Insurers Push Plans That Limit Choice of Doctor

As the White House begins to enact the new national health care law, the biggest insurers are promoting plans with lower premiums that allow fewer doctors and hospitals.

Comments: 125

  1. It's too bad that American's were terrified by the Canadian model of healthcare. In Canada you just pick your own doctor. As long as the doctors taking new patients you choose whoever you want.
    Kind of what America was like before it saved itself from Socialism.

  2. There is a term for what the administration and insurance industry have done here: bait-and switch. Note that single-payer would have preserved choice.

  3. In this article I kept seeing the words 'saves money'. 'Saves money.' 'Saves money.' What I notice in accordance with this is the money saved is by the insurance companies, quick to see how they can cover themselves.

    Again & again! THere is the situation of insurance companies and their money-lined agendas. When will this healthcare reform enact some changes that FORCES insurance companies to consider and work for the consumer.
    (You guys remember the consumers, right? That population of individuals whose $$$ seems to float out of their pocket to pay medical costs though all the while hoping to goodness that they will not experience health problems. And somehow, if they needed that 'specialist' not covered in the insurance packet, they will have to foot the bill themselves!? What is this nonesense? Healthcare should be about helping PEOPLE. People, that work hard day to day; enjoying their lives; working on themselves; taking care of their families; those that are not so lucky to be born with good health.-- It should be about helping people get healthier, stay healthy, be healthier.

    Or maybe we should just find the $ in that.

    Why

  4. I wonder how the approved doctors are selected. How are approved hospitals to be selected. Are the doctors who treat aggressively the so called "Gucci" doctors and are the doctors who "wait and see" the approved doctors?

  5. Of course we can all continuing to go to the doctors of our choice. It's just that it won't be convered under the new plans. In effect we'll have coverage that won't do us any good. So much for not increasing our costs and other campaign promises.

  6. The headline makes this sound like a bad thing. But I've had insurance for years through my union, insurance which provides different levels of choice at different prices. What's wrong with that in a free market?

  7. It really is unacceptable to limit a patient's choice of physician. If you find a physician that you trust, you should not have to give up that relationship because your health insurance is dictating who you are allowed to see. This is just one more example of health insurance companies having too much power in this country.

  8. National health care.

  9. The Pelosi-Obama super-recession is about to grind harder as the IRS enforces existential insurance purchases on those at the low end, and 2011 tax increases make a grab for the remaining assets of everyone else. Their lies are becoming clearer now. Consent of the governed, indeed.

  10. This is nonsense. The insurance companies allow only pre-set rates for each procedure anyway, so whether or not a doctor charges a lot, or a little to the customer, the insurance company generally pays the same amount. This just boils down to whether or not the insurance pays the whole "adjusted to their rate" bill and the patient doesn't have to pay anything except the deductible, or the patient has to pay additional for an "outside the group" doctor. The insurance should pay their standard amount either way.

  11. NOW will the American public come to grips with the fact that insurance companies are out to line the pockets of their top management without regard for the quality of health care of their clients?

    IT'S TIME FOR A SINGLE-PAYER SYSTEM!!!!!!!!

  12. Sept 2009 - "It absolutely is NOT a tax. I completely reject that notion." July 2010 - "It absolutely IS a tax." "If you want to keep your doctor, you can." Well, that is UNLESS he/she doesnt meet our bureaucratic standards. "Taxes will NOT be raised on families making less than $200k"

    Just a special thank you to the people who voted for this fraud!

  13. Obama kept saying "Yes, you can keep your doctor". Doesn't look like it with this kind of plan. YOU LIE!

  14. Wouldn't it be easier if the insurance companies just paid the portion they would cover an in-network Dr. to an out of network Dr. of the patients choice? The patient would have the option of going to a higher priced Dr. if he wanted to pay a higher co-pay. The insurance companies need to be regulated, not the patients or Dr.'s. We already have this choice in medications. If we can't afford the cost of a medication we have to ask the Dr. to prescribe something cheaper. Maybe not the best but what we can afford. Look at the pharamceutical companies if you really want to make health care "affordable".

  15. So will health insurance companies be regulated by the same government that gave us the SEC? My advice for Americans, don't grow old and don't get sick.

  16. The best plan would be national health care that caps the present usurious health plans at a 15% profit, and tax those who go above it at 100%. Time to stop the greed.

  17. Democrats said this was a landmark and a victory. Not for the American people, nor for the doctors. Canada has a better system at much lower cost. Why do we deserve less?
    Right and left, politicians oppose policies that benefit everyone.

  18. Bring on the death panels. It was bound to happen, through the pocketbook, not the law. The Tea Party and its members should be chastened -- and then hung.

  19. One more thing, the guy who used the term 'Gucci' doctor should have to all his health care needs met for the rest of his life by a cranky 5 year old w/ a toy stethoscope.

    I wonder how he selects medical care for his family? Does he call around to see who will work for the absolute cheapest or who's most conveniently located? I'm guessing not. I'm guessing he too would move heaven and earth if someone he loved as at risk.

    His employees reading his hateful quote most feel very, very valued today...

  20. "What's wrong with that in a free market?"

    Are you actually saying the health care system we have in America operates in a free market? Really?

  21. Doubletalk! It has nothing to do with saving money for the patient, and all to do with preserving profits for the insurance companies.

  22. I've been with the same gastroenterologist for years monitoring chronic liver and esophagal diseases and paying hefty deductibles and co-pays for annual check ups and five year biopsies. If I now have to pay the same prices and be re-assigned to a lesser doctor (this guy is the best in my small town) so that my insurance company can keep more of my money, I am worried about the continuity of my care and the knowledge that my doctor and I have accrued over the years. This is exactly like the banks reconfiguring fees to avoid the intended consequences of the new financial legislation. Mercenaries should not be calling all the shots at these institutions. Where are the good people?

  23. As usual, greed is alive and well in the American corporate world. As soon as laws are passed, corporate America does everything it can to get around those laws. The spirit of the law means nothing to them. Greed rules.

  24. Health care insurers have been doing this for years. They are the true "rationers" of health care. The political Right refuses to recognize this and calls everything else "socialized medicine". After a few years' I suspect they will be clamoring to be covered by "Obama Care". That is, if they have any sense.

  25. The for-profit insurance companies previously lowered the standards of health care in the US while increasing the cost. The new law allows them to continue down the same road. Hold onto your wallets!

  26. I had US Heathcare in the early 1990's and loved it. My firstborn son had to spend 10 days in a neonatal ICU at one of the top hospitals in NJ, and when it was all over my out pocket expenses were $200. The pushback against HMO's was really an effort by doctors who hated the way the HMO's used their purchasing power to hammer their fees.

  27. This has been going on since the 80's. First the monopolization of a industry and then outsourcing and/or downgrading of services. Welcome to the new big business fueled democracy.

  28. It seems good to be able a network if you choose to do so even if you have to pay a little more.

  29. Perhaps all of this could have been avoided if President Obama had allowed "single-payer" to the table.

  30. Is anyone surprised? We'll be very lucky if 5% of what the politicans said and promised holds up. Everything they do is a sucker's game.

  31. This is not the change I can believe in.

    This is not what we voted for.

    This is going to bite Democrats bigtime

    What happened to the Patient Protection and Affordable Care Act?
    Where's our protection?
    Where's our affordable care?

