Robert Pear, in a 1,200-word front-page analysis for the New York Times (9/23, A1, Pear, Subscription Publication, 9.61M) under the headline, “Lower Health Insurance Premiums To Come At Cost Of Fewer Choices,” says Administration officials “often say that health insurance will cost consumers less than expected under” the Affordable Care Act, but, according to Pear, “they rarely mention one big reason: many insurers are significantly limiting the choices of doctors and hospitals available to consumers.” Pear says that in an effort to “hold down costs,” insurers “have created smaller networks of doctors and hospitals than are typically found in commercial insurance,” but argue that “having insurance with a limited network of providers is better than having no coverage at all.”
Blogfinger Medical Commentary: By Paul Goldfinger, MD, FACC
As the truth begins to emerge regarding the impact of Obamacare on quality in our healthcare system, I will continue reporting on this aspect of the ACA controversy. One of the biggest problems with Health Maintenance Organizations (HMO’s) that I witnessed in the past was the limitation of patient choices in selecting doctors and hospitals. Americans are used to having such free choice, and most patients I met were furious that those choices were restricted. The impact came when the best doctors and hospitals were excluded from network lists. Typically, the highest quality places were not on the lists, and I was limited in where I could refer my patients for complex surgery and expert opinions.
The Times article doesn’t make my point that some medical providers are superior than others, but we all know that is the truth. If I get cancer, I want to be able to go to Sloan Kettering, but as noted, under a restricted insurance policy, the out-of-pocket cost could be high. Peace of mind is also worth something, but insurance companies don’t want to pay for that, so if you believe that a second opinion or a treatment (eg surgery) from a particular doctor or hospital will satisfy your quest for the best care, then you may have to put your policy in the drawer and get out your checkbook.
Although I believe that choices in healthcare promote quality, I have learned that when it comes to the bottom line (eg insurance premiums) patients will opt for price and get used to a new way of doing things. But, as we are hearing lately on the news, those premiums may actually go up, not down in many cases. So some of you may wind up with higher costs and fewer choices.
blogfinger.net 
And what would you propose instead of ACA?
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Free choice allows patients to choose the best doctor. Doctors compete for patients through their reputations and word of mouth. The ACA, and it’s small networks of doctors, limits the patient’s access to quality physicians.
How does a physician get into the network? By accepting a low level of reimbursement. What kind of doctor would sign up for a network focused on cost minimization and low physician reimbursement? Low quality doctors who cannot compete in the free market. My cardiologist now accepts only cash. He can do this because he is great.
The ACA is destroying American Healthcare….but that’s the system people voted for so we have to submit to our fate.
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Ken. Are you suggesting that in order to critique the new health plan, we must have an alternative plan? The ACA is the law of the land, and all of us who care about our country should be taking a good look at it. A Democrat in Congress said yesterday that if we want to know how the ACA will work, we need to wait until it takes effect. As far as I am concerned, that is unacceptable, so I will continue looking at it now from the perspective of a physician, with patient care as my main issue.
But, to answer your question anyhow, Medicare would be a pretty good model—Medicare for everyone. But, I hasten to add, it has to be Medicare before the current admin. strips it of its goods. Seniors need to be worried about Medicare v.2.0.
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Paul, I like your idea, “Medicare for everyone.” seems like a good plan, maybe even better than ACA since it is already up and running.
ken
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Medicare, as it stands today, for everybody, would be great! I believe it’s even something Obama has spoken of, as recent as the 2012 debates. Many liberals support the idea.
Sadly, the ACA, which is mostly based on 90s era conservative, market-based, private insurer healthcare reform ideas, is screamed about today as being socialism. Medicare for all would be seen as outright communism…or worse.
The ACA was the best we could get given the current political environment…Medicare for all, while a great idea, is fantasyland.
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The alternative to the ACA, and to Medicare for everyone, is the current system — that would be the system that works well for a majority of Americans and has for the last 50 years. You don’t have to blow up the whole system simply because <25% of people were not well served by it.
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Oldtimer – If it ain’t broke, don’t fix it, right? Except it is broke.
The un/underinsured you mentioned don’t get healthcare until they get to the point where they have to go to the emergency rooms, where they receive overpriced care that they can’t pay for, and those costs are passed on to those of us who are insured via higher premiums.
The ACA is far from perfect, and Medicare for everybody would be better. But the ACA doesn’t blow up the whole system – far from it. And with the ACA, tens of millions of working, uninsured American citizens will now have the option and ability to purchase (with their own money, assisted in part in some cases with government subsidies) affordable healthcare insurance.
Insurers will no longer be able to deny coverage for people with pre-existing conditions. It will help to close the Plan D donut hole. Programs will be implemented to help trim the fat and inefficiencies that we know are a large contributing factor to today’s inflated and growing healthcare costs. The status quo is simply unacceptable and getting worse.
