead in Congress, N.Y. Times, Sept. 27, 1994.

2 See Michael, Chernew, et al., Increasing Health Insurance Costs and the Decline in Insurance Coverage, 40 HEALTH SERVICES RES. 1021, 1031 (2005)Google Scholar; David, M. Cutler, Employee Costs and the Decline in Health Insurance Coverage, 6 F. for Health Econ. & Pol’y 27, 28 (2003)Google Scholar.

3 Kaiser Family Found., Health Care and the Middle Class: More Costs and Less Coverage 13 (2009), available at http://www.kff.org/healthreform/upload/7951.pdf.

4 Karyn Schwartz et al., Kaiser Family Found. & The American Cancer Soc’y, Spending to Survive:

Cancer Patients Confront Holes in the Health Insurance System (2009) [hereinafter SPENDING], available at http://www.kff.org/insurance/upload/7851.pdf.

5 Id. at 2.

6 Carmen DeNavas-Walt et al., Income, Poverty, and

Health Insurance Coverage in the United States: 2007, at 19 (2008) [hereinafter INCOME], available at http://www.census.gov/prod/2008pubs/p60-235.pdf .

7 Centers for Medicare and Medicaid Services, NHE Summary including Share of GDP, CY 1960-2008, http://www.cms.gov/NationalHealthExpendData/02_NationalHealthAccountsHistorical.asp# TopOfPage (last visited April 13, 2010) [hereinafter NHE Summary]; Centers for Medicare and Medicaid Services , NHE Historical and projections, 1965-2015, http://www.cms.gov/NationalHealthExpendData/03_NationalHealthAccountsProjected.asp# TopOfPage (last visited Apr. 13, 2010) [hereinafter NHE Projections]. See also Kaiser Family Found., Snapshots: Health Care Costs, How Changes in Medical Technology Affect Health Care Costs (2007) [hereinafter Snapshots], available at http://www.kff.org/insurance/snapshot/chcm030807oth.cfm.

8 NHE Projections, supra note 7; NHE Summary, supra note 7.

9 Centers for Medicare and Medicaid Services, National Health Expenditure Projections 2009-2019, at 1, http://www.cms.hhs.gov/NationalHealthExpendData/downloads/proj2009.pdf.

10 See, e.g. , Harry Alvin Millis, Sickness and Insurance: A Study of the Sickness Problem and Health Insurance 28-29 (1937); John E. Murray, Origins of American Health Insurance: A History of Industrial Sickness Funds 6 ( 2007); National Industrial Conference Board, Sickness Insurance or Sickness Prevention, Research Report Number 6 (1918).

11 W.S. Rankin, The Economics of Medical Service, in The Socialization of Medicine 51-52 (Edith M. Phelps ed., 1930).

12 Id.

13 Measuring Worth, Seven Ways to Compute the Relative Value of a U.S. Dollar Amount, 1774 to Present, http://www.measuringworth.com/calculators/uscompare/result.php# (last visited Apr. 13, 2010).

14 NHE Summary, supra note 7.

15 Randall, R. Bovbjerg et al., U.S. Healthcare Coverage and Costs: Historical Development and Choices for the 1990's, 21 J.L. Med. & Ethics 141, 145 (1993)Google Scholar.

16 The Committee on the Costs of Medical Care Presents Its Final Report , Milbank Mem’l Fund Q. Bull. (The Milbank Memorial Fund), Jan., 1933, at 21-30; Herman M. Somers & Anne R. Somers, Doctors, Patients and Health Insurance: The Organization and Financing of Medical Care 137 (1961); Joseph, S. Ross, The Committee on the Costs of Medical Care and the History of Health Insurance in the United States, 19 Einstein Q. J. Biology & Med. 129 (2002)Google Scholar.

17 See Robert Cunningham, III & Robert M. Cunningham, Jr., The Blues: A History of the Blue Cross and Blue Shield System (1997); Blue Cross Blue Shield Association, Blue Beginnings, http://www.bcbs.com/about/history/blue-beginnings.html (last visited April 13, 2010) (generally discussing the history of the BCBS symbol).

18 See Blue Cross Blue Shield Association, Birth of the Brands, http://www.bcbs.com/about/history/birth-of-the-brands.html (last visited Apr. 13, 2010).

19 Kaiser Permanente, News Center, Kaiser Permanente: More than 60 Years of Quality, http://xnet.kp.org/newscenter/aboutkp/historyofkp.html (last visited Apr. 13, 2010).

20 See Bradford H. Gray, The Rise and Decline of the HMO: A Chapter in U.S. Health- Policy History, in History and Health Policy in the United States 309-10 (Rosemary A. Stevens et al. eds., 2006).

21 Laura, A. Scofea, The Development and Growth of Employer-Provided Health Insurance, 117 Monthly Lab. Rev. 3, 3-10 (1994)Google Scholar.

