Obamacare narrow networks in California: as predicted
I’ve written quite exhaustively about the Obamacare narrow network problem, which I know is especially serious in California, because I spent a goodly portion of my spare time last winter researching Obamacare in California for a relative. It was tooth-grindingly, mind-numbingly frustrating and time-consuming to try to get any reliable information at all, but the gist of what I gleaned was bad, if a person wants to have the ability to choose or keep (quaint idea—wherever have we hard it?) his/her doctor.
The LA Times now tells us that the situation will be no better in 2015. In fact, it seems that it will be even worse, if possible, in most areas of California.
This was completely and totally predictable, like much of Obamacare’s bad news.
But did you know that Americans don’t really care about choosing their doctors? To say that, one must ignore evidence to the contrary, which says that Americans do care despite the efforts of health care insurance pundits to tell them they shouldn’t care because it doesn’t matter and all doctors are somehow the same:
Yet survey after survey has found that patients in HMOs (like Kaiser) are perfectly satisfied with their health care, and the doctors they have access to. We have a magical tendency to believe, if a doctor has done something good for us, that he or she was the only medical provider in the world who could have done that good. It’s not true.
First of all—and that’s just first of all—many people in Kaiser (at least in the past) were/are there because they chose Kaiser, which is an HMO where your choices of doctors are limited to those employed by Kaiser. Therefore these consumers are not a random sample of people; they are people who might be expected to be among those who care least about doctor choice.
Second of all, other polls indicate that many people—in fact, a majority—do care about choice for the most part.
I am most definitely one of those other people who care. My guess is that those like me, who have had a number of somewhat obscure health problems, value choice even more than most people do, because we’ve learned the value of it from personal experience.
My injuries were such that, if I had not had the capacity, through my health insurance (which for many decades I selected and paid more for in order to retain that choice), to go anywhere in the country for treatment for the nerve injuries in my arms, I would almost certainly have remained so overwhelmed, consumed, and distracted by chronic pain that I would hardly be functioning at all, if indeed I’d managed to survive (I’ve told the story here).
And I’ve seen this happen to many other people, too. Once you’ve had the experience you don’t forget it.
My guess is that many of the people who don’t care about doctor choice are young and healthy, and fortunate enough not to have needed much care, so for them any doctor will do. In fact, they probably almost never even go to a doctor. But someday they will. And most people who are older and/or sicker understand the enormous value of a doctor you like, trust, and have chosen.
Of course, choice costs money. That’s the problem. But one of Obamacare’s greatest flaws is that it not only restricts choice for those with subsidized health insurance, it standardizes all individual policies and restricts choice even for those who pay their own way (socialism is fair because it makes all people equally miserable).
All of this is why a number of states have passed or are considering what are known as “any willing provider” laws:
If approved, South Dakota would be added to the list of states with a so-called “any willing provider” laws that requires broader inclusion in health insurance networks. The health insurance industry opposes these laws, arguing that the laws hurt their ability to negotiate with physicians and hospitals and to drive efficient care ”” which, the industry says, translates to higher costs for patients…
Twenty-seven states in all have some form of any willing provider law but they vary significantly, according to the National Conference of State Legislatures. Many of these states have had these laws on the books since the 1980s, and the laws can be broad, covering most of a state’s doctors and hospitals, while others much narrower in scope apply to just pharmacies or certain provider types.
These laws reflects people’s dissatisfaction with narrow networks, a dissatisfaction Obamacare advocates are busy denying. How bad is the narrow network problem? This bad:
About 70 percent of health plans sold on the ACA’s health insurance marketplaces this past year had narrow or ultra-narrow networks, according to McKinsey and Co., which defined “narrow” as excluding at least 30 percent of an area’s largest hospitals. Narrow networks were increasingly being used before the ACA, but they’ve become more prevalent under the law…
Yes, this was already a trend. But there were a lot more choices available before Obamacare. After the passage of the Act, narrow networks made a Great Leap Forward:
It’s not a pretty picture.