    I thought I heard over and over, "if you like your doctor and your health plan, you can keep what you have". Obama just forgot to add, if you can pay for it.

    And I'm a loyal Democrat, I dread to think what Repugs. are saying and feeling.

  32. In Hawaii we are restricted by statute to just a few choices of insurers for health coverage. I wonder what health insurance is really going to cost us with mandated coverage and so few choices? So much for saving money for the consumer.

  33. if the insurance companies can dictate your health care provider, you can be sure obamacare will also have the same discretion with the addition of limiting the amount of visits you are allowed.

  34. The Federal Government should not be in the business of health care or insurance.

    Just another Obama bomb that needs to be removed from the books. In the meantime we have to deal with the damage.

  35. Ah, yes, Health Care Reform! I remember it's predicted to increase the deficit by $239 Billion over the first 10 years. Now, if I could just remember what it is supposed to actually accomplish.

  36. Why would anyone be surprised that insurance companies would figure out a way to not only make a faster buck, but make everyone else look like the bad guy.

  37. So...can we wise up and repeal this monstrous "health care" bill immediately? Or must we wait until after the November elections?

  38. The Structured and New Products Unit will specialize in cases
    involving complex financial instruments.

    The attorneys who investigate are: David Gottesman, Rick Simpson, Jeff Leasure, Cree Kelly, Lorin Reisner, Ken Lench, Reid Muoio, Jason Anthony, Mellissa Lamb and Jeff Tao...

    We should pin a tail on each of them and follow their progress...
    I am sure they were vetted, I wonder how well???

  39. Boy, am I glad I live in Canada where people can choose their own doctor and the government manages health insurance. The American system still sucks for all but the richest people.

  40. This article would be much more enlightening if it shed some light on how the insurance companies decided which doctors it would cover. Lazy reporting.

  41. And the loss of freedom, loss of choice, and the rationing begins. Thanks President Obama! More promises broken.

  42. Wait a minute. Didn't the NYT lie to all of us and tell us that we would be able to keep our plans? I think you did. Just another lie from the MSM to help obama pass this monstrosity. And now you are forced to tell the truth. Do you get an award for not doing your job too? Oh, yes. It's called going out of business.

  43. This first. Then rationing, they -- yes -- death panels. Sarah Palin was right.


  44. Americans still believe they can have great health care on demand, access to all procedures and drugs, choose whatever doctor and hospital they like, and that it can be cheap. But the evil insurers are preventing this healthcare utopia.

    Children.

  45. Our insurance asks us to choose from a list of "in-network" providers now. If we choose one from "out-of-network" we pay for it. I don't see that this is any different.

    If it gives us at least a few choices, and saves money, it works for us.

  46. So, less choice through Obamacare, Who'd have guessed it? Nancy Pelosi " We have to pass it to find out what's in it." More surprises to come....

  47. Another treat courtesy of Obamacare.

  48. We had better pray this healthscam gets repealed in 2011. If the dems are re-elected, we will be slaves in 2011 - healthcare be damned.

  49. Let the rationing begin

  50. In answer to poster #3 - it will be this way as long as the insurance companies are for profit. Whenever profit collides with people in the business world, profit wins.

  51. Remind me again why health care reform left the insurance companies still largely in control of our health care? Oh, I forgot, the Senate is bought and paid for by the insurance companies.

  52. Oh please President Obama make all my decisions for me. I love having the government do everything for me. I am one of the takers, I appreciate the givers that pay and pay the government to support me.

  53. But, but, but....President Obama said that we could keep our doctor!

    This is the law of untended consequences kicking in, right on schedule. The insurance companies are merely responding to the regulatory framework that His Munificence has bestowed on them, and us. Plenty more of this to come.

  54. Being in Maryland I call tell you first hand, as a physician, that the members of congress are not shopping for K-Mart doctors!

  55. Just another way to screw the people.

  56. Nearly five hundred dollars a month for bare-bones insurance? Twice that for a family? And people feel privileged to have it? Completely insane.

  57. I’d sure like to know what the excluded doctors have to say about this……..

  58. JimBob said: "I've had insurance for years through my union, insurance which provides different levels of choice at different prices."

    Well wait until 2018, when your union healthplan is deemed to be a so-called 'Cadillac Plan,' and your benefits are cut, or you're asked to pay a 40% premium on it.

    Nice job, everybody who supported this monstrosity of a bill.

  59. "That could come as a surprise to many who remember the repeated assurances from President Obama and other officials..." It's not a surprise to those who remember the assurances, just to the dumbasses who BELIEVED them.

  60. This story and the comments are really strange to me. I have had Blue Cross Blue Shield for years and for years they have had their "preferred providers" list. Those are the doctors that agree to charge lower prices and so more is covered. You can go elsewhere, but you pay more because the insurance won't cover the higher charges. Nobody is limiting anybody's choice of doctors -- unless you want the government to mandate what the doctor's charge. This has nothing to do with the Health Care legislation. It's the doctors, not the government that determine health care costs.

    This is no new change and it is no limitation-- other than the limitation of the market.

  61. Anyone who thinnks insurers won't limit the choice of physicians and hospitals to the lest costly regardless of quality is nuts.

    There is no way to really assess "quality." There are no measures for most medical services. And the few known measurers - heart attacks, infections etc - really don't apply to most specialties or even routine care.

    There is no way to measure whether the GP gets the diagnosis right or wrong if the patient isn't ever hospitalizes (readmission nonsense)

    There is no way to measure whether a chronic pain specialist is highly skilled at pain procedures (rather than just handing out drugs.) No organization - not Medicare, no insurers - keeps track of any kind of results of care let alone the skill and level of care.

    There is no way to measure whether the dermatologist is more effective in diagnosis and treatment than another.

    Bottom line is that the only so-called measures are things like 'hospital readmissions' which are very broad and inappicable to most care. (And given that insurers can and do refuse to approve a readmission or other care, meaninglessly skewed.)

    Trying to measure the quality of care by the grossly broad and unrelated data at hand is like trying to measure 1/1000th of an inch using a yard stick.

    So since it can not be done, the insurers wil resort to the lowest price.

    And frankly, I would not be willing to use the sole local pain care practice for my highly sophisticated pain management protocol set-up by one of the top 3 medical facilities in the US. The local practice admits they saw the procedure done when they were in training and might be able to do it. My physicians at the top medical facility have done it hundreds of times. And if the procedure goes wrong, a lung collapses and one arm can be paralyzed.

    And the insurer would pick the local inexperienced - but board certified - providers over the facility that is experienced but more expensive. And it will be the HMOs of the '70s all over again.

  62. What this article is describing is what I have had for decades in my union. If I belong to an HMO, its the cheapest price I can get. If I choose not to go with an HMO but stay with a list of contract doctors and hospitals, the price increases, but gives me more choice. If I go out of the network providers, then that is the highest of all. I would have to pay the difference that a contracted doctor would charge and a non-contract doctor or hospital would charge. As far as I know, very few people would take the last option because it could be bankrupting. So whats the point of this article? Its nothing new that the article is referring to.