22 Somers & Somers, supra note 16, at 11.

23 Sylvia Law, Blue Cross: What Went Wrong? (2d ed. 1976).

24 Employee Retirement Income Security Act of 1974, Pub. L. No. 93-406, 88 Stat. 829 (codified as amended at 29 U.S.C. § 1001 (2006)).

25 Jana K. Strain & Eleanor D. Kinney, The Road Paved With Good Intentions: Problems and Potential for Employer-Sponsored Health Insurance under ERISA , 31 LOY. U. CHI. L.J. 29, 29, 37 (1999).

26 29 U.S.C. § 1144 (2006).

27 Mary, Ann Chirba-Martin & Troyen, A. Brennan, The Critical Role of ERISA in State Health Reform, 13(2) Health Aff. 142, 142 (1994)Google Scholar. See also Wendy, K. Mariner, Problems with Employer-Provider Health Insurance — The Employee Retirement Income Security Act and Health Care Reform, 327 New. Eng. J. Med. 1682 (1992)Google Scholar (pointing out problems with federal preemption and state health insurance regulations).

28 Bovbjerg, supra note 15, at 154.

29 Cunningham & Cunningham, supra note 17, at 131-74.

30 Bovbjerg, supra note 15, at 152.

31 26 U.S.C. § 501(c)(4) (1982).

32 Tax Reform Act of 1986, Pub. L. No. 99-514, § 1012, 100 Stat. 2085.

33 IRS.gov, Coordinated Issue Paper - Blue Cross Blue Shield/Health Insurance; Life Insurance (Effective Date: June 4, 2008), http://www.irs.gov/businesses/article/0,,id=183646,00.html (last visited Mar. 3, 2010).

34 Wellpoint.com, Family of Companies, http://www.wellpoint.com/business/about_family.asp (last visited Apr. 15, 2010).

35 Social Security Amendments of 1965, Pub. L. No. 89-97, 79 Stat. 286 (codified as amended at 42 U.S.C. 18 §§ 1395-1396 (2006)). See Judith M. Feder, Medicare: The Politics of Federal Hospital Insurance (1977); Theodore Marmor, The Politics of Medicare (1973); Robert J. Myers, Medicare (1970).

36 Social Security Amendments of 1972, Pub. L. No. 92-603, §§ 301, 299I, 86 Stat. 1329, 1463-65 (codified as amended at 42 U.S.C. § 1395c (2006)).

37 42 U.S.C. §§ 1395I (Part A) & 1395t (Part B) (2006).

38 Id. §§ 1395c–1395i.

39 Id. §§ 1395j–k.

40 Id. § 1395w-21.

41 Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), Pub. L. No. 108-173, § 101(a)(2), 17 Stat. 2066 (codified at 42 U.S.C. § 1395w-101 (2006)).

42 See 42 U.S.C. § 1396.

43 See Id. § 1396a(l) .

44 Id. § 1396a(1)-(9).

45 Id. § 1397aa.

46 Marian, Gornick et al., Twenty Years of Medicare and Medicaid: Covered Populations, Use of Benefits, and Program Expenditures, 6 Health Care Fin. Rev. 13, 35, 42 (Supp. 1985); See Reimbursement Guidelines for Medicare: Hearing Before the S. Comm. on Finance, 89th Cong. 2 (1966)Google Scholar (staff report entitled Proposed Medicare Reimbursement Formula).

47 Stephen M. Davidson et al., Medicaid Myths: Trends in Medicaid Expenditures and the Prospects for Reform, 10 J. HEALTH POL. POL’Y. & LAW 699 (1986).

48 See Harold, S. Luft, Assessing the Evidence on HMO Performance, 58 Milbank Memorial Fund Quarterly/Health and Society 501 (1980)Google Scholar.

49 Health Maintenance Organization Act of 1973, Pub. L. No. 93-222, 87 Stat. 914 (codified as amended at 42 U.S.C. §§ 300(e) et seq. (2006)).

50 See Eleanor, D. Kinney, Medicare Managed Care from the Beneficiary's Perspective, 26 SETON HALL L. REV. 1163, 1173-76 (1996)Google Scholar.

51 Balanced Budget Act of 1997, Pub. L. No. 105-33, 111 Stat. 251, 4001(codified at scattered sections of 42 U.S.C. §§ 1391w-21, 1851 (2006)). See Medicare Program; Establishment of the Medicare Choice Program, 63 Fed. Reg. 34,968 (June 26, 1998) (to be codified at scattered sections of 42 C.F.R. pt. 400, 403, 410, 411, 417, 422).

52 Robert H. Miller & Harold S. Luft, HMO Plan Performance Update: An Analysis Of The Literature, 1997–2001, 21(4) Health Aff. 63 (2002).