One criterion for inclusion in a network is that a practice have a “robust” electronic health records system by which to provide payers, and hence the federal government, with the increasing volume of data they require.
Small practices in low income neighborhoods are less likely to have such robust systems. Patients who ride the bus to the doctor will not only lose that doctor but will be taking far longer bus rides to get care. This will certainly not help with patient compliance.
Practices along the bus routes that depended on privately insured patients along with Medicaid patients will now be increasingly dependent on the revenue from Medicaid, whose reimbursements are notoriously low. I fear that many of those practices will close.
An unintended consequence of ACA is that it will degrade the care for those it was intended to help.
I don’t think that this matters much to Progressives, who are more comfortable dealing with big institutions, including big medical systems.
Interesting that the Swiss have apparently just voted down a plan to turn the country’s all-private health insurance system into one that’s state run. And by a 64% majority.
As Bill says, BIG people prefer to deal with BIG institutions. Accompanying the bigness is a large gloss of BS. In health care, that gloss is “We really really care about you!”
Meanwhile, anti-trust laws are ignored by the anti-trust enforcers when it comes to health care.
In Rochester, MN, home of Mayo Clinic, there were zero Yellow Page ads under “Physicians” when I was last there. What for? You got the Mayo. Choose your doctor? Why? They’re all great, they’re all Mayo.
In Durham and Durham County, NC, all health care is Duke. Next door, in Orange County, all health care is by UNC. Raleigh/Wake County, the 3rd leg of the “Research Triangle,” is neatly divided, with one hospital owned by Duke, the other by UNC. So there is “choice.” Move 60 miles west to Greensboro and Guilford County, all health care is under the Moses Cone umbrella. And 40 miles west of Greensboro is Winston-Salem, with all health care by the Wake Forest entity.
I’m not going to recite a state-by-state inventory; you get the picture.
Yep, there’s competition, sure enough. The competitors divvy up the pie, kind of like how Congress gerrymanders Congressional districts. So we all live happily ever after, with the Bigs looking out for each and every one of us.
A good post Neo. I’m betting like everything else with the left, repeating this fairly tale is a propaganda tool with a couple of purposes – one being for those who do care about choice to feel as if they’re in a minority and supress the impulse to express discontent.
My own observation is that older people care more about choosing their doctors, for a lot of reasons that are too numerous to list, and younger people, not so much.
A couple of generations where it’s an unknown possibility, and the debate will be over.
This was the plan all along – incremental control of society is right on schedule
Or from your post the other day, it’s turtles all the way down
Kaiser damn near killed me.
The problem with Big Medicine — Big Digital Medicine — is that ONCE ‘they’ go wrong — they STAY wrong.
Kaiser is actually run to reduce its legal pains.
The Kaiser system screws up so often that it’s in court CONSTANTLY over malpractice.
The Kaiser solution is to let attorneys determine all protocols — based upon what’s required to stiff plaintiffs in court.
That’s how the ‘system’ REALLY works.
One has to be hopelessly naive to think otherwise.
It’s also why Kaiser physicians are compelled to spend so much energy documenting why the Kaiser cure was (legally) fault free — while at the same time not running up the meter.
Kaiser is not in any way prepared to deal with odd situations, unusual situations, diseases that are not common inside the US of A (all tropical diseases), unusual parasites, — basically anything that would hit a medical textbook as weird.
Further, ALL patient commentary is deemed virtually worthless: the system has a TOTAL faith in their approach. When error is detected the first impulse is to batten down the legal hatches. Kaiser has lost centi-million dollar tort claims!
Kaiser is praised to the rafters by those who are never seriously ill, never have anything medically odd happen.
It’s a dead end — in every sense of the word — if you don’t fall into Kaiser’s comfort zone.
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Seinfeld had an episode that illustrates the impact of Big Digital Medicine: Elaine Benes had her medical records stigmatized by accident. Thereafter NOTHING she said got through. Changing physicians was absolutely no help.