  63. Here's the problem with this. I had to see seven breast surgeons before one was able to correctly diagnose and treat my problem. It was two years of hell. But it would have been a lifetime of hell if I'd been restricted to the first or two who couldn't diagnose a hangnail if their life depended on it. And I'm not the only one--every one of my friends has a story about doctors who weren't able to diagnose them the first time around, and statistics show that doctors' first diagnosis is correct only 16% of the time.

    So I guess I'd be bankrupt today if I'd had to seek treatment for my difficult situation under the new plan. I think the Congress ought to create a new law for medical bankruptcy, because more and more of us will be choosing between our credit rating and our health.

  64. It should be pointed out that a plan that has virtually no out of network benefits, and that is very reduced in terms of in-network doctors simply is bad to the patient.

    In bean-counter mind all doctors are the same and all hospitals capable of treating any illness equally well... Something that is simply not true.

    This is a race to the bottom, and at the end, nickeled and dimed, we will end up with useless plans with one purpose only, and that is, to enrich insurance companies.

  65. No where are the insurance companies talking about quality of care. This is the scary part. I currently have United Health Care and the in-network doctors in my area are not quality, forcing me to go out of network, and mind you, I am healthy. Do you want quality? Then you still pay and pay a lot. This is where single payer would provide choice and has a better chance of providing quality -- because people would gravitate to the better doctors and hospitals leaving the others in the dust.

  66. This latest abomination is one more reason to go to a Single Payer, Medicare for All, system.

    This is an "industry" that has no legitimate reason to exist. Period. The only "purpose" of the existing business model for health insurance is parasitic profit at the expense of providing real health care to all Americans.

    Once you totally eliminate the sheer waste of the overhead costs of "health insurance" the money saved is sufficient to pay the costs of quality health care to the whole population.

    Senator Baucus knew that it was impossible for the existing system to go toe to toe with Single Payer in a nationally televised Senate hearing....so he took the discussion of Single Payer "off the table" and then had the doctors and nurses who spoke up and tried to participate in the debate *arrested* like common criminals.

    The American people know they are being screwed by the existing insurance industry. They want fundamental transformative change that would save money and save lives, but pay to play pols persist in self serving lies that Single Payer is not "politically" feasible. What they're really saying is that they are bought and paid for by and that they like it that way.

    The whole industrialized civilized world has found ways to provide universal health care to all....and they do it without the kind of perverse health insurance industry business model that we inflict on our people in America. Even Taiwan has gone to a single payer system, yet our own elected representatives remain more motivated by fear of the existing insurance industry than by love of the actual people/human beings they were elected to serve.

    It ultimately comes down to a moral/ethical decision. The actual policy merits were settled long ago. Will we continue with a system that is little more than organized thievery in the pursuit of profit at the expense of human life.....or will we finally put an end to a parasitic "industry" that continues to feed off the life's blood of the American people?

    Sadly, the billions of dollars that this industry spends on lobbying, campaign "contributions", public relations efforts to confound confuse and distort and divide us all seem to be winning the day.

    Having said all of that, I affirm that a Single Payer system is going to eventually come to America and that we will become part of the rest of the civilized sane world at some point. It's just a question of how many more millions of Americans will have to suffer and die before the sheer moral and economic burden become of an unsound and insane status quo so unbearable that we are so broke that we are *forced* to eliminate the parasites in our midst.

  67. What happens to people whose life depends on the availability of the experts at John Hopkins, M.D. Anderson, or the Mayo?

    This scenario sound to me like just one more barrier to health care for folks are the least likely to be able to pay out of pocket and/or who live in underserved health care markets.

    Why would any reasonable consumer continue to live in a market that didn't include access to top quality health care? Why would any employer who wanted access to the best and brightest employees choose to locate their business in a health care market that didn't include access to top quality health care?

    Though my husband and I both work for a large public university that hosts a med school, there's no one here w/ the expertise necessary to insure he has any chance of living a normal life with a normal life span. He requires access to the level of care that can ONLY be provided by an expert in the field. We regularly travel two hours to St. Louis to see a name that anyone in the field of my husband's issue would recognize immediately.

    We understand that access to this physician's expertise may or may not solve my husband's problems. However, it's the best chance that he's got. I would quit my faculty position in a heartbeat to take a job as unskilled, minimum-wage laborer at his physician's university if that was the only way he could continue to have the care he requires.

    Are the folks so hot to limit access and ration care really (capable of) thinking through the likely consequences of their decisions?

    Ultimately, I'm a rational economic actor. I'm going to move heaven and earth, do whatever I can to make sure my family is healthy, safe and protected.

    Folks like me number in the millions. Before we start laying down our lives so Aetna and United Health (& all the other brethren of Beelzebub)can maintain its growth in profit margin, we'll do everything in our power to hold them responsible for their greed and misappropriation of decency and humanity.

    This is the face of health care rationing. This is what the 'death panels' will look like. They won't decide on who gets end-of-life treatment and who doesn't, they'll decide who gets access to what level of quality of care. If you're lucky enough to have plenty of money or live near a quality medical network, you'll get a shot at the fullest, longest life. If you're not lucky enough to have financial or geographic access, you're out of luck and out of life.

  68. Some of the claims in this article are unrelated to reality. Current HMO plans in California restrict VERY severely which physicians and hospitals one can use. Very severely. So, the idea of "re"-introducing such plans is complete fantasy. What I suspect we are talking about here is actually plans that will restrict choices even more severely, so that one has essentially NO choice in what provider to see. Then, it will turn out that the only available provider is a recent graduate of a foreign medical school, in a place such as Pakistan, India, Africa, or the Muslim middle east. These recent immigrant doctors are the ones who will be willing to work for lower wages in cut-rate practices until they have developed the ability to move up, only to be replaced by other recent immigrants from third rate foreign medical schools.

    What's more, let's look at those wonderful "savings" that accrued from the great HMO revolution of the 80's and 90's. There were none! Any savings disappeared within a few years in double digit rate hikes. The only savings went into the profits of the insurers.

    Let's face it: the health care system is just as broken as it was before, if not more so, except now more people will have access to the most broken part, health insurance.

  69. According to Sarah Palin, if we had government managed health care - we'd have death panels and limited choice of doctor. It now appears that even with private insurance - we're getting death panels and limited choice of doctor. The only difference is that with private insurance - we get a higher bill and the CEO's of the insurance companies continue to get their 100 million dollar bonuses. The only way to avoid being ripped off by the insurance companies is to die quickly - which of course, increases their profits because they don't have to pay doctors to watch you die slowly.

  70. Costs have to be contained. If we continue along this path it will bankrupt the US. We have expensive care but not effective care. Time and time I have read that again other countries have less costly but more effective health care. Why? Our care is driven by market forces and nothing else. In the US we take more drugs than about 20 countries combined.The elderly are way overmedicated. Doctors get kickbacks for prescribing drugs. That is the ugly truth. We need to take more responsibility for our health choices. Before you take that statin-take care of yourself. Educate yourself and go in to a doctors appointment with a list of questions. People do more research on buying a car than they do on deciding what is appropriate for themselves. When I have questioned friends that work in the healthcare field say that changes are long overdue. Because of the impending changes doctors and hospitals have incentives to improve outcomes.