I firmly believe that time will show that the ACA is an improvement over the alternative you proposed – doing nothing. Remember, in the early 60s Ronald Reagan told us that Medicare was a radical socialist program that was going to destroy freedom. Does anybody hold that opinion today?
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Here is my problem with the above thinking. First, Medicare is going broke in 10 years, according to the Medicare Trustee’s report. Medicare is an entitlement program that is simply out of control and it is basically a redistribution of income program (what some might call socialist). Do you really want to make this program bigger?
Second, the ACA is now projected to cost $300-500 billion dollars (depending on whose estimates you chose) more in the next 10 years than originally forecasted when the law was passed. Again, this is a redistribution of income program (what some might call socialist). The ACA is, in fact, more socialist than Medicare because the Government does not require you to join Medicare (while you are penalized through a large and growing fine if you do not enroll in the ACA).
While the current system is not perfect, it does serve a significant majority of Americans well. As we march down the road to socialism through Medicare and the ACA, we will find ourselves in a situation similar to other countries — where everyone is “equal” — all get the same lower quality, rationed care.
My question is: Why should I (or anyone) have to compromise my (their) current excellent medical care to benefit someone else? Said another way, when the “takers” are finished taking, will the “makers” just shrug?
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Oldtimer— Your preferring the current system is costing ME money. Why should I have to pay, through higher insurance premiums and federal taxes, the overpriced billings hospital emergency rooms charge?
And the 25% you refer to who are uninsured, do NOT pay for their Emergency Room visits —-it is the rest of us who do.
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Ken: By your logic, when the ACA kicks in, your premiums will go down since you will no longer be bearing the cost of the uncompensated care of the 25%. Not going to happen. Instead your premiums and taxes will go up to pay for the uncompensated to consume far more medical care than they do now. Seems like the 75% get a raw deal while the 25% — who probably are not paying much taxes (if any) — reap the benefits of everyone else’s hard work. No wonder 58% of Americans do not support the ACA!
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Oldtimer – The most recent report has Medicare falling into insolvency in 2026 – 13 years, not 10. But that’s just 3-years, not a big difference. What one should note is the variance between the projections and reality. And the ACA actually increased years to insolvency – pre-ACA, in 2009, years to insolvency was 8…now it’s 13. Back to projections v. reality – in 1998 the projected insolvency year was 2008. That obviously didn’t happen. One shouldn’t ignore the insolvency projections but one should also note that government will react to those projections to increase the years to insolvency for what is a very popular – across party lines – government program. The ACA does that.
The ACA is a deficit reducer – every CBO reports says so, regardless of cost estimates. Freeriders increase fees for those who have coverage – why should they not be required to purchase the reduced insurance the ACA provides, especially when subsidies for coverage will be available?
Why should I pay more because somebody else decides not to pay? And as I noted earlier, most of the uninsured in our country today have jobs, but jobs that don’t offer health insurance or offer it at a cost-prohibitive rate. Some are self-employed. They are not “takers”. Just because they ain’t me with my generous employer provided plan doesn’t mean they are “takers”: – they’re probably “making” more than me on a daily basis – and to say otherwise is offensive to tens of millions of working Americans.
And are you really calling Medicare an entitlement program? Many of the ACA’s loudest opponents do so by saying, “keep government’s hands off my Medicare!” Should we couple the elimination of the ACA with the elimination of Medicare? I’d love to see the reaction to that.
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Ken, the counter argument is why should I be forced to pay for something I don’t need, or be forced to pay more for less service.
My premium under BCBS is going up unless i switch to an Obamacare approved plan which would cost what i pay now. However, i would have to find a new doctor, the closest is in Eatontown and that doctor has privileges at Monmouth. Right now my doc is in Neptune and has privileges at JSUMC. So i am being forced to either travel further or pay more for what ive had for the last 4 years. Now granted i am still young, so im the one everyone relies on to fund insurance and hope i dont get sick
What i would really like to see is allow companies to compete across state lines. There are 50 different branches of BCBS in this country, with 50 redundant structures. If the entire country was allowed to buy in to one company, premiums would go down because the company could streamline their infrastructure and you have a larger pool of payers covering the sick
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Abbott – Most uninsured Americans are working hard – probably harder than me with my generous Wall St. provided healthcare insurance plan – and are paying, at least, payroll taxes. Many are also likely paying some income taxes…maybe not as much as the wealthy on their flat income but then they also don’t have as much to deduct.
Most of the people who are truly impoverished are covered by Medicaid. The majority of the uninsured are people who work hard but their employers don’t offer insurance and don’t pay enough to afford it, or work part-time, or are self-employed, or are in between jobs in a tough economy.
Where you see “takers”, I see people trying to hard to get by who should at least be able to have a wellness visit once a year without having to go into debt. Or go to the emergency room when needed without having to incur costs on those lucky enough to have employer provided insurance or government provided insurance (Medicare, Medicaid, VA, etc).
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