This is something that Americans, the earlier generations, have never experienced. One always had the option of getting a ‘clean slate’ at a new doctor if your were not getting proper treatment/ had no credibility. Now, this is going to be impossible — nationwide.
So once ANY physician makes ANY error it will stand uncorrected. The doctor is going to be accepted over your testimony every single time. You are cattle. You are a prole.
You will also find that gate-keeping is now EVERYWHERE. You can’t directly approach any specialist… unless you’re astoundingly wealthy.
So if you realize that you’ve got this or that — you can’t go to a doctor that has expertise in the ailment. That’s outside the universal protocol. You must sell your ailment to your primary physician. This can prove impossible for soft injuries.
There are countless injuries that Big Digital Medicine can’t handle. If an injury doesn’t show up on X-rays, etc. then Big Digital Medicine falls back on the eternal medical cop-out: It’s all in your head.
It also trots out the Alternate Explanation. The “AE” stopped medicine from discovering bacteria, Vitamine D, viruses, prions, the nature of ulcers, the true source of inflammatory diseases, etc., etc.
It is taking physicists to tackle cancer. Doctors don’t think scientifically — not at all.
Doctors use anti-scientific methods; and always have. No-one would suffer a doctor who actually treated them scientifically. Look what scientists do to protons, bacteria, and chemicals!
Doctors work to an if-then/ heuristic tick list. They await researchers to add to their heuristic decision stack.
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It should be obvious by now that cancer is — in most cases — caused by deliberate poisons released by fungal infections. Fungi are everywhere. They are universally blocked by living tissue. But they are irritants, nonetheless.
When a smoker injures his lungs, he’s created dead tissue all over the surface of his lungs. Fungi are CERTAIN to populate such dead tissue. Fungi are witnessed — EVERY TIME — in the lungs of lung cancer victims — by pathologists.
But, they have an Alternate Explanation. So, there’s nothing to study, you see.
By a simple Darwinian thought-experiment it’s obvious that fungi emit toxins that protect themselves AND which accelerate the provision of decay/ kill cells — all the better to propagate.
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Big Digital Medicine refuses to look at S L O W diseases. Fungi are slow — prions are even S L O W E R.
THEY are what’s responsible for countless maladies: joint troubles. They infect human cartilage. They do EVERYTHING slowly. They irritate the human defense system — which takes the form of laying on calcium deposits — as a feeble attempt to protect bone marrow. The human immune system misreads the nature of prion attack.
Prions can be easily defeated by L O N G T E R M antibiotics, as in 100 days.
Big Digital Medicine NEVER permits anyone to receive antibiotics for 100 days.
Everything is backwards with them. Again, doctors are anti-scientific. If you EVER talk scientific with them — you’re DONE. They’re insulted, embarrassed, and ashamed. You WILL be punished: “difficult patient” — and there are millions of difficult patients out there.
With the doctor’s failure rate: there always will be.
Blert, I was with you until you began talking about fungi causing cancer and about prion disease. I can’t understand what those diseases have to do with Obama care.
Through epidemiological studies researchers have linked fungi in improperly stored peanuts to liver cancer in Africa. Beyond that, where did you get your information? Also prion disease is caused by a misfolded protein which causes other similar proteins to misfold. Which antibiotics would be effective against prions?
Right now Medicare patients still have the option for traditional medicine with their own physician – if the physicians will accept Medicare patients. Undoubtedly this will change in the future.
Just wait until it really sinks in for people that doctors might not want to see them – if they’re on Medicare or Medicaid, or if the only available appointments are with their nurse-practitioner due to doctor shortages.
* * *
My husband thought he had a great doctor, but was only able to see his nurse-practitioner for a series of odd symptoms over the past year. It was only after he nearly perished that the ER/hospitalist found the sizable cancerous tumor growing and bleeding inside him. All of his symptoms had been treated individually by someone who lacked the training and/or attention to detail to even consider that there might just be more going on (especially the low iron, a sign of blood loss).