  71. I want to see something altogether different. I want doctors to operate the same way other professionals operate. Clearly stated hourly rates ($100/hr, $125/hr, etc), and written estimates, made available to patients before any services are performed. But I also want to see a more on/off version of health insurance. Either you have it or you don't. If you have it, you have coverage, and if you don't have it, you aren't covered. No 200 page contracts filled with exemptions from coverage and definitions that conditions must meet prior to coverage. On/off. That's it.

  72. The health care reform is the biggest mistake the current administration has passed. When insurance companies start controlling which Doctors one can see or not see the insured are not much better off than when they did not have insurance. Companies saying that young people do not need as much health care as others are living with their heads under he sand. The majority of people using alcohol, drugs, and cigarets are young people and that increases the need for "care". auto accidents. The fact that some people recover from surgery quicker with certain Drs. and not others camafloges that genes and previous lifestyle have a great influence on the outcome. The government needs to get out of healthcare and i hope that the present measures adopted will be repealed by the next Senate, Congress. & Administration.

  73. JIMBOB WROTE: "The headline makes this sound like a bad thing. But I've had insurance for years through my union, insurance which provides different levels of choice at different prices. What's wrong with that in a free market?"

    Well, the problem is that you get what you pay for in a free market, but in the insurance world, you don't because it isn't a free market. They'll line up the hungriest doctors to take smaller payments -- but the BEST doctors aren't hungry enough to accept those smaller payments, so they don't sign up to be in the smaller group. If you get really sick, especially if you get sick with an ailment that isn't run-of-the-mill, there won't be any doctors in the smaller group who are competent to take care of you. So one of them will take care of you all right. Better get some funeral insurance with the money you're going to save on your bargain health insurance.

    Health care shouldn't be a "free market" commodity any more than sanitation services or water services or police services or fire department services or children's public education should be. How would you like it if people who pay higher taxes get better teachers for their kids? Oh, wait. That's already the case. OK, how would you like it if garbage collection was more frequent for people who pay higher taxes? Oh, wait, that's already the case.

    Never mind. The country's already a mess because of so many years of manipulation of the political process by the wealthy. Our health care system is already the laughingstock of the free world. So it gets a little worse, so what? Right?

  74. Thank you Obama for not only increasing my future healthcare costs, but now managed care (another name for HMO coverage) will be sneaked back in (call it what you want, it is once step from that). Every year my employer raises employee's share of costs while cutting coverage and this year is expected to be even greater increase on employee's end or settle for less coverage in the form of higher deductibles or other fancy cost shifting to enrollees.

    Insurance is a BUSINESS with making money and pleasing shareholders as a goal, the same as the businesses who contract with them. Whenever government legislates benefits thereby increasing costs, these are passed onto the business who cannot absorb all the increase then transfer those costs to their employees (this is a fact). I will be punished next year with higher costs to cover children until 28, etc, and that will just be the beginning.

    WAKE UP AMERICA. How can the economy recover when every employee will have to pay more out of their pocket for health coverage or settle for the 'generic' version. It may not provide the same benefit as name brand, but it WILL BE CHEAPER.

    It used to be that the young, healthy empoyee helped offset the older, less healthy ones in a single or a couple plans, but now the pool for a plan with decent coverage will be only be the truly sick or older (not retired, but over 50) and will cost a fortune. The future will be one of the sick not getting the coverage they need again OR let's choose between food and health coverage.

  75. Talk about bait and switch. The Federal Office of Management and Budget (OMB) put out charts showing us lacking 120,000 generalists (GP,Internist, peds, ob-gyn and general surgery), by 2020, when all the new 30 million walk around with the required coverage. This is in spite of all the new medical school and nurse practitioner schools we've since 2000.The doctors are not going to be there for the insurance companies to pick and choose.It'll be a real train-wreck, with people's high health care expectations..Thanks, White House-Congress team.

  76. Depending on one's point of view, this narrowing of choice will either be blamed on "Obamacare" or on the profit motive of private health insurance companies. Restriction of choice has been a feature of group health policies, though,for many years, in my experience. Some doctors are on the list I get each year from my insurance company, some hospitals are on the list, some medical labs are listed while others are not, etc. Doctors, hospitals, medical labs choose whether or not they will accept various health insurances yet none of them, to my knowledge, refuse cash as payment for their services. True "choice" is only available to those willing and able to pay cash for their medical needs directly to the provider. Or, as Reader #1 from Victoria, Canada, comments, it is also available to those in a single-payer system where its impractial for a provider to refuse that single-payer insurance. I don't doubt that some providers in Canada accept cash directly from an individual but I do doubt that any decline to participate in the only other game in town - the single provider system.

  77. What it boils down to is that what will happen under the new "scheme" will be just what happened in Medicaid: The young inexperienced doctors just out of residency who want a resume of cases for their Board exams accepted Medicaid, but the doctors who already have their Board certification don't need or want to accept the paltry fees Medicaid offers, but don't need the litigation risks from a poorer patient population who try to get money by suing for frivolous reasons, while the young inexperienced doctors get no support from the courts which look upon them as the rich enemy. Tort reform has not been tackled and remains a source of income for fraudulent patients, and in America fraud is the god and is seldom punished.

    I once had a secretary who forged my check and embezzled me for thousands of dollars, and even though I was armed with a proven forged signature, the judge dismissed my case declaring that I shouldn't waste the court's time because "everyone knows that surgeons are rich". I never appealed because I was too busy and the courts know that.

    This lack of justice discourages doctors from entering the profession especially if they are not adequately compensated and already there is a decline of people entering medical schools and the quality of medicine is already declining.

    WE are rapidly becoming third world.

  78. Come August 1 I join the ranks of senior citizens eligible to obtain health care benefits through Medicare with a Medicare Advantage supplement plan (with no monthly premium) with Empire BS/BC MediBlue Plus HMO.For the last ten years I had been saddled with a so-called discount group plan through HIP. For the past year they denied my requests for physical therapy for a progressive and chronic disease. The current HIP quarterly rate for a single person is over $1800 - and that's just for the premium with no other benefits. To see a specialist I had to pay a co-pay of $50 per visit. Since I am still self-employed part time as a psychotherapist, my current quarterly Medicare Part B rate is $331. That rate is based on my current self-employed income. I will have a $15 co-pay to see a specialist and a $5 co-pay to see my PCP. My wish for Medicare is that it is expanded for all those who are between the ages of 50 to 64. My ultimate wish is for a single payer/universal health coverage for all Americans.

  79. We have had choice and continue to have choice in health care: unlimited physician and hospital choice on demand, where we as patients can shop around for tests, procedures, doctors, and hospitals until we get whatever we want, whenever we want it, as long as we know who to ask. This works for voters as long as we perceive someone else ( anyone else) is paying for our right to do so. Obama's health care plan is a disgrace because it does not provide health care to all. Unless it rations care, health care will grow as a proportion of our national budget. This article is simply trying to soft soap the news to those of us who had been paying for care ( employers and employees) and will be paying more for less! Perhaps the hospitals that throw people out while they are still sick or who have poorly payed employees will thrive.
    The lawyers are still happy with him though.

  80. 'There wasn’t any pushback,' Mr. Skoda said. Haro’s employees are generally young and healthy, he said, and they rarely need to go to the doctor.' Great - so companies who engage in pro forma discrimination against workers over 35 get the benefit of workers who are not interested in preserving quality health care for themselves because they 'don't get sick as much,' or 'recover from operations more quickly' (one of the criteria cited in the article as a determinant in 'choosing doctors for the network').

