A Learning Opportunity

Peter Turchin has pointed out in his book, End Times, that while the elites are generally bastards when it comes to their treatment of their subjects, they can be motivated to institute reforms by violence or the threat of violence. The Tactical Hermit makes essentially the same point in his recent post, "Anatomy of a Hit," where he notes lawlessness by government and private corporations can lead to a reactionary "revolutionary criminal insurgency." 

    This is why the labor unrest of the late 19th and early 20th Century finally produced significant reforms when the Depression hit. Although the media of the day censored accounts, there were food riots in towns and cities across the nation, and I think this not only pushed reforms as to labor and the introduction of government assistance, but, I believe, also contributed to the push for the National Firearms Act. After all, you can't let the peasants have military weapons, especially when they are on the edge of revolt. 

    I believe we saw a bit of this in action with the recent targeted killing of UnitedHealthcare CEO Brian Thompson, albeit with a different insurance company. Just a couple of weeks ago, "Anthem Blue Cross Blue Shield plans representing Connecticut, New York and Missouri [ ] unilaterally declared it will no longer pay for anesthesia care if the surgery or procedure goes beyond an arbitrary time limit, regardless of how long the surgical procedure takes." 

    Payment for anesthesia services is based on several factors, including the exact amount of time for anesthesiologists to deliver care preoperatively, during the operation, and when transitioning the patient to the recovery unit afterwards. With this new policy, Anthem will arbitrarily pre-determine the time allowed for anesthesia care during a surgery or procedure. If an anesthesiologist submits a bill where the actual time of care is longer than Anthem's limit, Anthem will deny payment for the anesthesiologist’s care. With this new policy, Anthem will not pay anesthesiologists for delivering safe and effective anesthesia care to patients who may need extra attention because their surgery is difficult, unusual or because a complication arises.

    “This is just the latest in a long line of appalling behavior by commercial health insurers looking to drive their profits up at the expense of patients and physicians providing essential care,” said Donald E. Arnold, M.D., FACHE, FASA. “It’s a cynical money grab by Anthem, designed to take advantage of the commitment anesthesiologists make thousands of times each day to provide their patients with expert, complete and safe anesthesia care. This egregious policy breaks the trust between Anthem and its policyholders who expect their health insurer to pay physicians for the entirety of the care they need.” 

But, coincidentally I'm sure, immediately after Thompson's murder, Anthem announced it was "reversing a policy that was set to go into effect in February of that would have limited anesthesia coverage during surgeries and other procedures[.]" With this sudden reversal, Anthem also distanced itself from the proposed policy, trying to suggest that it was never actually going to enact the policy.

    In an email to CBS News on Thursday, Anthem said it was backing away from the policy, and added there had been "widespread misinformation about an update to our anesthesia policy."

    "As a result, we have decided to not proceed with this policy change," an Anthem spokesperson wrote in an email. "To be clear, it never was and never will be the policy of Anthem Blue Cross Blue Shield to not pay for medically necessary anesthesia services. The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines."

But it had only been earlier this week that Anthem had informed providers in New York that: "Claims submitted with reported time above the established number of minutes will only pay up to the CMS established amount." 

    It is true that the American Society of Anesthesiologists had come out strongly opposed to the proposed plan, and there were lawmakers that had indicated they were going to look into the matter, so it is possible that Anthem was already considering not moving ahead with the new policy, but it seems a strong coincidence that the decision came on the heals of the murder of an insurance executive.