Physician choice is limited by private insurance, too

When discussing health care reform options, it’s always important to acknowledge tradeoffs. People who favor private insurance over government involvement will often argue that they want choice. They think that those who accept Medicaid or Medicare (or god forbid, Medicare-for-all) won’t get to choose. They assume private insurance is superior. Here’s the WSJ (of all places) to set them straight:

This fall, Indiana’s new online health-insurance marketplace will present some tough choices for consumers like John Nowak, who will be able to pick a plan from his current insurer—or go for one that includes his primary-care doctor.

That is because Mr. Nowak’s current insurer won’t include Indiana’s biggest health-care provider, 19-hospital Indiana University Health, in the plans it sells on the consumer exchange. If Mr. Nowak buys a new exchange plan from WellPoint Inc.’s Anthem Blue Cross and Blue Shield, he will generally have to pay the cost out of his own pocket if he sees the system’s doctors, because they aren’t in the network.

He’s not alone:

Similar situations are likely to occur around the country, as details emerge about the coverage available through the new consumer marketplaces created by the federal health law. Many of the plans will include relatively few choices of doctors and hospitals. In some cases, plans will layer on other limits, such as requirements that patients get referrals to see specialists, or obtain insurer authorization before pricey procedures.

A McKinsey & Co. analysis of 955 consumer exchange-plan filings, from 13 states that were among the earliest to make them public, found that 47% were health-maintenance organizations or similarly designed plans. Such plans generally don’t pay for care provided outside their networks. A number of other plans, though classed as preferred-provider organizations, or PPOs, will also have limited choices of doctors and hospitals in their networks.

The big reason behind these limited plans: Cost.

Full disclosure: I work at Indiana University, and after some mergers are finalized, I’ll be part of Indiana University Health. But that’s irrelevant to this story. What you’re seeing is a product of cost control in the private insurance market. Sure, you might not like government regulations or price setting as a means to lower spending. But the tools available to the private market aren’t magical. They can ration, or deny you expensive care. They can use cost-sharing to try and get you not to obtain care. Or, they can contract with certain networks of physicians, getting better deals with them, and making it much more expensive for you to see a doctor they don’t favor.

If the doctor you like is out of that network, you’re out of luck.

I can’t stress this enough – this is private insurance. Ironically, the insurance program with the largest network in the country is likely Medicare. You can go to almost any hospital and get care, without worrying if you’re “in network”. I bet more physicians nationwide accept Medicare than almost any other insurance product.

Remember that the next time someone warns you off public insurance because it limits “choice”. One more piece of irony, for those of you who hate Medicaid (emphasis mine):

Indiana University Health said it would be included in the exchange plans of at least one Indiana carrier, MDwise Inc., a largely Medicaid-focused nonprofit in which it has an ownership stake.

Chew on that.


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