When your overriding goal is "bending the cost curve," and you don't care about making private health insurers even more of a power in the delivery of health case, this is the result. Like providing universal coverage by simply telling people to buy private health insurance, keeping down costs by reducing coverage is a simplistic and anti-consumer. And it moves the needle further away from single payer. Not to mention even having a public option.
Federal officials often say that health insurance will cost consumers less than expected under President Obama’s health care law. But they rarely mention one big reason: many insurers are significantly limiting the choices of doctors and hospitals available to consumers.http://www.nytimes.com/...
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Consumers should be prepared for “much tighter, narrower networks” of doctors and hospitals, said Adam M. Linker, a health policy analyst at the North Carolina Justice Center, a statewide advocacy group.
“That can be positive for consumers if it holds down premiums and drives people to higher-quality providers,” Mr. Linker said. “But there is also a risk because, under some health plans, consumers can end up with astronomical costs if they go to providers outside the network.”
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“Doing so enables health plans to offer lower premiums,” the study said. “But the use of narrow networks may also lead to higher out-of-pocket expenses, especially if a patient has a complex medical problem that’s being treated at a hospital that has been excluded from their health plan.”
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Outsiders might expect insurance companies to expand their networks to treat additional patients next year. But many insurers see advantages in narrow networks, saying they can steer patients to less expensive doctors and hospitals that provide high-quality care.
Even though insurers will be forbidden to discriminate against people with pre-existing conditions, they could subtly discourage the enrollment of sicker patients by limiting the size of their provider networks.
“If a health plan has a narrow network that excludes many doctors, that may shoo away patients with expensive pre-existing conditions who have established relationships with doctors,” said Mark E. Rust, the chairman of the national health care practice at Barnes & Thornburg, a law firm. “Some insurers do not want those patients who, for medical reasons, require a broad network of providers.”
While right now this is a factor in the public exchanges, one has to wonder how long until this model is applied in the private exchanges increasingly being used by employers. It's is analogous to employers switching from pensions to 401ks. Employers benefit, employees take on more costs, or less coverage, and more risk. Over time this may make a mockery of the president's promise that if people like their coverage, the can keep it. They may not have the same coverage, or the implicit promise that they won't have to pay more for it will be violated.
This is what happens when you try to build on the existing private health insurance system to provide coverage, rather than moving to a public one. More and more people will be in an HMO-type plan. With higher costs for keeping the same coverage, and massive costs if they want to go out-of-network.
This is not how the Democratic Party should go about providing universal coverage. But unfortunately, this has become the party of Max Baucus, not of Harry Truman.