I started my career in Philadelphia, which, in the mid-1980s, was dominated by two large health insurers: US Healthcare, which was later acquired by Aetna, and Blue Cross of Greater Philadelphia. One of my positions was to work with one health system to negotiate and implement managed care relationships. There were advantages to the hospital in terms of patient volume and market share, but I did learn how insurance market power could drive lopsided negotiations and set the terms for health care delivery.

In 2020, ASA, along with other specialty societies, have paid substantial attention to the impact of insurance company practices as they pertained to “out of network” billing or “surprise medical bills.” Going forward, I believe we will need to pay even more attention to changes taking place in the commercial insurance industry. These trends are reshaping...

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