    Are institutions like the Mayo Clinic considered 'Gucci Doctors' - in Rochester they've been able to deliver the highest quality care for years without these restriction or ballooning costs.

    How much is UHC's Dr. Ho compensated? Mark T. Bertolini, Aetna's President, received $12,627,800.00 in annual compensation for his 'black belt' treatment of the health consumer. Stephen Hemsley - UnitedHealth Group weighs in at tenth place with total compensation: $3,241,042 for keeping your family young enough not to need to go to the doctor.

    As for the headline of this article 'Insurers Push Back' - - push back?? You must be kidding, they've been surreptitiously funding the Know Nothings and the Tea Baggers and pushing aggressively with putrid and racist imagery through surrogates with the aid of corporate shills like FOX Noose since the push for health reform was first mentioned.

  81. Mark my words ... despite what was promised, everyone will soon learn that their healthcare premiums are increasing and choices are decreasing. Not to mention that everyone will be required to work longer not just to collect SS benefits or a pension (if you're lucky) but out of NECESSITY! Those of us in our 40s are certainly bearing the worst of the mess: too young to be grandfathered into the "old rules", too old to "rethink our career and/or our the way we thought one should invest", too financially obligated with mortgages, kids, college to "play the new game" and too "old school" to accept the notion that we should just let someone else (government) pay our way in life and take care of us. What a conundrum!!

  82. Apparently, I am the first doctor to respond to this comment list. I was a victim of closed panels of doctors of HMO's when I was in solo private practice for 38 years in Miami. The HMO's only selected doctors who would not (in their opinion) over utilize, perform too many procedures or tests, and of course, accepted their reduced fee schedule. Thus, the docs who were having problems getting patients were eager to sign up. The patients and the docs had NO freedom of choice. They had to go to to the hospitals who offered the best negotiated deals, discounts, etc. All very similar to big-brother controlled health care. This was partially what eventually drove me out of practice and retirement earlier than I would have otherwise.

  83. I just found a book in the free box at our local post office. (This is an exchange set up by and cared for by locals.) The book has the title "A Confederacy of Dunces," and I thought, "Gee, maybe this is about the US Congress." It isn't, of course, though parts of it seem to be really close. By the way, it's by John Kennedy Toole, and is really funny.

  84. Just like the firefighters/first responders (remember them) who are forced by the cities providing their health care to use the doc in the box, not a hospital, and then the worst hospital in the area, whenever their families need treatment..... another banana peel for the american suckers.

  85. American's have a strange notion about the quality of medical care. Like we all know how to pick that "best" doctor - and like that really means anything? So one plan allows 3000 doctors in-plan and another 300 - is that really going to be an issue?

    One commentor is complaining about a "wait and see" doctor. Well, a "wait and see" approach may actually prolong both your life and the quality of your life. Rushing into procedures is actually a symptom of our broken medical system - the more the doctor does, the more he gets paid. So a "wait and see" doctor might actually have your best interests at heart, not his own financial interest. Even if you paid for an out-of-network doctor for a second opinion - these are not the most expensive parts of your medical care. You could be saving enough per month in the lower premiums to pay that occasional out-of-network provider if that's what you really want to do.

    Americans are so trained to think that more medical care is better medical care. In my family, I see more medical care, especially some optional procedures, leading to a downward health spiral not longer life.

  86. What's more, if you're a woman with MS, say, or cancer, and you buy into the high-risk pools, you'd better not get pregnant because if you can't handle being sick & pregnant at the same time, too bad -- no coverage for abortions. No doctor will even see you. http://www.prochoiceamerica.org...

  87. Perhaps there should be a system that approves insurance companies? What if the AMA and the hospital system association exercised a little free enterprise themselves?

    And for JimBob (#6), there is something a little bit eccentric about a system involving our lives and well-being that would suggest a menu of decision-making that mirrors my choice to go to Ruth Chris Steakhouse or Wendy's.

  88. The new HMO will be PPO of future , the doctors will be pushed to accept lower payments which will be equivalent to the medicaid payments or 40-50% below medicare. The hospitals will be poor quality institutions
    while record breaking profits will be racked by the for profit health demons , Aetna,United, Wellpoint, etc etc.
    There goes the "Choices", Mr Obama offered "You can keep your doctors"!!!
    US Administration needs to step up and prevent this Multi tier system that is being created
    'FOR SAVING MONEY" AKA PROFITEERING.

  89. 6.JimBob Los AngelesJuly 18th, 201011:43 am The headline makes this sound like a bad thing. But I've had insurance for years through my union, insurance which provides different levels of choice at different prices. What's wrong with that in a free market? ++++++++++++++++++
    Jim you must be a public employee! Correct! If so you are in a protected class "public union" where cost really is not an issue since taxpayers pay the premiums for public union workers for very very good coverage compared to your private sector counterparts.

  90. This is OK as long as some common sense is applied. For instance, if there is only one of a certain specialist in a large area, they should be covered under all plans. This is not always happening currently - I have a friend whose child needed plastic surgery, and the only pediatrc plastic surgeon in Idaho was not covered under their health insurance plan. That's ridiculous.

  91. Would the insurance companies eventually get "cut out" since the providers will be these medical groups?

    I am generally NOT in favor of forcing people into medical groups because I have experienced a wide variety of patient care and have picked my doctors (a patchwork of choices) according to their competence and my needs, not by insurance recommendation.

  92. It is outrageous that the US government is allowing these insurance companies to restrict the choice of doctors and hospitals to patients.
    The US never learns, even in time of economic crisis, instead of installing more equality, it is still all about MONEY.
    What a shame.

  93. The health care law which will provide universal coverage is far better than what we had. I think of it in terms of the Civil Rights Act of 1957. It made things better, but not all the way under law. The REAL benefit of that legislatio will hopefully be the same as this. It proved that despite the unified opposition of conservatives (at that time in 1957 primarily Southern Democrats, whose opposition to civil rights led most of them to becme republicons - except the few who saw the gave error and changed their minds like Robert Byrd) --i digress -- despite the unifeid opposition of conservatives laws could be passed through the senate that made America a land of MORE equality, a better place to live, and put the benighted forces of evil in their place -- as must be done with further legislation on health care. If insurers are going to continue to try to cheat their customers, then they should eiether be forced by new legislation to do right, or they should be eliminatated in favor of a single payer national system like Canada. And no conservataards - Canada is not "socialist medicine" nor is it bad. Itconsistantly raks in the top 3 in the world while the US consistantly ranks around 37th. And they pay way less for better care and access.

  94. Remember how so many of us were for Single Payer, and, when Obama didn't even allow it to be discussed, for a Public Option?

    Remember how Rahm & Obama met with the insurance companies and basically allowed them to write the health insurance bill?

    Remember how progressive Democrats folded and walked away from their promised support of the Public Option after Obama assured them it couldn't get passed, and that this was "a start"?

    Notice that the chief lobbyist for Wellpoint [and former Baucus staff person who wrote the health insurance bill] is now going to be in charge of writing the regulations for the health insurance program?

    NOW do you understand why we were [and continue to be] so vociferous in our criticism of Obama and this phony "reform"?