53 Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), Pub. L. 108-173, § 201, 117 Stat. 2066 (codified as amended at 42 U.S.C. § 1395w-21 (2006)). See Robert A. Berenson & Brian E. Dowd, Medicare Advantage Plans At A Crossroads--Yet Again, 28(1) HEALTH AFF. w29, w32 (2008); Marsha Gold, Medicare's Private Plans: A Report Card on Medicare Advantage, 28(1) Health Aff. w41, w41-w54 (2009).

54 See Robert E. Hurley et al., Managed Care in Medicaid: Lessons for Policy and Program Design 111-13 (1993) (discussing managed care); Deborah A. Freund & Edward Neuschler, Overview of Medicaid Capitation and Case-Management Initiatives, Health Care Fin. Rev., 1986 Annual Supp., at 21, 21-22.

55 Omnibus Budget Reconciliation Act of 1981, Pub. L. No. 97-35, § 2175, 95 Stat. 809 (codified as amended at 42 U.S.C. § 1396n(b)(1) (1994)). Balanced Budget Act of 1997, Pub. L. 105-33 § 4702 (to be codified at 42 U.S.C. § 1396u-2).

56 42 U.S.C. § 1315(a) (2006).

57 See John Holahan et al., Insuring The Poor Through Section 1115 Medicaid Waivers, 14(1) Health Aff. 199, 200 (1995); Judith M. Rosenberg & David T. Zaring, Managing Medicaid Waivers: Section 1115 And State Health Care Reform, 32 HARV. J. ON LEGIS. 545, 555-56 (1995).

58 Congressional Budget Office, Key Issues in Analyzing Major Health Insurance Proposals ix (2008), available at http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf.

59 Id.

60 Sara R. Collins et al., The Commonwealth Fund, Losing Ground: How the Loss of Adequate Health Insurance Is Burdening Working Families—Findings from the Commonwealth Fund Biennial Health Insurance Surveys, 2001–2007 (2008), available at http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2008/Aug/Losing-Ground--How-the-Loss-of-Adequate-Health-Insurance-Is-Burdening-Working-Families--8212-Finding.aspx#citation.

61 Kaiser Family Found. & Health Research Educ. Trust, Employee Health Benefits: 2008 Annual Survey 1 (2008) [hereinafter Employee Health Benefits], available at http://ehbs.kff.org/. See also National Coalition on Health Care, Health Care Facts: CostS (2009), available at http://nchc.org/facts-resources/fact-sheet-cost.

62 Employee Health Benefits, supra note 61.

63 Id.

64 Jonathan Gruber & Robin McKnight, Why did Employee Health Insurance Contributions Rise? 22 J. Health Econ. 1085, 1085 (2003).

65 Carmen DeNavas-Walt et al., U.S. Census Bureau Income, Poverty, and Health Insurance Coverage in the United States: 2007, 19 (2008), available at http://www.census.gov/prod/2008pubs/p60-235.pdf .

66 Id.

67 Collins, supra note 60.

68 Kaiser Daily Health Policy Report, Coverage & Access: 21% of U.S. Residents Report Trouble Paying Medical, Drug Bills in 2008, Poll Finds (2009), available at http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=57425.

69 David U. Himmelstein et al., Illness And Injury As Contributors To Bankruptcy, 24(1) Health Aff. w5 (2005).

70 Christopher, T. Robertson et al., Get Sick, Get Out: The Medical Causes of Home Mortgage Foreclosures, 18 Health Matrix 65 (2008)Google Scholar.

71 See American Cancer Society, Cost of Cancer, http://www.cancer.org/docroot/MIT/content/MIT_3_2X_Costs_of_Cancer.asp (last visited Apr. 2010); Cost of Cancer On the Rise, Newer Chemotherapy Treatments Lead Soaring Drug Prices, Am. Cancer Soc’y, Apr. 19, 2002, http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Cost_of_Cancer_On_the_Rise.asp

72 Gina Kolata & Andrew Pollack, The Evidence Gap: Costly Cancer Drug Offers Hope, but Also a Dilemma, N.Y. Times, July 6, 2008, available at http://www.nytimes.com/2008/07/06/health/06avastin.html.

73 The High Concentration of US Health Expenditures, Research in Action (Agency for Healthcare Research and Quality), June 2006, at 2, available at http://www.ahrq.gov/research/ria19/expendria.pdf.

74 Schwartz, supra note 4.

75 Liz Szabo, Study: Many Cancer Patients Forgoing Care Because of Cost, USA TODAY, Oct. 13, 2008, at D5, available at http://www.usatoday.com/news/health/2008-10-12-cancercosts_n.htm.

76 American Cancer Society, Cancer Facts & Figures 2008, at 38 (2008) available at http://www.cancer.org/downloads/STT/2008CAFFfinalsecured.pdf.

