Having unwittingly tweaked my honorable colleague from Pennsylvania by risking a (very limited) positive comment about his governor's medical malpractice reform, I move to Ohio, where physicians are lobbying for a law that would require more transparency in the contracts that they sign with health plans.

Imagine this: an ophthalmologist, whose single biggest operation is cataract removal, does not know what the insurers with which he is contracted will pay him for his procedures! H.B. 125 will require health plans to be more forthcoming about their rates, and credential physicians quicker, while allowing docs to cherry pick from an insurer's plans rather than accepting all plans from a given insurer (the latter which insurers obviously prefer).

I hate to say it, but I don't like it. Like most, my instincts favor doctors versus health insurers, but dogfights like this always leave me asking: "Why do they doctors continue to sign these contracts? Why don't they just quit and work for cash?" Now, that won't work for oncologists, I suppose, but it should for primary care practitioners.

Sure, health insurers will try to use government power to prevent it (as we learned from the Wall Street Journal's coverage of a West Virginia doctor's "concierge" practice that insurers are lobbying to have regulated as "insurance"). But how do two wrongs make a right, as my grandmother used to ask? For instance, outlawing an insurer from asking a doctor to treat patients enrolled in all its plans, instead of just the ones she prefers, will have the unintended consequence of reducing choice in plans - thereby giving power to doctors by taking it away from patients, not insurers.

With respect to price transparency, I am more sympathetic, although I am hardly a price-transparency fanatic. And the discontent continues to invite the question: "Why do you sign these contracts?" If you speak to a doctor, the answer is always: "Health plans are oligopolies, we are fragmented, so we have to sign contracts because we have no choice."

Well, ok, but much of the sytemic "fragmentation" is due to physicians' lobbying for state regulations that protect their status as a guild. One example is limits to so-called "corporate practice of medicine", a long-standing concept that organized medicine uses to prevent its members from entering professional arrangements that would displease organized medicine. Because of its importance, this restriction is a measurement in the U.S. Index of Health Ownership.

Once physicians and health plans decide to negotiate in good faith, without the one enlisting government power to tilt the playing field against the other, we will take a significant step on the path to consumer-directed health care.