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Table of Contents
II. BACKGROUND:
The Dominant Changes in Healthcare Law and Policy during the Past 30
Years
A.
Phase One: The Healthcare
“Cost-Containment” Era Begins
B.
Phase Two:
Broadening the Actuarial Base of Healthcare.
1. The HMO Act, as amended ― More “takeback”
2. ERISA and Federal Preemption
C. Phase Three: The Advent of the Managed-Care
Industry — The Move
From Indemnity
1. “Quality review”: Myths and Truths ― Mergers and
the Use of Uniform Standards to Stabilize Prices
2. More Myths and Truths of Healthcare
Costs ― The Catastrophic Coverage Act and FASB 106
III. The Availability of Federal Antitrust Law
A. The Supreme Court’s
Pilot Life, Firestone and
Travelers Cases
B. ERISA’s Core Problems ― A Nexus with Antitrust
Law
2. The Fiduciary Double Standard
C the Health Insurance Benefit Plan
Dichotomy
C. Managed Care after
Travelers ― the ERISA Compromise
with States Rights
D. Cutting “Costs,” or Coercively
Lowering Prices?
1. The “treating physician rule” ― that
is: Can Your Doctor Be Trusted?
2. Interstate Commerce in the “Chain of
Events” of Managed-Care Insurance Management
3. Capitation or De-capitation? ―
Medicine’s “Rising Cost Curve”.
4. Managed Care’s Theatrical Exit from Government
Programs
6. The
Monopoly Game, Marginal Cost Pricing and the Cost-Stimulating Sovereign
7. Monopsony and the Antitrust Acts
9. Marginal-cost pricing
—
competitive or predatory? ― and the
“Nonprofits”
11. Doctor plays managed-care entrepreneur
12. Unmasking the Noerr Defense
IV. Healthcare Monopsony ― Buyer Collusion by
Coercion.
1. Value, Price and Profit
C Are
Healthcare Insurance Companies “Too big to fail”?
2. Incurring Private Losses as a Waste of Social
Resources
A. Physician Practice Management Companies
—
Managed Care as Real Estate, Furniture and Equipment.
1. FPA Medical Management, Inc. ― Paradigm for a
Market Failure
2. PhyMatrix
—
a broken company or a breaking system?
3. PhyCor and MedPartners, Inc. ― A Slippery Slope
4. United Payers & United Providers ― More Buyers
Buying-off Sellers
1. Capitation ― Contract, Collusion and Coercive
Networking
2. “Quality review” and
Pireno: Is it really the “business
of insurance companies”?
3. Clearing ERISA’s Muddy Waters ― when “insurance”
is “noninsurance”
VI. The Modern “Business of Insurance Companies” ―
the Emerging Nexus Between McCarran and ERISA
1. Three criteria indispensable to the “business of
insurance”
3. Survey Satisfaction with the System?
VII. Further Market Failure in Managed Care
1. Is Cost Containment the Reality and Healthcare
Merely the Illusion? ―
They’ve got algorithm
2. A Market Failure in Healthcare Prevents an
Effective Underwriting of Risk
3. “Adverse” or “Anti-selection”
4. Entrepreneur Plays Doctor: “I Can Get It For You
Wholesale”
5. “Disease Management,” “Pay-for-Performance” and
“Bundling” ― the New Ploys on the Block
6. The beginning and end of the P4P “never events”
VIII. As Managed Care Ripens for Review
1. Contra proferentem ― the Great Leveler
2. ERISA’s Other Legal, Contradictory, and Advocacy
Trends
3. Are These “Natural Monopolies”?
X. A Summary Judgment – “Activity” v. “Inactivity”
XI. The Ethics of Managing Managed Care
— The Affordable
Care Act Enters
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