ObamaCare’s enforced transformations
Bloomberg Businessweek very gingerly approaches the topic of reduced doctor choice under the Affordable Care Act, in a piece entitled “ObamaCare limits choices under some plans.” Some plans? Has anyone found an ObamaCare plan that doesn’t significantly reduce doctor choice, especially if you’re buying the bottom-tier “bronze” coverage that’s only a little more expensive than health insurance used to be?
However, the case Businessweek cites to kick off its article concerns a man with prostate cancer who paid big bucks ($792 per month) for top-level “platinum” ACA coverage, after running afoul of Barack Obama’s Big Lie and watching his old coverage get discontinued. He soon discovered that even under “platinum” coverage, he couldn’t go to the hospitals where he was accustomed to receiving treatment.
Since the ACA created marketplaces for private health plans last fall, insurers expecting to lure customers with low premiums have fashioned smaller networks of medical providers. By cutting out expensive hospitals and negotiating favorable rates with doctors in exchange for sending more patients their way, insurers can keep premiums down. Blue Shield’s new network includes 43 hospitals in Los Angeles County, about 64 percent of what its standard coverage offers, spokeswoman Lindy Wagner says in an e-mail.
In addition to having fewer options, buyers are making decisions about which plans to buy based on incomplete or misleading information, says Karen Pollitz, senior fellow at the Kaiser Family Foundation, a health policy research group. “Consumers have a very limited ability to shop in advance and evaluate provider networks,” she says.
Before Obamacare, the market for individual health plans was too small for most insurers to bother creating provider networks separate from those they offer large employers. If you bought a plan on the private market, you had access to the same doctors and hospitals the insurer’s large, employer-based plans offered. That changed as insurance companies created offerings for price-conscious shoppers on healthcare.gov and state exchanges. For insurers, controlling costs has become more important since the ACA barred denying coverage or charging higher rates to people with preexisting conditions. Reducing choices can lower costs by 5 percent to 7 percent, estimates Craig Hasday, chief operating officer at Frenkel Benefits, a New York brokerage. “On the exchanges in many states, the narrow networks are the only networks that are available,” he says.
The story goes on to claim that “many consumers say they don’t mind the limitations” – and then cites a Kaiser Family Foundation poll showing “37 percent of respondents prefer cheaper plans with fewer doctors and hospitals over broader, more expensive coverage.” A multi-trillion dollar boondoggle that coughs up inaccurate provider listings about half the time, still costs more than old-fashioned insurance despite these “cost saving” measures, and gets 37 percent approval for its restricted networks? Sounds like a rip-snorting Big Government success story to me!
Leaving aside ObamaCare’s magical ability to deliver the worst of all worlds to so many of its “beneficiaries,” it provides an example of how government force is deployed to compel decisions that people might have made voluntarily, under far better circumstances. There certainly are people who don’t mind smaller provider networks, if it saves them a few bucks. People who are battling serious illnesses with the help of talented doctors and preferred hospitals, on the other hand, are understandably interested in retaining their favored health care providers.
When these choices are presented to consumers in a competitive business environment, the results are far more efficient, and more pleasant, than using gigantic regulatory clubs to beat them into line. Another example is the notion of having a policy with low premiums and high deductibles, a rational choice for young and healthy people. ObamaCare screwed this up and left young people with the choice of buying policies with high premiums and high deductibles… or else pay a trans-constitutional tax penalty for failure to do as they’re told, assuming President Obama doesn’t have another poll-inspired nervous breakdown and waive the penalties.
Another arguably good idea being forced down our throats, in the worst possible way, involves breaking the link between employment and health insurance. This relationship only exists in the first place because of decades-old government regulations that forced employers to use insurance benefits as a form of compensation. It’s not without its advantages for the consumer, particularly the convenience of having a human-resources department handling much of the paperwork, and the purchasing power of belonging to a massive group plan at a big company. But it has many disadvantages as well, because it thwarts the normal powers of competition, and distances the ultimate consumers from the products they purchase, which invariably distorts the marketplace.
One of ObamaCare’s chief perpetrators, Zeke Emanuel, has lately been boasting that the Affordable Care Act will bring “the end of employer-sponsored insurance,” which would make Obama’s “if you like your plan, you can keep your plan” lies even more grotesque. Nobody would be able to keep their plan. Not once were the American people ever told that the Affordable Care Act would completely wipe out health insurance as we know it. It was sold as a graceful, fundamentally voluntary program.
Maybe the end of employer-provided insurance would ultimately be a good thing – Emanuel seems sincerely convinced of it – but it’s a decision Americans should make voluntarily, not get hoodwinked or frog-marched into. Not only is free and informed choice morally superior, it’s practically superior, producing more affordable results of higher quality. The lies Barack Obama told to get his precious Affordable Care Act are a form of compulsion; a choice based on deliberately misleading information is not a free choice. But that’s only a prelude to the levels of even more direct “do this or pay a penalty” and “do this because you have no other choices” compulsion coming our way, if the ACA is not repealed.
Instead of the ObamaCare disaster, we should have reforms that increase competition and make it possible for insurance providers to devise attractive options. One of the reasons ObamaCare is unsustainable is that large populations cannot be permanently forced into positions they would never choose voluntarily. The spiraling costs of the not-so-Affordable Care Act are a manifestation of this fatal flaw – it costs an increasing amount of money to push free people down roads they don’t want to walk. Eventually no amount of money is sufficient, and bayonets must be used instead of dollars, if a coercive regime is to survive.
Low-cost insurance with limited provider networks and high deductibles may sound like a good idea to plenty of customers. Why not give them the ability to make that choice intelligently, and willingly, instead of shoving the entire country into a system that profits insurance companies and government bureaucrats at the expense of everyone else? Massive subsidies are not necessary to enable desirable commercial transactions. Appalling levels of coercive force are not necessary to make people do what they want to do.