Nurses and nurse-practitioners are not doctors, even when they’re well-trained and great at their job. Given that we don’t have enough doctors now, and that politicians think they can wave a magic wand and declare nurse-practitioners and others primary care physicians (as was considered in CA a while back), the quality of care will suffer.
We, spouse and I have seen the same internist for 30+ years, he has announced he will end his pratice come 1/15. His reason for retiring is the onerous tape of odcare
THIS, yes, absolutely this: My guess is that many of the people who don’t care about doctor choice are young and healthy, and fortunate enough not to have needed much care, so for them any doctor will do. In fact, they probably almost never even go to a doctor. But someday they will. And most people who are older and/or sicker understand the enormous value of a doctor you like, trust, and have chosen.
For the past 3+ years I’ve been working in a job that is totally beneath my education, experience and skill set. The salary is ridiculously low, the hours are brutal (my workday typically begins at 5 AM, and twice a month I have to work midnight to 8 AM) What it does provide is a PPO health care plan, combined with an HSA. I choose my doctors, and I can pay the deductible from pre-tax savings). That right there keeps me at this job. My entire family is covered as well. My husband’s significantly higher salary pays our living expenses, but his company does not provide this level of health care.
Right now, I’m recuperating from elective foot surgery, done by the best surgeon in my town, and for which I paid roughly $300. Insurance covered the rest. That kind of health care is priceless. That is what I stand to lose by leaving for a “better job.”
And then there’s my eldest daughter, who needs surgery for a tethered spinal cord. If she was under Obamacare, God only knows if or when she’d be treated, or by whom.
For a very brief time in the past I had Kaiser. I agree wholeheartedly with the comments posted by blert. The first hand horror stories I’ve heard are appalling.
illuminati…
While the mechanism is unknown, a double-blind test in Denmark established that plain, off-patent, antibiotics — when administered over a 100 day period cured at least half of their test subjects.
The patients had been suffering classic chronic spinal pain — but without any evidence of ‘hard’ injuries. (ie, no traumas, not even calcification.)
Naturally this was primarily in their lower-backs.
The standard protocol for such victims has been surgery. The Danes published less than two-years ago. I’ve lost the link. It made it into the popular press and was put on the Internet by some Fleet Street outfit, I can’t remember which.
The working theory is that the irritating agent is actually a protein that’s on the loose. It’s so tiny that it can lie inside cartilage. It’s enough of a trigger to upset the human immune system which then causes what amounts to an allergic reaction. But, everything is in slow motion. Unlike a food, these loose proteins hang around.
The implication is that — somehow — the very nature of cartilage provides a nano-habitation for a critter that’s well below the previously known threshold of life. While this protein may hover around the edge of cartilage it’s able to S L O W L Y replicate itself. It may actually be the oldest form of life — that which existed before cellular walls. It can persist in tight quarters so small that T-cells and the like are actually too big to get at it.
Nonetheless, it’s able to get the T-cells to ‘swarm’ and fire off the rest of the immune system.
As to how the antibiotics work: I’ll assume that these are able — by dint of size — to eventually flow though the cartilage and bind with the alien DNA segments. This actually shuts them down — the very binding action. Virtually all antibiotics work by binding with cell walls/ ruining cell walls. That’s more than enough to ‘take out’ errant DNA segments.
As to WHERE these beasties come from: they may actually come from us, ourselves. They are embedded in the ‘waste’ DNA in our cells. Under certain conditions, they leak out of the clean-up processes that are routinely used to sweep the body of dying cells.
Unlike viruses and bacteria — these malignant DNA strands are actually from inside us. This is why the ‘problems’ run in families. It’s also why some of these troubles are largely age related.
Errant DNA sequences must always be floating through our bodies. Normally our T-cells get them before they’re real trouble. In that sense, our immune system is — like the heart — perpetually on duty. It really is busy night and day, with most of its efforts actually concentrated on internal screw-ups.
None of this has been much perceived before now because:
1) There is absolutely no mechanism for transmission… no contagion at all.