  95. I have been in an HMO for 35 years. Unless there is an emergency, or I need medical assistance out of my area, or I need a specialty my HMO group does not offer, I am limited in what doctors I can see and what hospitals they send me to. I have not had any problem with this arrangement. The medical care has been skillful and caring. I pay about 20% less than persons where I work who can choose any doctor anywhere. Why are insurers considered to be doing something wrong when they try to save you money?

  96. After controlling "which doctor" Insurance companies will try to control - "which treatment". Having had a lousy experience of that - I suggest that this idea is thrown out as rapidly as possible.

    I had four operations on my eye. (3 in Switzerland and one in France)
    1st. operation. Which went wrong, leaving a floating retina, haemorrage and no lens left in the eye.
    OK, hard luck. The doctor did his best.

    Now comes the lack of choice.

    2nd and 3rd. ops. Non-doctor dictated operations that were failures. The doctors admitted that they couldn't do an older but complete operation as the insurance/TARMED wouldn't pay for it. The TARMED, - Swiss Cantons Convention on Tarifs, which dictates what is the least costly method. This was the ONLY treatment allowed.
    4th. op. By choice, I went to France, was recommended the best, (Who happened to be President of the Association of Retina specialists.) Cost to me. 1'000 euros, plus 250 for the Anaesthetist. End of story.

    What use is it if Insurers limit choice based ONLY on cost? Particularly if you then need "extra" operations, or need to leave the country to get a cure?

  97. This only clarifies that the insurance companies are still in the driver's seat when it comes to health care policy and that they plan to keep their huge profits while health care cost continue to increase dramatically for consumers. The article casts this as Obama not doing enough but he and his advisors had to settle for less than they wanted on health care reform because of the members of Congress who are totally in the pocket of the big insurers and big pharma. What HCR mostly produced was a way to cover the uninsured, which is vital but also lines the pockets of insurers. All the other perverse incentives are still in the market. Yes, the middle class is going to get gouged for wanting to retain the doctor they've known but that's in spite of health care reform. The situation where consumers pay a large premium for choice is also a product of health care delivery system which has seemingly no limites on its profit structure and no incentives to deliver more cost efficient care. A lot of the messiness of the changes of the next few years can be attributed to failure to address cost management and waste in the system while requiring coverage for most Americans. HCR just did not go far enough. But Obama is not to blame for that--let's remember what a vicious over the top show the Republicans put on to try to kill HCR--it comes back to how much influence the health care industry in general has over Congress.

  98. This is not about saving money, this is about controlling who dishes out medicine. It is the consumer vs insurance company in which the consumer cannot win. Why? Because the consumer will never have the information about the doctors that the insurance company will have. Consumers are depending on word of mouth or the equivalent of picking a name out of hat. There is no way of knowing what type of care they are going to get.

    The problem is they are selling the sizzle, not steak. These health care providers are going to get the lowest reimbursements from the insurances companies and there is no guarantee that they will solve anything. Another issue I can see is them overselling providers so they cannot service their patients. Your ill and need to schedule an appointment? Maybe next month. Want to see a doctor you will have to go out of network, and that will be out of your pocket.

    This is a game, that consumers are just not going to be able to win. Until we realize that, insurance companies are going to rule the roost and nothing will change.

  99. I clicked on the article because of the subject matter, but was immediately grabbed by the picture above the text, of two men on bicycles in a warehouse. What a fascinating image, and what a shame that it wasn't even captioned to let us know a little more about it.

  100. This is the way the insurance companys get back at the government for enacting into law what they won't do: provide health insurance.

    Now they will so restrict who you see, your level of care, and whether you can even go to a hospital. They'll make sure that they only cover aspirin when you need chemotherapy.

    Let the civil suits begin.

  101. For the insurance companies to save money (which would never translate to consumer savings), we will be forced to see nurse practitioners and physician assistants (considered "primary care providers" under the new health care bill). NPs and PAs have one-third the clinical training as real physicians and undergo no residency; most of them couldn't get into medical school if their lives depended on it. They are okay for chronic problems like diabetes or routine checkups, but if there is any complication or zebra, then it's over. NPs and PAs can only follow rigid protocols since they don't have the science training to know what they should do if something is outside a protocol. And they simply don't know what they don't know.

    Meanwhile the rich will still have access to the MDs and specialists of their choice.

  102. The NY Times articles states:

    “What’s not changed are the old techniques of black-belt managed care,” said Mark T. Bertolini, Aetna’s president. “We have to create the same kind of model without the ‘Mother, may I.’ What we want is the ‘Mother, should I.’ ”

    Your readers may be interested in his compensation. Below are data from Forbes

    Mark. T. Bertolini, Compensation for 2009
    Salary $932,414.00
    Restricted stock awards $7,150,030.00
    All other compensation $71,692.00
    Option awards $ $3,806,838.00
    Non-equity incentive plan compensation $612,144.00
    Change in pension value and nonqualified deferred compensation earnings $54,682.00

    Total Compensation $12,627,800.00

    If you are in the medical business for money, you are in there for the wrong reason.

    It is too bad that Congress did not follow the Swiss or German model, which uses private insurers, but set up as non-profit agencies. They compete for patients, not for earnings.

    Mr. Bertolini's compensation only would then have covered a thousand families. Fully.

    But Congress needs campaign contributions.

  103. Respondents like Jim above (#5) seem to feel these limitations are new. However,they have nothing to do with the recent health care legislation but are increasingly standard practice and have been in development for years. Like most things, there are positive and negative implications. Doctor and hospital selection are driven by cost and, after complaints from consumer and medical groups, some broad and imperfect measures of quality. The latter may weed out some truly poor practices and the former often removes doctors with reputations that allow them to charge and obtain more than what insurance companies offer. The more expensive the insurance plan the broader the choice. Medicaid has the least choice in doctors, high tech companies like Microsoft (for example here in Washington State) and high end financial institutions have the most. The truly wealthy do not worry about insurance. Union and public employee plans are usually somewhere in the middle. HMOs like Kaiser or Group Health limit patients to a relatively small, usually employed, group of physicians (and more and more physician extenders like nurse practitioners)and a very small number of hospitals that they either own or contract with, based largely on price. This has been the current system and its huge weaknesses have been that many of our fellow citizens have no access to any of it because they have too little money or too much risk of actually needing health care.

    There is no magic or conspiracy. The U.S. has made a policy decision that health care should be an economic commodity and that for-profit insurance companies are the best way to organize allocation of its limited resource. This is called rejecting socialism. The changes that the country selected to try to allow more people to get at least reasonable treatment do not alter the underlying paradigm. The more money you have the more choices in health care you get. Only single payer offers a meaningful alternative and that was rejected.

  104. To me the entire conversation begins and ends with the Aetna exec who refers to the insurer-consumer interaction as "mother..." I don't buy the idea that insurance is supposed to be my parent. If that's the goal, then I'd rather pay my own way -- with the added benefit that I avoid being tracked by disease management programs or penalized for side effects of drugs. Because once you're coded into the system, all that is possible (and standard practice).

    Coverage for emergency and trauma care, yeah, that's highly desirable as it (in theory) covers injuries and accidents. But the rest, I've come to believe, is my choice. Increasingly, I choose to keep my care decisions and plans between myself and the providers I choose. Since starting this approach, my health has improved, and interactions with my providers have improved. They even work together, willingly. I'll gladly pay my own way for that scenario.

