Health insurance is regulated at the state level. Every state has their own laws and regulations. In-state insurers sign contracts with in-state providers and hospitals. When you are out-of-state and need medical care, it is considered out-of-network and health insurance will either cover very little or not at all. What will happen to someone with insurance in Massachusetts if they get hit by a car here in NYC?

The bills circulating through congress do nothing to change the state insurance regulations. If they were to mandate that all doctors anywhere in the country were “in network” this would eliminate the “discounts” insurers get by signing agreements for bulk medical care with local providers.

Why, then, should the federal government mandate insurance I can’t use across state lines?

And we see another example that the federal government is saying to the insurance companies, “Here are 50 million new customers. Carry on.”

Two Bostonians responded with relative praise to my post “Massachusetts has the most expensive health insurance premiums in the country.”

Response #1 and #2.

Both speak of the lack of primary care doctors. There is a 52 day wait to see a primary care doctor, not a single primary care doctor at Mass General is accepting new patients, and only about 10% of primary care doctors in Massachusetts are accepting new patients at all in the entire state. However, that makes sense to me:

Primary care doctors typically fall at the bottom of the medical income scale, with average salaries in the range of $160,000 to $175,000 (compared with $410,000 for orthopedic surgeons and $380,000 for radiologists). In rural Massachusetts, where reimbursement rates are relatively low, some physicians are earning as little as $70,000 after 20 years of practice.

Dr. Atkinson, 45, said she paid herself a salary of $110,000 last year. Her insurance reimbursements often do not cover her costs, she said.

“I calculated that every time I have a Medicaid patient, it’s like handing them a $20 bill when they leave,” she said. “I never went into medicine to get rich, but I never expected to feel as disrespected as I feel. Where is the incentive for a practice like ours?”