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[UPDATE]  See update after fold

The Obamacare haters are in the last gasp of trying to shoot down the ACA before people realize what a great thing they’re getting.  To that end, they have resurrected the old canard that you won’t be able to choose your own doctor.   Of course this is just more misdirection from our friendly neighborhood nihilists, but maybe we all should take a deep breath and think through just what is meant by the concept of choosing your own doctor.

First of all, if you are paying out of your own pocket, you can go to any doctor who will accept your money.  This would be pretty much all of them except for some who might not be accepting new patients; any doctor you are currently seeing will presumably continue to see you as long as you pay (unless he/she drops dead, retires, is indicted, etc.).  So, if you don’t have any health insurance at all, I guess that means you are completely free to “choose your own doctor,” as long as you pay the full cost.  

OK, but let’s say you now have health insurance.  In most policies these days, there are  “in-network” and “out of network” doctors, sometimes called “preferred providers” and “non-preferred providers.”  Basically, the in-network providers have negotiated favorable rates with a specific insurer.  Some doctors belong to multiple networks; some don’t belong to any network at all.  You usually can determine whether a physician is in-network for a specific insurance plan by consulting the plan’s website.  

This does not mean that you can’t see an out-of-network physician under your plan, only that it will cost you somewhat more to do so.  The normal practice is that an in-network doctor visit is reimbursed at, say, 90 percent (after you have met your deductable), whereas an out-of-network visit might be reimbursed at 70 percent.  This is not a feature of the ACA; it has been standard practice in the medical insurance industry for at least two decades now, and I presume that most of the plans offered by the exchanges will have some form of the in and out of network distinction.   Like many people, I have several doctors I have seen regularly over the years; most are in network but at least one is not.  I continue to go to him because I think he is good, but I could save some money by switching to someone in-network in his specialty.  

Now if you have a major medical issue, the whole thing will basically become moot.  You will most likely exceed your yearly out-of-pocket limit (usually around $6000) and everything else will be paid at 100 percent, even if the providers are out-of-network.  Some policies have two different out of pocket limits; mine is $4000 for in-network and $6000 for out-of-network.  However, I assume that if anything that bad ever happens to me, the treatment will probably include consultations with specialists and outside providers who are out-of network, so I figure that I will have to satisfy the higher out-of-pocket limit.  

The bottom line is that there is no question of not being able to choose your own doctor.  The only question is the rate at which it will be reimbursed below satisfaction of the out-of-pocket limit.  Even if you had an insurance policy that wouldn’t pay for a specific doctor for some reason (most likely because it is some unproven alternative therapy), you would still be completely free to consult that doctor at your own expense.  There is absolutely no requirement in the ACA or anywhere else that says you must claim a medical expense on your insurance; you can always just pay for it on your own.  

So what if you are uninsured and have no financial resources?  Well, you can't choose much of any doctor, can you?  Our GOP potentates are fond of reminding us that these folks can just head to the emergency room, but my experience with emergency rooms is that you don't get to "choose your own doctor" there.  


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Update.  Thanks to all those who commented.  There seems to be a fairly wide range among plans as to how big a difference there is in reimbursement rates for in-network and out-of-network doctors.   However, keep in mind that, in a true medical crisis, it should become mostly moot after you hit the out-of-pocket limit.  This underlines why the out-of-pocket limit is the most important aspect of any health insurance plan and should be the first thing you look at when comparing (you want it to be as low as possible).  

What it gets down to is that "choice" in any consumer product or service is to some extent related to how much you are willing or able to pay.  We have a choice of what car to drive, but if our resources are limited, it will be a Chevy or Honda rather than a BMW or Rolls Royce.   I may want Dr. Oz as my personal physician, but I suspect he's too busy raking it in on the talk show circuit to take me on right now.  Maybe if I were Jeff Bezos...  Even in that most "socialistic" of health care systems, the British, you still have the option to "go private."  

The other point, of course, is that the ACA will not affect this situation one iota.  Everyone who has a good plan now will be able to keep it and continue to see their current doctors.  Physician networks are a fact of life now, and have been for twenty years.  The ACA won't change that.  The ACA will just make it possible for most people to get affordable insurance, and will protect all of us from the worst insurance industry abuses, such as yearly limits and rescissions.  

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