2) It’s endemic. We take this problem to be the normal consequence of aging. We live in our ALTERNATE EXPLANATION.
3) The idea that inflammation is a KILLER is only recent.
4) You can see how as the ‘garbage’ piles up, (aging) we get weaker and weaker.
Unlike bacteria, these booboos are not going to mutate away. So plain, ordinary, off patent antibiotics will end up proving to be a godsend to countless victims of inflammation.
We’re ONLY beginning to attack this matter. Much of what I’m posting is likely to be invalidated by further research.
But, keep in mind, I’m a fantastically lucky ‘guesser.’
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This whole area is destined to open the final doors into how life booted up from lifelessness. The era before cellular walls.
Everything done before has been at scales too large. These fragments will prove to be so small that it will take a new generation of analytical tools to properly tackle them.
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Fungi are as common as dust in cancer cadavers.
There are fungi that exist in structures no more than one cell thick. It should be obvious that they depend upon chemical protection — and breed on the wind.
That fungi produce toxins… they have to, else be eaten. There’s always something out there looking for an easy meal, and fungi can’t move.
It’s already known that many, many, fungi produce cancer causing agents. The CDC has an official blurb out on the matter. Main stream medicine has finally conceded that fungi practically radiate carcinogens.
It’s something that had been rejected for many, many, years.
EVERYTHING about fungal infections has been taboo. Some of my Kaiser doctors STILL don’t believe that any fungi can be troublesome…. skipping past the obvious ones.
If you didn’t know, most (American) medical colleges ENTIRELY skipped fungi as a pathogen agent. They’re looking in every other direction.
It’s so bad, so pervasive, that overseas websites have bloomed selling Americans anti-fungal medicines that are off patent — and in use for decades — but illegal to prescribe to humans within the USA.
Giving them to pets is okay.
I once had to go to 6 physicians to cure a dermatological issue. Five had it totally wrong but No. 6 immediately had the answer. Only a fool would say that one’s choice of physician makes no difference. A fool OR someone with a not-so-hidden agenda.
Narrow networks means the doctors don’t like it.
Why should docs take a pay cut when the Masters of the Universe make millions and get bailed out by taxpayers?
Next to the Fugitive Slave Act, Obamacare will go down in history as the worst law in US history.
Non healthcare people have no real idea of how difficult and complex medicine is. And, yes, a great doctor is both hard to find and very valuable.
The corporate people and bureaucrats just want to drive down costs (think PAs and nurse practitioners) AND capture all of the equity and profits by putting everyone on salary.
“We have a magical tendency to believe, if a doctor has done something good for us, that he or she was the only medical provider in the world who could have done that good. It’s not true.”
WTF??
Who came up with that idea? How insulting.
In the distant past I had a situation misdiagnosed by 2 doctors. A very serious misdiagnosis. I CARE about who I see for certain things. However for issues of lesser importance I am usually happy to see whomever.
These people make me sick.
There has been a lot of discussion about where the money is going to come from to pay for all the supposedly improved medical care the ACA is giving us.
But I’ve seen almost NO discussion of where the medical care itself is going to come from. We’re supposedly giving improved medical care to millions of people, without increasing the number of doctors, nurses, or specialists. It’s not possible. Depending on the obfuscation of the system, this problem will show itself in different ways (e.g. poor quality, long waiting times, small networks), but it WILL show itself, and no complaining about the details will help.
Juli:
Who came up with that idea? Why, people who want to sell narrow networks to the public, that’s who.
“You’ll save money and it will all be fine because all doctors are the same, and all providers are the same.”
Meanwhile, the speaker goes to the elite physicians and either pays his/her own way or has employment-based insurance with wide networks. Narrow ones are for us peons.
“The health insurance industry opposes these laws, arguing that the laws hurt their ability to negotiate with physicians and hospitals and to drive efficient care – which, the industry says, translates to higher costs for patients…”
That’s horse crap on stilts. What it hurts is their ability to put a contract in front of a doctor or pharmacist with subsistence-level reimbursement rates and say “take it or leave it,” when “leaving it” is the same as committing business suicide.
