Ramblings by Aaron Levine MD


Anthem purchases Cigna, and Aetna buys Humana. We have the big three left. The younger readers may not recall the days of the Clinton Health program which believed in managed competition. This was to be a reduction of the number of health insurance companies to control redundancy and therefore costs. Prudential, Travelers, The Hartford and others no longer provide health care. Health care costs did not drop. The report in the LA Times cited in the Houston Chronicle on 7/25/15 said that the CEO of Anthem reported this “as a way to eliminate unnecessary costs and offer more affordable benefits…”  The paper further stated “Anthem may also use its increased clout to exact lower prices from hospitals, doctors and rug makers.” It also noted that “health policy experts warn that there’s no guarantee that savings would be passed along to consumers.” Does this sound familiar?

This was the reason the airline industry used for its consolidation. I have not seen airfares drop. There are more seats per plane, fewer sitting space for passengers per plane, more fees for baggage, snacks, etc. And there are fewer flights. Too many similarities exist. There were monopolistic organizations in the past. Ma Bell split up and had competition. Phone service became competitive and costs dropped. Just the opposite of what is likely to happen now. Further, remember the big 4 automakers (I include American Motors)? They were unchallenged until first Volkswagen and then the Japanese cars arrived. They won not only on price, but on quality. They forced American companies to become leaner, but also to improve quality. Will we have such a white knight in healthcare? Although I fear not, Public Radio disagrees. They did a report discussing the rise of hospital operated insurance companies and how they will offer quality care and lower costs. Someone forgets the profit is taken out before the quality goes in (pardon me Ford).

I was watching the Best Exotic Marigold Hotel (not the newer second one). In the first few minutes, Maggie Smith is told she needs to wait 6 months or more for a hip replacement. She said at her age, she could be dead. She was told her options were to be outsourced for the surgery. She wound up in India. (I am not meaning to offend the Indian Doctors. It is a plot of the movie). I was at Baylor when the Netherlands sent their cardiac patients to Houston for surgery. History comes around.

Oh, and a couple of days after the announcement, Anthem and BC/BS announced eliminating a whole group of PPO patients (mainly Obamacare patients) for cost reasons and offering them HMOs. More details will follow this fall.


I received an email that I misplaced. It notes that 25% of doctors are over 65 and need to be evaluated for competency. After all, this is done for pilots. It suggested there be a means of biannual testing of knowledge, physical and cognitive skills before physicians be allowed to practice.

Most medical school graduates finish training at about 30, So at each decade of life to 60 would be about 25% (30-40, 40-50, 50-60 60+). Second, most hospitals do require biannual assessments for staff privileges that usually address physical and mental status. I thought the CMEs and then board recertifications would be enough for the knowledge factor. Then the MOCs came on site. It is interesting as this suggestion developed as there is push back against the MOCs. Is this a back door approach to reinstate them?

72250cookie-checkRamblings by Aaron Levine MD