    The question remains, how can we make that possible for all Americans? The discussion often ends at references to the cost of *providing* care. But the real affordability problem is at the cost of *receiving* care. Call me an idealist, but I think everyone should be able to see who they want, when they want and when they need, without shame or poverty. Until then, it's all rhetoric.

  105. Is this a "news" story or an opinion piece? The sentence "Prominent officials like Mr. Obama and Hillary Rodham Clinton learned to utter the word “choice” at every turn as advocates of overhauling the system" sounds like partisan opinion masquerading as news.

  106. If private companies are forced to do the right things, they will do the right things. Limiting the choice of doctors in exchange for lower cost is the right thing to do. In time, most of the doctors will join the plans and the patients will have wider choices of doctors. They should do the same thing with hospitals so that for even a lower premium, patients can go to the limited hospitals and eventually all hospitals will join the plans and bring down the cost of hospitalization. The net effect is that the cost of medical care will spiral down to the point that socialized medicine will longer be attractive. That is the ultimate goal of private medical care.

  107. So much for "Health Care Reform." Americans are had again by our holy, sacred corporations. Until we can learn to accept universal health care as the only fair and equal approach to nationwide health delivery, it must be back to the drawing boards. Until we accept that "pro-choice and pro-life" are merely catchwords for a political issue framed around supernatural belief and political leanings and a handy hot button to be pressed upon any progress in any field of endeavor, we will never attain equal protection and democracy. Walwyn Trezise

  108. I'm fortunate enough to have health insurance with "out of network" coverage through my employer. While the salaries are on the lower side, those of us who work here have always felt that our benefits made up for that. I thank God too, because I have a chronic medical condition.

    My doctor is "out of network," but his outstanding care has helped me to be able to continue working, to be a functioning and contributing member of society. He is cutting edge, willing to treat aggressively, instead of letting his patients get worse and worse (which usually equals greater health care costs down the line).

    I now fear that I will no longer be able to afford to see him should my "out of network" coverage change or be taken away. I'm not against everyone having to contribute into their own healthcare, but the idea that we will be getting less when more folks will be contributing into the costs of healthcare, seems so wrong and terribly misguided.

    I can tell you that there are many of us, if we are denied the quality care we need, will end up costing the healthcare system so much more down the road.

    Mr. Obama, I voted for you, even though I had excellent coverage at the time. I cared for my friends and family who were not so fortunate, who were uninsured. I thought you said that, “those that are happy with their insurance can keep the plans they have,” but now, I feel like I have been duped.

    I'm scared for what the future of healthcare holds for me and the impact it will have on my family.

  109. This anticipated restriction of choice is no surprise. Indeed, we can expect even more measures that will restrict patient choice. Indeed, the word "patient" itself no longer describes the individual in the patient-doctor relationship. Those seeking health care can today be better described as "clients" in a medical care marketplace where services are gauged by cost cutting strategy rather then medical protocol.

    Ever since the widespread institution of HMOs the quality of care has deteriorated. There is much about "managed" health care that the general public is ignorant about; I was an administrator at the beginning and have seen the evolution of a system that has put profits, and assembly line mentality at the forefront of policy.

    Americans should be aware that many top physicians, especially specialists in all fields have abandoned the insurance industry all together; they have opted out and will no longer accept medical insurance of any kind.

    The end of "Gucci," medical care as mentioned in this article is a delusion. Those with money have always had the best medical care and always will. As with every other policy instituted by our political system, (essentially a plutocracy of business and finance) the elite are favored.

    As in any other business enterprise, the cut-rate practitioners will provide cut-rate services. Those that can afford better (the top income brackets) will have the real choice: to go elsewhere.

  110. I consulted one of the wait-and-see doctors last year. Now that I have waited, the situation has become worse. Since I now regard that physician's treatment methodology as ineffectual, I will see a new doctor, in another health system, and will not accept the wait-and-see approach. So my treatment will cost more than if I had had more aggressive treatment in the first place. For every person like me, there are probably several whose condition improves with very little intervention, thus saving health care dollars. We should not lose sight of the fact, however, that the slow approach results in increased suffering for those who are not so lucky.

    Another aspect to keep in mind is that explicit limitation of providers is not really necessary, as reduced reimbursement rates make getting an appointment with some physicians who are nevertheless part of one's stipulated network very difficult. In other words, although the plan provisions may say that a patient doesn't need a referral to see a specialist, the plan may not pay the specialist for diagnostic procedures, so that specialist may refuse to see patients who, despite displaying all of the classic symptoms for a particular affliction, have not been diagnosed and referred by another physician. So the plan is effectively limiting access without stating that fact.

  111. What will this whole system to small companies that are trying to expand their staff and trying to keep their good employees? What will happen if people are afraid of joining start-up companies, if they don't have good medical coverage?

  112. Not smart but clever that Obama. When people complain he will say not my fault, blame your insurance company. Yet it is his law that will force sub-standard care on the middle class. Did Teddy Kennedy have *Gucci care*? Will the Obamas and friends? Will the local union boss? And they told me Bush was a liar?

  113. There were actually plans that haven't operated by restricted HMO-type coverage??? (except for those for our politicians, of course) Wow! Haven't had a completely-free-choice plan for 20 years. I'm totally content with my physician, and the highest-quality medical care in the region is available. There's a difference between limiting choice by refusing to provide any insurance unless one complies with a single option, and offering a variety of plans from which a person chooses.

  114. It didn't take long for the insurers to look for the loop holes. Middle America must pay up again if we want quality care.

    Will our congress leaders be offered the same choice, a narrow network plan or, pay much more to go outside the network?

    Thought we were supposed to get the same coverage our congress leaders get, the exact same.

  115. Single Payer is still very alive. With politically poor manners and really just rude behavior, the President has blocked and refused to have even a private dialogue with top medical doctors and scientists that represent millions of us across the country; not even a "Beer Summit". A senior oil company executive friend of mine noted this is a no-brainer and would help every level of the business community. He said all that needs to be done, even now, is a half page law that opens Medicare to everyone. There's the "Public Option" It's also a potential savings of nearly 1 billion dollars in "1 year" instead of the "trillion
    dolllar cost over 10 years" to the tax-payers. Factor in interest savings, real health care option for the uninsured, more job creation, more family dollars to spend in the whole economy, fewer bankruptcies, etc. All with a single page bill passed this session. Everyone from the far right to far left is paying and being used when you do not look beyond and you help produce the propaganda. Battling eash other, we all lose.Single Payer Option now will begin health reform.