77 Id.

78 Abraham Flexner, Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching (1910).

79 Id.

80 William J. Bishop, The Early History of Surgery (1960).

81 Eric Lax, The Mold in Dr. Florey's Coat: The Story of the Penicillin Miracle (2004).

82 Michael Bliss, The Discovery of Insulin 11-12 (1984)

83 Framingham Heart Study: A Joint Project of the National Heart, Lung and Blood Institute and Boston University, http://www.framinghamheartstudy.org/ (last visited Apr. 10, 2010). See Thomas R. Dawber et al., Epidemiological Approaches to Heart Disease: The Framingham Study, 43 AM. J. PUB. HEALTH 279 (1951).

84 National Library of Medicine, The Edward D. Freis Papers: The VA Cooperative Study and the Beginning of Routine Hypertension Screening, 1964-1980, http://profiles.nlm.nih.gov/XF/Views/Exhibit/narrative/study.html (last visited Apr. 14, 2010).

85 Snapshots, supra note 7.

86 See James D. Watson, The Double Helix: A Personal Account of the Discovery of the Structure of DNA (2001).

87 See, e.g., Robert E. Adler, Medical Firsts: From Hippocrates to the Human Genome (2004); John G. Simmons, Doctors and Discoveries: Lives that Created Today's Medicine (2002).

88 See William B. Schwartz, In the Pipeline: A Wave of Valuable Medical Technology, 13(3) Health Aff. 70 (1994). See generally Kant Patel & Mark E. Rushefsky, Health Care Policy in an Age of New Technologies (2002).

89 See, e.g., Progress in Drug Research (Ernst Jucker ed., 2002). See also FDA Regulatory Affairs: A Guide for Prescription Drugs, Medical Devices, and Biologics (Douglas J. Pisano & David S. Mantus eds., 2008); Elaine Whitmore, Development of FDA-regulated medical products: prescription drugs, biologics and Medical Devices (2004).

90 See Bernhard J. Stern, The Commonwealth Fund, Medical Services by Government: Local, State, and FederaL 53-54 (1946).

91 See Sidney Farber et al., Temporary Remissions in Acute Leukemia in Children Produced by Folic Antagonist, 4-Aminopteroylglutamic Acid (Aminopterin), 238 New Eng. J. Med. 787 (1948).

92 See Rose, J. Papac, Origins of Cancer Therapy, 74 Yale J. Biol. Med. 391, 391, 394 (2001)Google Scholar.

93 See Benjamin Djulbegovic, et al., Treatment Success in Cancer New Cancer Treatment Successes Identified in Phase 3 Randomized Controlled Trials Conducted by the National Cancer Institute–Sponsored Cooperative Oncology Groups, 1955 to 2006 , 168 Archives Internal Med. 632 (2008).

94 Richard A. Rettig, Medical Innovation Duels Cost Containment, 8(3) Health Aff. 7, 15 (1994).

95 Joseph P. Newhouse, Medical Care Costs: How Much Welfare Loss? 6(3) J. Econ. Persp. 3 (1992). See also SnapshotS, supra note 7 (citing Newhouse).

96 See, e.g., Kaiser Family Foundation, U.S. Health Care Costs: Background Brief, http://www.kaiseredu.org/topics_im.asp?imID=1&parentID=61&id=358 (last visited Apr. 13, 2010); Thomas Bodenheimer, High and Rising Health Care Costs. Part 1: Seeking an Explanation, 142 Annals Internal Med. 847 (2005) (The first in a series of four articles on health care costs); Peter R. Orszag & Philip Ellis, The Challenge of Rising Health Care Costs — A View from the Congressional Budget Office, 357 New Eng. J. Med. 1793 (2007).

97 See, e.g., Kenneth J. Arrow, Uncertainty and the Welfare Economics of Medical Care, 53 AM. ECON. REV. 941 (1963); Martin S. Feldstein, Hospital Cost Inflation: A Study of Nonprofit Price Dynamics, 61(5) AM. ECON. REV. 853 (1971). See also Health Care and its Costs: Can the U.S. Afford Adequate Health Care? (Carl J. Schramm ed., 1987); A New Approach to the Economics of Health Care (Mancur Olsen ed., 1981).

98 See, e.g., Robert H. Brook et al., Quality of Medical Care Assessment Using Outcome Measures: An Overview of the Method (1976); Robert, H. Brook & Kathleen, N. Lohr, Efficacy, Effectiveness, Variations, and Quality: Boundary-Crossing Research, 23 MED. CARE 710 (1985)Google Scholar.

99 David M. Eddy & John Billings, The Quality of Medical Evidence: Implications for Quality of Care, 7(1) Health Aff. 19 (1988), available at http://healthaff.highwire.org/cgi/reprint/7/1/19.pdf; David M. Eddy, Variation in Physician Practice: The Role of Uncertainty, 3(2) Health Aff. 74 (1984).

