Kept in the Dark About Doctors, but Having to Pick a Health Plan

By Austin Frakt
The New York Times, November 13, 2017

When you select a health care plan, you probably consider premiums, and maybe you check deductibles and other cost sharing. But you can’t easily scrutinize the plans’ networks and the quality of the doctors in them. That’s too bad, because you may be missing something important.

Many health insurance options offered by employers or sold on the Obamacare marketplace come with narrower networks — covering treatment from a limited slate of doctors and hospitals. (Though there’s no official definition of a “narrow network,” many studies classify networks as narrow when they include less than about 30 percent of doctors or hospitals in the area.)

It’s virtually impossible to thoroughly check the quality of doctors in each insurance plan. A typical plan, even a narrow one, may have a network of hundreds or thousands of physicians.

https://www.nytimes.com…

Narrow networks are a tool of private insurance companies designed to enhance their business model rather than to improve patient service. They add to the administrative waste that characterizes the private insurance model of health care financing.

A public insurance model, such as the traditional Medicare program, is designed to help patients receive the care that they need. Why should we pay private insurers more in administrative costs in order to prevent us from having access to 70 percent of the physicians and hospitals in the community?

Not only is the traditional Medicare program more efficient administratively, and gives us greater choice in our health care providers, Medicare also has been more effective than private insurers in controlling health care prices.

We really do need to replace the intrusive, superfluous private insurers with an improved Medicare that covers everyone.

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