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Obamacare: If You Like Your Doctor, You Can't Keep Him


The New York Times has some good news and some bad news for Obamacare. The good news is that, as many had predicted, health insurance costs will indeed be lower than initially projected (although this does not mean that they will be lower than they are now). The bad news is that many insurers are achieving this by dropping a large number of hospitals and providers from their networks, making it considerably more difficult to access quality, in-network care:

When insurance marketplaces open on Oct. 1, most of those shopping for coverage will be low- and moderate-income people for whom price is paramount. To hold down costs, insurers say, they have created smaller networks of doctors and hospitals than are typically found in commercial insurance. And those health care providers will, in many cases, be paid less than what they have been receiving from commercial insurers. […]

“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.”

This is particularly problematic because of the fact that in some states insurers are excluding hospitals that cater to the poor and underserved people Obamacare was intended to help, for fear that treating people at these hospitals would be too expensive. For those in rural areas, this could force patients to drive extremely long distances to access in-network care.

This points to the deepest problem with Obamacare: it doesn’t do nearly enough to address the poorly aligned incentives that drive costs up across the US health care system. As long as this problem isn’t addressed (and the only way to do it long term is to move to a system in which pricing mechanisms can work), exploding costs will inexorably narrow our options and limit the care that all but the wealthiest can have.

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  • Kavanna

    Hmm … I keep wondering about this “cost” thing — doesn’t it keep coming up again and again?

    Perhaps any putative reform of the system should have started with this “cost” thing and everything else would have then been easier?

  • wigwag

    I get it; Via Meadia thinks costs can be reduced at the same time that everyone receives gold plated service and total choice.

    Wake up and smell the java. For costs to be contained something had to give. Limiting the choice of providers for those receiving subsidized insurance isn’t a bug, its a feature. Rather than lamenting this reality, Via Meadia should be celebrating it.

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