Tradeoffs in care?

August 3, 2010 

America's for-profit health insurance system is driven by companies that make a buck or millions of them by trying to sign up healthy people whose premium payments will be steady and whose health will be good. Health care reform won't change that entirely, but by the time reform comes more or less into full bloom in 2014, those insurers no longer will be able to deny coverage to people with health problems. That change stands to cost those companies some money.

Clearly, the industry is scrambling for ways to make up the anticipated difference, and one of them, as reported by The New York Times, is a move to offer cheaper policies with a catch: people would have fewer choices of doctors or hospitals.

Those who chose to go to "outside" physicians and treatment centers not on the insurance company's approved list either would pay full costs or much higher costs. At a time when even the simplest procedures or treatments can quickly produce bills climbing to the stratosphere, that obviously would be prohibitive for many people.

Companies that are experimenting with "narrow network" plans believe consumers will like the idea of lower premiums as a tradeoff for restrictions. But will they? The HMO movement of several years ago showed promise as a way to control costs, but it fizzled because people who were in those plans grew angry over the fact that they couldn't pick their own doctors, or least were limited beyond reason in their choices. Some felt that certain rules of coverage denied them the chance to develop relationships with a single primary care physician.

The Times notes that the health care reform plan narrowly approved by Congress this year is supposed to protect people from having two few choices in their health care. But it's virtually impossible for the government to put a number on what represents adequate choice.

Then there is the question of quality. Will insurers fill their lists of choices with new physicians or those who might be less expensive, say, than a doctor with a long-established reputation in the community who might charge patients (and thus insurers) more?

The companies say they are mindful of quality, and keep track of how well a doctor's patients do in recovering from surgery and the like before adding that doctor to their list of covered care providers. But precautions of that kind should be codified in regulation and not left entirely to the judgment of the industry. Patients will be willing to accept their share of responsibility under reform. The companies must also accept theirs.

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