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Response to Tansy_Gold (Original post)

Thu Dec 26, 2013, 11:41 PM

8. Americans Suddenly Discovering How Insurance Works

 

http://prospect.org/article/americans-suddenly-discovering-how-insurance-works

Did you know that if you never get sick, you'll pay more in premiums than you'll get in benefits? Damn those lucky duckies with cancer!...The only people who come out ahead in dollars and cents on insurance are those people who have had terrible things happen to them. What the rest of us are buying, as any insurance salesman will tell you, is peace of mind....



It's been said to the point of becoming cliche that once Democrats passed significant health-care reform, they'd "own" everything about the American health-care system for good or ill. For some time to come, people will blame Barack Obama for health-care problems he had absolutely nothing to do with. But there's a corollary to that truism we're seeing play out now, which is that what used to be just "a sucky thing that happened to me" or "something about the way insurance works that I don't particularly like"—things that have existed forever—are now changing into issues, matters that become worthy of media attention and are attributed to policy choices, accurately or not. Before now, millions of Americans had health insurance horror stories. But they didn't have an organizing narrative around them, particularly one the news media would use as a reason to tell them.

The latest has to do with the provider networks that insurance companies put together. This is something insurance companies have done for a long time, because it enables them to limit costs. If an insurer has a lot of customers in an area, it can say to doctors, "We'll put you in our provider network, giving you access to all our customers. But we only pay $50 for an office visit. Take it or leave it." An individual doctor might think that it's less than she'd like to be paid, but she needs those patients, so she'll say yes. Or she might decide that she has enough loyal patients to keep her business running, and she wants to charge $100 for an office visit, so she'll say no. So every year, doctors move in and out of those private-provider networks, and the insurers adjust what they pay for various visits and procedures, and inevitably some people find that their old doctor is no longer in their network. Or they change jobs and find the same thing when they get new insurance. And that can be a hassle.

But now they have someone new to blame: not the insurance company that established the network, and not the doctor that chose not to be a part of it, but Barack Obama. It's not just my hassle, it's a national issue. As Politico reported, "Speaker John Boehner (R-Ohio) said to reporters on Tuesday that the 'fundamentally flawed' health care law is 'causing people to lose the doctor of their choice.' Chief GOP investigator Darrell Issa has launched a House probe into the doctor claim. And House Republicans have highlighted the physician predicament in their weekly GOP addresses." So to reiterate: Your insurance company set terms for its network that your doctor didn't like. Your doctor decided not to be in that network. And that, of course, is Barack Obama's fault.

Before we move on, there's something we should note. You know who never loses their doctor? People who have single-payer insurance, that's who. If you live in pretty much any other industrialized country in the world, you don't have to worry whether your doctor accepts the national health plan that insures you and everyone else, because every doctor accepts it. Even here in America, there are people who almost never have to worry about losing their doctor: the elderly people who benefit from America's single-payer plan, Medicare. Despite their constant gripes about payment levels, 90 percent of doctors accept Medicare, because there are just too many Medicare patients and doctors don't want to be shut out of that business.


...............................................................................................................

To get back to the place we started, it can seem now that people are saying for the first time, "Wait a minute! Insurance is a raw deal! I mean, Obamacare is a raw deal!" And the media are doing their part by running stories that characterize the side effects of the private insurance market, like limited networks of doctors or the fact that less expensive plans have higher deductibles, as something new that's occurring only because of the Affordable Care Act. But they aren't. If you want to have a system of private health insurers, that's how it has worked in the past, and that's how it will continue to work. If you really want to be free of those problems, you'll have to wait until you're 65 and can join the big-government, socialist plan called Medicare.


Paul Waldman is a contributing editor for the Prospect and the author of Being Right is Not Enough: What Progressives Must Learn From Conservative Success.


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