Meanwhile, the insurance company just gets fatter on the “spread” between what they charge the payer and the pittance that they pay to the provider.
Hogarth…
The general public would be shocked to know that about 30%+ of the tab is spent inside the ‘paper mill.’
0-care has a provision that mandates that the Insurance Cartel hold themselves down to 15%.
That’s an impossibly low figure.
It also ignores the tremendous paper churn that follows totally free health care for illegal immigrants.
Go to any central city ER and witness how LONG illegals spend at the counter getting their ‘records’ straight. If one applies appropriate overhead burdens to the clerks’ time it costs about $100 every time an illegal sits down.
(It’s nothing for them to burn up 40-60 minutes of clerk time on a visit. While the clerks aren’t paid large, their office space comes dear, very dear. Most ERs have 30-50% of their floor plan dedicated to super-clerking.)
Yet all of this has to be eaten by the Insurance Cartel… as in passed on to Whitey.
In racial terms, the only terms that Barry uses, 0-care takes from Whites and gives to Blacks — and Latinos.
Being innumerate, it has never occurred to Barry that he’s set up a system that simply HAS to implode… to go ‘Detroit.’
Open borders and a welfare state can only hold together for a brief moment, like any embezzlement.
The ‘kids’ that Barry is bringing in by the train-load are NEVER going to fit in.
The orphan grinder is making their teen years a total Hell.
This is best told in fiction: “Thief” — Frank/ James Caan explains to the adoption bureaucrat what it’s like to grow up in an orphanage. He has other words about surviving prison life and his ‘adopted father’ — Okla / Willie Nelson.
Barry is inflicting this upon uncounted thousands. His activist policy is to destroy families. Those sending their kids north have absolutely no idea what they’re getting themselves into.
They think they’re going to enter the set of “Dallas.”
Yet, most are destined for foster homes, prison, and penury — courtesy of our welfare state.
As to who would hire them? No-one. There are countless Latinos ahead of them in suitability — right now. And robots are destined to eliminate countless Latino jobs in the immediate future.
Barry is as ideological as any despot to precede him.
Cruel, too.
LTEC
The federal gov’t funds the residency positions for doctors.
But it doesn’t pay enough money for all the people that are graduating from medical school! And an MD must get through a residency.
The ACA did nothing to fix this. The USA needs more doctors and Obama did nothing on the supply problem and only made it worse.
Ask Zeke Emnanuel about this.
Cornhead: actually, O-care reduces the GME (Graduate Medical Education) subsidy. That’s one of the cuts they used to fund the beast. That, and reducing reimbursment to doctors and hospitals.
It’s really very simple — the whole thing is a plot by the Indian Medical School Association,
Yes, here in California, where I am again — in San Francisco to be exact, SFGate, which was/is “The San Francisco Chronicle” was crowing about how many are covered under Obamacare in California. How many more are insured. I have to say I got a laugh out of that. It has been IMPOSSIBLE, or nearly — to get anything at all to work on the website. I have a friend who has tried and tried and tried, for months – I am not kidding you. She is calling now also and gets the phone that doesn’t get picked up (and rings and rings and rings in a government office, that idea) or they tell her they will call her back — but never do. I think eventually something will work. For awhile, I was between jobs and before I got my latest, I did get into Medical here. Well, it was better than the alternative. But it took months also, and when I finally got my card, I would get my job soon thereafter! So, it was just months of stress. I don’t even know what finally did it. I saw people in person to get it. That didn’t help, but finally – yes, my card came so something happened. Again, a little late but whatever. I can’t believe how bad it is!
I remember a much healthier and more competent public health system in California, before Obamacare. It started going downhill before that but this put the kabosh on it. My friend is an Obama supporter but she is in shock and can’t believe how bad it is!
So, this whole thing is a joke. A bad one.