  116. This is actually a good thing. It is already offered to state and corporate employees California. The insurer networks still have hundreds of doctors, but it is not open ended. Some people may shop around for the ultimate doctor, but busy and healthy people like myself don't have the time or interest to do that. We just want a good doctor we can see now. My employer offers a number of choices of health plans. I used to have an open ended PPO that let me pick any doctor anytime, but I switched to Kaiser, which requires you to see only Kaiser doctors in Kaiser facilities. I like Kaiser better. It's more organized, cheaper with no surprise bills, the medical care is as good or better, they have all my medical records at one place and coordinate my care, and there are numerous doctors and locations to choose from. Most of the insurance plans that limit access to specific doctor network offer a wide range of good choices. While people might find that their doctor is not in the network, just as likely, their doctor IS in the network. I agree with Jim, there is nothing wrong with a choice like this in a free market. Some people prefer it.
    I believe that all people deserve access to affordable adequate health care - not free health care and not full service, “what ever they want” health care. It is possible to find a balance and Obama’s health care bill is finally a step in the right direction. The US does not have to be a carbon copy of Canada. We can ensure that all people have access to affordable health care within a capitalistic free market. Things are already turning around. I think the US will find that as Obama’s healthcare legislation is implemented, insurance prices will drop and health care will improve. The sCHIP program has already done wonders to provide affordable health care to children. Families pay a low monthly premium based on income and the children are enrolled into insurance plans similar to ones offered by employers. These programs are operated by ISO certified for profit companies and they are extremely efficient with quality controls and employ a large number of people in many regions. Obama’s overhaul of health care will strengthen the US. All these dooms day predictions are wrong and not based on the facts.

  117. The fault lines of the "new" health insurance environment are immediately apparent, just as we knew they would be.

    The immense flaws of the Obama compromise will be evident over time. It may well prove the President needed to weaken the national health care bills in order to get them by our bought-and-paid-for Congress but we all know that what we have is half-baked.

    The flaws, work-arounds and compromises will be addressed in their turn in the coming years and hopefully, in the end, we will emerge with what we could have had right in the beginning, for billions less:

    Single payer, universal coverage for all Americans. Lifetime, full-featured coverage, any doctor, no mandates, no exceptions, but, most importantly, NO INSURANCE COMPANIES.

    When are we going to wake up to the fact that this free-market, capitalist nonsense doesn't apply to our social programs?

  118. Doesn't seem any different than what insurance companies have been doing recently anyway. Everybody that I know has an "inside network costs less, but you can go outside network and pay more" insurance plan from their employer. There is no actual "new"s here – except maybe that I hadn’t realized the HMO concept had been abandoned. Certainly nothing that is actually any different because of Health Care Reform.

    If there were actually companies out there that didn't have plans like this, then it was only because they didn't have plans like this YET. As costs were continuing to rise, every year more and more companies would be switching to plans like these. It's just an extension of the fact that so many companies had already switched to these plans.

    So no change in what's happening with companies. Plus we'll have insurance pools with plans guaranteed to meet certain requirements to help people get affordable insurance when the CEO of their company decides he can't make his huge salary and bonus unless he cuts you and 20 or so other workers from the payroll. Plus people will now actually have to pay, through insurance, for the emergency medical services they are using instead of passing their costs on to me. Plus most everyone should now be going to a doctor on their insurance plan earlier during their ailment rather than waiting until it becomes an emergency room visit. Plus the incentives to increase the number of prompt-care style facilities will help to further decrease the burden on emergency rooms. Looking good so far.

  119. IF larger companies really wanted to save money, they would make accommodations that allowed staff to work out during work hours e.g., 75 min. lunch break, rather than 60 - enough time to work out and shower and return to work and/or fitness classes/gyms onsite; easy and affordable access to nutritious meals - a salad bar, for ex.
    But aside from corporate America not really wanting to have to actually DO something proactive to help employees and lower costs simultaneously, how exactly do insurers save money by limiting which drs a patient can choose? Are ins cos negotiating ala Walmart for group discounts w/doctors? If so, won't that result in longer waits to see a dr? And is this really what good, reliable internists want? Why not offer people the chance to pay the difference if using a non-network dr?
    Insurers: Show me the money (i.e., how limited plans save you money)!!

  120. If Gucci stands for quality, albeit at greater cost, what does this say about the "Wal-Mart" medical options. Will our seams not be tightly stitched? Will they match up the patterns (nerves, etc.) to an exacting standard after we've been cut, or will we just be patched together with quality controls being replaced by time efficency standards? I'm willing to buy my clothes from a discounter, but why should Americans, nearly alone in the developed world, be forced to buy their medical services in this manner?

  121. It's a game, can't people see that? Insurance companies are businesses that answer to shareholders. They are NOT in the business of providing FOR something, they are in the business of providing insurance AGAINST possible but hopefully unlikely events. I have fire insurance on my house, but the likelihood of needing it is low--unless I live in an area prone to wildfires, in which case the insurance is either not available to me or is outrageously expensive or they dictate which contractors can rebuild my house. The new health reform bill said that the insurance has to be available to everyone, they cannot leave out the high risk people any more, so of course the insurance companies will increase the price for the insurance or dictate which doctors can take care of me.

    Until we grow up and have a single payer system, spreading the risk among everyone, this game between the government and for-profit insurance agencies will continue. We cannot legislate a fair and comprehensive system in a free market.

    As for the argument (#6) that we have the choice to buy different levels of insurance based on our "needs"---your needs can change in the blink of an eye. That little stomach ache you have? Colon cancer. That driver who went through the red light while texting? Brain damage. And who will pay for it?

  122. And again proof that so called "health care reform" was more about health insurance profits, doctor salaries and for profit health care provides/medical equipment companies, than it was about the people who live in the United States. The government gets extra revenue for those who can't afford health insurance in new taxes, the health insurance companies gets millions of new customers and the premiums that go with them, the doctors/medical centers get even more revenue from patience who will still want to keep their doctor/hospital; no matter the costs. As the article say; so called "health care reform" save money; for all those who make money off the health care system.

    As so called "health care reform" move forward; a reform this very newspaper endorsed and was against the Canadian System of single payer health care, the American people are sure to find even more surprises. More money out of pocket, being funnelled into health care plans that do little for them and more tragedies which was the basis on why our so called representatives in Congress to enact "heath care reform" in the first place.

    Down the road, there will still be bankruptcies because of inadequate health care plans. The insurance companies will replace denying care fro pre-existing conditions and for getting sick, with purely legal plans that limits choice, doctors, hospitals, etc. Our health care system will continue to be two tiered, the wealthy who can pay top dollar for everything and everyone else who will see less coverage and more money coming out of their pockets.

    So, probably in about 10 years, this country will revisit a failing health care system which is still costing the government, and the people, much money per capital and of the GDP, then every other industrialized country in the world. Also, the people will no longer be able to keep the coverage or doctors they have, because insurance companies will force it for their bottom line. Maybe by then, Americans may be ready to adopt the Canadian system of health care; I doubt it. The corporate oligarchs will have completed their takeover the country by then.

  123. So we now see the downside of not having a single-payer system. It doesn't take a genius to know that if we take a plan, such as the Dem's health care plan, rip it to shreds and pass only bits and pieces of it, it's not likely work as well as the original concept. What we ended up with shouldn't be called "Obama-care" but "Republi-care" and they need to take the blame for its shortcomings.

  124. Big surprise huh....and so we get poor care, no choice. Let's face it insurance companies, oil companies, tobacco and junk food really run this country - greed and big fat bonus's come first and peoples lives come second. I believe Obama's intentions was right, but hey, it's the way we are her in God Bless America. So many with fiancial power believe in greed first, lives second.
    Afterall - we sent thousands of good, very young Americans to Viet Nam and Iraq and for what...Greed or who even knows why - (see Fog of War)