100 See John, E. Wennberg & John, Gittelsohn, Small Area Variation in Health Care Delivery, 182 SCIENCE 1102-08 (1973)Google Scholar; John, E. Wennberg & John, Gittelsohn, Variations in Medical Care Among Small Areas, 246 Scien. Am. 120 (1982)Google Scholar; John E. Wennberg et al., Professional Uncertainty and the Problem of Supplier-Induced Demand. 16 Soc. Sci. & Med. 811 (1982).

101 The Dartmouth Atlas of Health Care, http://www.dartmouthatlas.org/index.shtm (last visited Apr. 14, 2010).

102 Pricewaterhouse Coopers, The Price of Excess: Identifying Waste in Healthcare Spending 2008, http://www.pwc.com/us/en/healthcare/publications/the-price-ofexcess.jhtml (last visited Apr. 14, 2010).

103 See WHO, World Health Statistics 2006, available at http://www.who.int/entity/whois/whostat2006_healthsystems.pdf (last visited Mar. 23, 2008).

104 See Gerald F. Anderson et al., Health Spending in the United States and The Rest of the Industrialized World, 24(4) Health Aff. 903, 904-05 (2005).

106 Glenn Greenwald, Healthcare industry stocks explode as bill progresses, SALON, Dec. 22, 2009, http://www.salon.com/news/opinion/glenn_greenwald/2009/12/22/health_care/index.html.

107 Paul Maidment, America's Best- and Worst-Paying Jobs, FORBES, May 15, 2008, http://www.forbes.com/2008/05/15/jobs-careers-compensation-lead-careerscx_pm_0515jobs.html.

108 Id.

109 Ha T. Tu & Paul B. Ginsburg, Center for Studying Health System Change, Losing Ground: Physician Income, 1995-2003, 1 (2006), available at http://www.hschange.org/CONTENT/851/851.pdf.

110 Id.

111 Rie Fujisawa & Gaetan Lafortune, The Remuneration of General Practitioners and Specialists in 14 OECD Countries: What are the Factors Influencing Variations Across Countries? 7-8 (OECD Health Working Papers, No. 41, 2008), available at http://www.oecd.org/dataoecd/51/48/41925333.pdf; Written Statement from Mark Pearson, Organization for Economic Co-operation and Development, to Senate Special Committee on Aging: Disparities in Health Expenditure Across OECD Countries: Why Does the United States Spend So Much More Than Other Countries? (Sept. 30, 2009), available at http://www.oecdwash.org/PDFILES/Pearson_Testimony_30Sept2009.pdf.

112 See Ellyn Boukus et al., Center for Studying Health System Change, A Snapshot Of U.S. Physicians: Key Findings From The 2008 Health Tracking Physician Survey (2009), available at http://www.rwjf.org/files/research/hscbulletin35sept2009.pdf (table 2a provides information on physician compensation arrangements, specifically: income, method, availability of bonuses, and sources of practice revenue).

113 CNN Money.com, Fortune 1000 - 2009, http://money.cnn.com/magazines/fortune/fortune500/2009/full_list/601_700.html.

114 US Oncology, Company Background, http://www.usoncology.com/portal/page/portal/PubWeb/1AboutUSON/05CompanyBackground (last visited Apr. 15, 2010).

115 David Rynecki et al., 100 Fastest-Growing Companies, FORTUNE, Sept. 1, 2003, http://money.cnn.com/magazines/fortune/fortune_archive/2003/09/01/348175/index.htm.

116 Eleanor, D. Kinney, The Corporate Transformation of Medical Specialty Care: The Exemplary Case of Neonatology, 36 J. L. Med. & Ethics 790, 790-91 (2008)Google Scholar.

117 S. Elizabeth Wilbom Malloy, Physician Restrictive Covenants: The Neglect of Incumbent Patient Interests, 41 Wake Forest L. Rev. 189 (2006).

118 Kinney, supra note 116, at 790.

119 American Hospital Association, Fast Facts on US Hospitals, http://www.aha.org/aha/resource-center/Statistics-and-Studies/fast-facts.html (last visited Apr. 15, 2010).

120 American Hospital Association, TrendWatch Chartbook 2009: Trends Affecting Hospitals and Health Systems, Chart 4.4: Annual Change in Hospital Operating Revenue and Expenses per Adjusted Admission, 1987 – 2007 (2009), available at http://www.aha.org/aha/trendwatch/chartbook/2009/chapter4.pdf; Melanie Evans, Will it last?; Hospital profits hit an all-time high in 2004, Modern Healthcare, Nov. 7, 2005, at 8.

121 Hospital Profitability, FACT FILE (Media Healthleaders), June 12, 2008, available at http://www.healthleadersmedia.com/content/FFL-213320/Hospital-Profitability.html.

122 Bernard Friedman et al., New Evidence on Hospital Profitability by Payer Group and the Effects of Payer Generosity, 4 Int’l J. Health Care Fin. & Econ. 231, 239 (2004).

