As a former constituent, I have discussed health care issues with Rep. Victoria Spartz when she was an Indiana state senator.

I agree with her that government solutions in health care typically create harmful, unintended consequences. Regrettably, I strongly disagree with her assessment of the health care landscape in Indiana and the finger-pointing at hospitals.

Instead, we must address the true health care monopoly in Indiana – the insurance market.

One cannot be critical of the trend of physicians becoming employed by hospitals without first examining its root causes. Spartz should pay more attention to Indiana being the fourth-lowest state in how physicians are reimbursed by private insurance companies.

The dominant insurance companies have long employed a dangerous strategy of depressing payments to physicians by simply granting no annual rate increases. As a retired health care financial consultant, I have often heard senior insurance executives boast about keeping physician fee schedules flat for more than a decade.

Communities need physicians and other medical professionals to have a vibrant hospital. There are a number of communities in Indiana that could not recruit and retain their medical providers, and eventually their hospitals failed.

When a community’s hospital fails, local businesses also begin to struggle. Eventually, economic development suffers.

A sage mentor of mine once shared that you can drive through small to medium-sized communities in Indiana and, if the downtown is failing, you will likely find a weak hospital.

While our dominant insurance companies have underpaid physicians and other medical professionals, Indiana hospitals have chosen to step up, either by guaranteeing a salary through employment or providing other subsidies.

I can state with firsthand knowledge that even for the average-size Indiana hospital, the annual financial losses associated with this subsidization are enormous and unsustainable.

To be clear, this was never a true “choice” because the alternative for the hospital was to close or, in many cases, merge with a larger system with greater financial resources.

The only other alternative, allowing the government to run hospitals – not unlike Canada or the United Kingdom – would be a disaster.

So to keep physicians and other practitioners here in Indiana and create a more rational payment model, we must address the true source of market distortions – the dominant insurance companies.

Two dominant health insurance insurers control roughly 75% of health care payments in Indiana. This duopoly has systematically suppressed payment to physicians then criticized hospitals for employing doctors to ensure access for Hoosiers.

If policymakers “lower the boom” on hospitals without addressing the underlying insurance market, patient care will be compromised and communities, especially in rural areas, will become health care deserts.

I strongly urge Spartz and all of our state and federal legislative leaders to support our community-based health care providers and seriously look at the monopolistic, dominant health care insurance companies.

Unlike our hospitals, these companies don’t employ hundreds of thousands of Hoosiers who provide compassionate care 24/7 across the state. Instead, these insurance companies only cash checks from our businesses and citizenry and remit the profits to Wall Street.

Edmund R. Abel of Beech Grove is a retired certified public accountant and health care consultant.