In my travels all over the country (and recently outside the U.S.!) telling the story of our facility, making the case for market-driven health care, I have met many great people and made many friends. On my most recent trip, I met several individuals who described themselves as “recovering brokers.” They were struck with how candid I had been with them about the U.S. health cartel and how it worked, part of which they hadn’t grasped. Eager to fill in what they saw as missing puzzle pieces in my narrative, these former “brokers” described to me one of the darkest and most sinister things I had ever heard.
Keep in mind that the reason these people were “recovering brokers” was that they simply could not do what they had been doing any more. They couldn’t sleep at night, posing as their clients advocate while motivated to act as anything but their client’s advocate. To put it plainly, these individuals were part of huge brokerage firms that made recommendations to their clients based on the “over-rides” (bribes) paid to them by various vendors, rather than what was in the best interest of their clients. Basically, these brokers worked for the vendors who were bribing them, not their clients.
Companies which self-fund to provide for employee health benefits often times hire large, national brokerage firms, these firms marketing their ability to navigate the complicated federal regulations governing self-insurance, as well as providing “advice” in selecting various vendors, such as claims processors. Few if any of these self-funded companies realize that these brokerage houses make the lion’s share of their dough in the form of “over-rides” or kickbacks from the vendors they recommend to their “client.” Whether it is the big carrier acting as the PPO, the pharmacy benefit program, the wellness program or the “on-site” clinic, many times these vendors are paying the broker handsomely for this opportunity, this payment forming the foundation of the broker’s recommendation, not the actual interests of the client.
Not all brokerage companies act in this manner. A frightening number do, however, blaming the ever-increasing amounts spent on health care every year on the inexplicable rise in “the cost of health care.” That we have put our prices online, prices which are a fraction of what these self-funded companies are accustomed to paying has revealed the lie that has hidden the fleecing these self-funded companies have received from their army of “consultant/brokers.”
It was therapeutic for these “recovering brokers” to talk frankly with me. They needed to unload this toxic information, and were obviously relieved to have done so. They told me that there was an increasing trend for self-funded companies to hire independent consultants, through whom no vendor services were acquired, to advise them on the performance of their primary consultant/brokers. This is often done in an attempt to keep the primary consultant/brokers honest, accountable and monitored.
Some insurance carriers are so notoriously abusive to physicians and independent facilities like mine that we simply refuse to do business with them. This means that the employees of a self-funded company using this carrier have limited access to the care rendered by physicians too busy to mess with the abusive hassles. The uninitiated might ask, “why would company X use carrier Y to administer its health plan? No good doctor is in that network.”
The right question is, “why would company X not consider the possibility that their ‘broker/consultant’ has advised them to use carrier Y, not because it makes sense for company X, but rather because carrier Y has lined the pockets of the broker/consultant?”
The good news is that many are waking up to this scam, shoving the carrier their consultant has “recommended” to them aside, contracting directly for the services of facilities like mine. The giant savings (hundreds of thousands of dollars in a month or two, not uncommonly) materialize shortly, confirming the worst of suspicions of those in command of the self-funded health plans, namely that many “carriers” and “vendors” are in business not because they provide value, but because they provide sufficient bribes to those in a position to recommend their “service.”
Transparent pricing and market competition are the medicines needed to cure this infection, both of which are catching on, particularly here in Oklahoma City. History has shown countless times that lower prices and higher quality will abide where those courageous enough to trust the free market rule the day. I look forward to meeting even more “whistleblowers” who can, with their stories, help us all see more clearly behind the veil(s).
G. Keith Smith, M.D.
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