123 John Carreyrou & Barbara Martinez, Nonprofit Hospitals, Once for the Poor, Strike it Rich, Wall St. J., Apr. 4, 2008, available at http://online.wsj.com/article/SB120726201815287955.html?mod=googlenews_wsj.

124 Maggie Fox, U.S. Hospital Profits Fall to Zero, Thomson Reuters, Mar. 2, 2009, available at http://www.reuters.com/article/idUSTRE5216G320090302.

125 Anemona Hartocollis, Insurer Steps Up Fight to Control Health Care Cost, NY Times, Jan.24, 2010, available at http://www.nytimes.com/2010/01/25/health/policy/25insure.html.

126 Blue Cross Blue Shield Association, History of BCBSA: 2000s, http://www.bcbs.com/about/history/2000s.html.

127 See generally Christopher. J. Conover et al., The Impact Of Blue Cross Conversions On Health Spending And The Uninsured, 24(4) Health Aff. 473 (2005).

128 U.S. Gov't Accountability Office, GAO-09-864R, Competition in Health Insurance Markets (2009); James C. Robinson, Consolidation and the Transformation of Competition in Health in Health Insurance, 23(6) Health Aff. 11 (2004).

129 Jeff Jacoby, Editorial, Hyperbole in the Health Care Debate , Boston GlobE, Nov. 1, 2009.

130 Joanne Silberner, Are Insurers’ Profits as Low as They Claim?, Nat’l Pub. Radio, Aug. 3, 2009, http://www.npr.org/templates/story/story.php?storyId=111494182.

131 Ezra Klein, Economic and Domestic Policy and Lots of it Blog, Profit and the Insurance Industry, Wash. Post, http://voices.washingtonpost.com/ezraklein/2009/09/profit_and_the_insurance_indus.html (Sept. 9, 2009, 4:46 PM); Calvin Woodward, Fact Check: Health Insurer Profits Not So Fat, Associated Press Fin. Wire, Oct. 25, 2009, available at http://abcnews.go.com/Business/wireStory?id=8910507 Calvin Woodward, available at Fact Check: Health Insurers’ Profits 35th of 53, ASSOCIATED PRESS FIN. WIRE, Oct. 26, 2009, available at http://abcnews.go.com/Business/wireStory?id=8914676.

132 Brett Arends, Will a Public Option Hurt Insurance Company Profits?, Wall St. J., Aug. 5, 2009, available at http://online.wsj.com/article/SB124947013703607453.html.

133 Kaiser Family Found., Prescription Drug Trends (2008).

134 Top Companies: Most Profitable (2008), CNNMoney.com, May 4, 2009, http://money.cnn.com/magazines/fortune/fortune500/2009/performers/companies/profits/.

135 Congressional Budget Office, Research And Development In The Pharmaceutical Industry 4 (2006).

136 Jon Kamp, US Medical-Device Firms Shed Issues in 2010, But Gain Others, DOW JONES NEWSWIRES, Dec. 29, 2009.

137 Julie Appleby, Kaiser Family Found., Proposed Tax Rattles Orthopedic Device Industry, Kaiser Health News, Oct. 14, 2009, http://www.kaiserhealthnews.org/Stories/2009/October/14/Medical-device-tax.aspx (noting that medical equipment and suppliers as a whole showed five-year gross margins of 59%, compared with 45.8% for the S&P 500).

138 See F. M., Scherer, The Pharmaceutical Industry – Prices and Progress, 351 NEW ENG. J. MED. 927 (2004)Google Scholar.

139 Michael, O. Adams & Gbolahan, S. Osho, Drugs Company Profits In The United States: Are They Excessive? Evidence From Public Administration Perspectives, 4 J. Bus. & Econ. Res. 85, 85-86 (2006)Google Scholar.

140 Dan Eggen & Ceci Connolly, Medical Device Makers Court Unlikely Allies: Pro Reform Democrats Defend Home State Firms, Wash. Post., Oct. 18, 2009, at A01, available at http://www.washingtonpost.com/wpdyn/ content/article/2009/10/17/AR2009101700718.html .

141 See supra notes 100-101 and accompanying text.

142 Atul Gawande, The Cost Conundrum: What a Texas Town can Teach us about Health Care, New Yorker, June 1, 2009, http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all

143 Id.

144 Ewe E. Reinhardt, The Pricing of U.S. Hospital Services: Chaos Behind A Veil of Secrecy, 25(1) Health Aff. 57 (2006).

145 Claudia Birkenshaw, Handbook for Hospital Billing 50-57 (2009).

146 Id. at 317-71.

147 Reinhardt, supra note 144.

148 American Hospital Association, Hospital Statistics 2005, at Table 3 (2005); Reinhardt, supra note 144, at 57.

149 42 U.S.C. § 1395f (2006) (Medicare); 42 U.S.C. § 1396 a(14) & 1396o (2006) (Medicaid).

150 Birkenshaw, supra note 145, at 402-03.

151 Gerald F. Anderson, From ‘Soak The Rich’ To ‘Soak The Poor': Recent Trends In Hospital Pricing, 26(3) Health Aff. 780 (2007); Margaret K. Kyle and David B. Ridley, Would Greater Transparency and Uniformity of Health Care Prices Benefit Poor Patients?, 26(5) Health Aff. 1384 (2007); Glenn A. Melnick & Katya Fonkych, Hospital Pricing And The Uninsured: Do The Uninsured Pay Higher Prices?, 27(2) Health Aff. w116 (2008).

152 Peter Davidson, The Basics: 10 ways to avoid outrageous hospital overcharges, Moneycentral.msn.com, http://moneycentral.msn.com/content/Insurance/Insureyourhealth/P74840.asp (last visited Apr. 15, 2010).

153 Sarah Rubinstein, Hospitals Put Patients’ Debt Up for Auction Collection Agencies Bid Online For Right to Recoup Funds; Worries About Tougher Tactics , Wall St. J., June 3, 2008, available at http://online.wsj.com/public/article/SB121244901525139563-KNO1CygwzzD0IGqMG8IfVp8_z80_20090603.html?mod=rss_free.

154 American Hospital Association, Hospital Billing and Collection Practices Statement of Principles and Guidelines, available at http://www.accessproject.org/adobe/AHA_hospital_billing_and_collection_practices.pdf.

155 A Pound of Flesh: Hospital Billing, Debt Collection, and Patients’ Rights , ISSUE BRIEF (Families, USA), Mar. 2007, available at http://www.familiesusa.org/assets/pdfs/medicaldebt.PDF.

156 See, e.g. , Hospitaldebtjustice.org, About the Hospital Debt Justice Project, http://www.hospitaldebtjustice.org/about.html (last visited Apr. 15, 2010); The Kaiser Family Found., Kaiser State Watch | Baltimore Sun Series Examines Debt Collection Practices of Maryland Hospitals, Kaisenetwork.org, Dec. 23, 2008, available at http://www.kaisernetwork.org/Daily_Reports/rep_index.cfm?DR_ID=56225.

157 Andrew McKinley, Hospital Billing Practices and the Uninsured: An Emerging Legislative Response, Health Care Fin. Mgmt. Ass’n, Nov. 2004, available at http://findarticles.com/p/articles/mi_m3257/is_11_58/ai_n6359492/.

158 Internal Revenue Service, IRS Exempt Organizations (TE/GE) Hospital Compliance Project: Final Report (2009), available at http://www.irs.gov/charities/charitable/article/0,,id=203109,00.html.

159 Id.

160 Id.

161 Provena Covenant Med. Ctr. v. Dep’t. of Revenue, 2010 WL 966858 (Ill. 2010), aff’g, 384 Ill.App.3d 734, 894 N.E.2d 452 (2009). See also Utah County v. Intermountain Health Care, Inc., 709 P.2d 265, 269 (Utah 1985).

162 Terminations of Individual Health Policies by Insurance Companies: Hearing Before the H. Comm. on Energy and Commerce, Subcomm. on Oversight and Investigations, 111th Cong. (2009) [hereinafter Hearing on Health Policies].

163 See, e.g., Karl Vick, When Your Insurer Says You're No Longer Covered: Firms Defend ‘Rescissions’ as Fraud Control, Wash. Post, Sept. 8, 2009, available at http://www.washingtonpost.com/wpdyn/content/article/2009/09/07/AR2009090702455.html Cancer Patient Tells of Rips in Health Insurance Safety Net , CNNPolitics.com, Jun. 16, 2009, http://edition.cnn.com/2009/POLITICS/06/16/health.care.hearing/index.html.

164 Hearing on Health Politics, supra note 6 (opening Statement, Rep. Bart Stupak, Chairman, Subcommittee on Oversight and Investigations).

165 Id.

166 Organization for Economic Co-Operation and Development, Pharmaceutical Pricing Policy Project, http://www.oecd.org/document/57/0,3343,en_2649_37407_35715449_1_1_1_1,00.html (last visited May 7, 2010).

167 Id.

168 Income, supra note 6, at 19-22.

169 U.S. CensusBureau, Health Insurance Coverage: 2008 - Highlights, http://www.census.gov/hhes/www/hlthins/hlthin08/hlth08asc.html (last visited Apr. 15, 2010).

170 Ctrs. for Medicare & Medicaid Servs., Office of the Actuary, National Health Expenditure Projections 2008-2018, at 3-5, available at www.cms.hhs.gov/nationalhealthexpenddata/downloads/proj2008.pdf.

171 Id.

172 Id.

173 I.R.C. § 162 (2006).

174 Joint Comm. on Taxation, Tax Expenditures for Health Care 2, 4 (2008), available at http://www.jct.gov/publications.html?func=startdown&id=1193.

175 Martin Gaynor & Deborah Haas-Wilson, Change, Consolidation, and Competition in Health Care Markets, 13(1) J. of Econ. Persp. 141 (1999);Thomas L. Greaney, Whither Antitrust? The Uncertain Future of Competition Law in Health Care, 21(2) Health Aff. 185 (2000).

176 Patient Protection and Affordable Care Act (PPACA), Pub. L. No. 111-48, 124 Stat. 119- 1025 (2010).

177 Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-52, 124 Stat. 1029-84 (2010).

178 PPACA §§ 1401-02. See Kaiser Family Foundation, Focus on Health Reform: Summary of New Health Reform Law 1, 2 (2010), available at http://www.kff.org/healthreform/upload/8061.pdf [Hereinafter Summary of New Health Reform Law].

179 PPACA § 1311. See Summary of New Health Reform Law, supra note 178, at 4-6.

180 PPACA §§ 1311-24, 1515. See Summary of New Health Reform Law, supra note 178, at 4.

181 PPACA §§ 1311-24, 1515. See Summary of New Health Reform Law, supra note 178, at 1.

182 PPACA §§ 1201-2708. See Summary of New Health Reform Law, supra note 178, at 6-7

183 PPACA §§ 2001-202. See Summary of New Health Reform Law, supra note 178, at 7.

184 PPACA §§ 3101-602. See Summary of New Health Reform Law, supra note 178, at 8.

185 PPACA §§ 3001-27. See Summary of New Health Reform Law, supra note 178, at 9-10.

186 Congressional Budget Office, Health Care: Cost Estimates for Health Care, http://www.cbo.gov/publications/collections/health.cfm (visited May 5, 2010).

187 Id.

188 David Whelan, Cranking Up the Volume: One Reason Medical Costs Are Getting Way Out of Control: GE Employs Too Many Good Salesmen, Forbes, Feb. 25, 2008, http://www.forbes.com/forbes/2008/0225/032.html.

189 See, e.g., Neil, Kirschner & Michael, S. Barr, Specialists/Subspecialists and the Patient- Centered Medical Home, 137 CHEST 200 (2010)Google Scholar; P. A. Nutting et al., Initial Lessons From the First National Demonstration Project on Practice Transformation to a Patient-Centered Medical Home, 7(3) Annals Fam. Med. 254 (2009).

190 See Anne C. Beal et al., The Commonwealth Fund, Closing the Divide: How Medical Homes Promote Equity in Health Care (2007), available at http://www.wafp.org/documents/ClosingtheDivide.pdf.

191 Jack Ginsberg, Am. Coll. of Physicians, Controlling Health Care Costs While Promoting The Best Possible Health Outcomes (2009), available at http://www.acponline.org/advocacy/where_we_stand/policy/controlling_healthcare_costs.pdf.

192 See Vasilios J. Kalogredis, Should You Consider Concierge Medicine?, PHYSICIAN's NEWS DIGEST, Feb. 2004, http://www.physiciansnews.com/business/204.kalogredis.html Is A “Concierge” Medical Practice for You?, The Entrepreneurial MD, Mar. 1, 2007, http://www.entrepreneurialmd.com/index/2007/3/1/is-a-concierge-medical-practice-for-you.html.

193 U.S. Government Accountability Office, Physician Services, GAO-05-920, Concierge Care: Characteristics and Considerations for Medicare (2008).

194 Daniel P. Kessler & Mark B. McClellan, Do Doctors Practice Defensive Medicine?, 111 Q. J. ECON. 353 (1997); Daniel P. Kessler & Mark B. McClellan, The Effects of Malpractice Pressure and Liability Reforms on Physicians’ Perception of Medical Care , 60 Law & Contemp. Probs. 81 (1997); Daniel P. Kessler & Mark B. McClellan, How liability law affects medical productivity, 21(6) J. Health Econ. 932 (2002).

195 Office of Tech. Assessment, 103rd Cong., Defensive Medicine and Medical Malpractice (1994); Patricia M. Danzon, Liability for Medical Malpractice, in 1B Handbook of Health Economics 1339, 1339-1404 (Anthony J. Culyer & Joseph P. Newhouse eds., 2000); Henry J. Aaron & Paul B. Ginsburg, Is Health Spending Excessive? If So, What Can We Do About It?, 28(5) Health Aff. 1260, 1270 (2009).

196 General Accountability Office, GAO 08-880, Nonprofit Hospitals: Variation in Standards and Guidance Limits Comparison of How Hospitals Meet Community Benefit Requirements (2008), available at http://www.gao.gov/new.items/d08880.pdf.

197 Robert Pear, Health Executive Defends Premiums, NY Times, Feb. 24, 2010, available at http://www.nytimes.com/2010/02/25/health/policy/25health.html.

198 Organization for Economic Co-Operation and Development, supra note 166.