Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Walter White and the narrow networks of Obamacare

Brian C. Joondeph, MD
Policy
June 7, 2014
Share
Tweet
Share

121813-ww-1800-1387390916

As we behold the continued wonders of Obamacare, we receive another reminder of the president’s empty promise: “If you like your doctor, you can keep your doctor.”  The New York Times observed, “No matter what kind of health plan consumers choose, they will find fewer doctors and hospitals in their network — or pay much more for the privilege of going to any provider they want.”  What a surprise.

Insurance networks are common features of many plans.  The network represents a group of physicians, hospitals, and other providers that contract with an insurance plan to provide specified medical care at set fees.  As insurer United Health Care describes it, “Receive quality care at reduced costs because our network providers have agreed to lower fees for covered expenses.”

For the providers, this agreement represents a tradeoff: access to patients, but for lower payment.  For the insurance companies, it’s a way to cut costs.  These types of business arrangements are common.  Businesses that join the AARP network agree to provide discounts to AARP members in exchange for access to AARP members.

In health care, access to patients is paramount for providers, and this access is through insurance networks.  While AARP members won’t go bankrupt if they don’t take advantage of their half-price movie theater tickets or two-for-one lunch deals, going out of network for heart surgery or cancer care is another matter.  According to United, “The out-of-network provider’s actual charge [may be] billed to the member.”  Meaning that the patient could be on the hook for the entire cost of care.

This forces physicians and hospitals to accept  lower fees in order to have access to patients.  From an economic perspective, this makes sense, as the Times notes: “Narrower networks are essential to controlling costs and managing care.”  But from the provider side, at some point the economics make no sense, and providers opt out of these networks.  A restaurant may provide AARP members with free dessert as a perk, but it won’t provide $2 steak dinners and hope to remain in business.

Hence, many physicians and hospitals are not part of these narrow provider networks because they cannot or will not accept fees that don’t cover their expenses.  Health care is a noble profession, but it is still a business.  It doesn’t take a Harvard MBA to understand that working for a loss is an unsustainable business model.

It turns out many of the Obamacare insurance plans have extremely narrow provider networks.  As the Associated Press is just discovering, “Consumers realize they bought plans with limited doctor and hospital networks, some after websites that mistakenly said their doctors were included.”  If you have cancer and want treatment at one of the elite cancer centers, good luck.  Many of the nation’s top cancer hospitals are out of network under Obamacare plans.  Walter White discovered this in the first season of Breaking Bad.  He had to go out of network for his cancer care, cooking meth to pay for it.

And this is not just about cancer care.  Seattle Children’s Hospital is out of network for most Obamacare exchange plans in Washington State.  If your child needs open heart surgery or cancer care, where would you rather go?  A regional children’s hospital or the community hospital down the road?

The president is certainly pro-choice when it comes to abortion and other women’s health issues.  But what happens to women in New York City who need cancer treatment and “choose” world-renowned Memorial Sloan Kettering Hospital?  Good choice if they happen to have insurance through either of two of the nine insurers in New York City where Sloan Kettering is in network.  Otherwise, choose somewhere else, and good luck.

“Pro-choice” sounds good on the campaign trail.  But the dirty little secret is that the reality is “no choice.”  As one insurance executive explained, “We have to break people away from the choice habit that everyone has.”  If you like your doctor, that’s nice, but you can’t keep your doctor.  “We’re are trying to break away from this fixation on open access and broad networks.”  Silly me, thinking I could choose my doctor.  I’ll just go where the government or insurance company thinks I should go.  After all, they know best.

Such limitations are not new.  Twenty years ago, we saw the advent of HMOs and their restricted networks.  Here we go again, and over four years into Obamacare, the mainstream media is just learning this.  The Times believes that “there is evidence that consumers are willing to sacrifice some choice in favor of lower prices.”  We’ll see.  Walter White wasn’t willing to make that sacrifice.

Brian C. Joondeph is an ophthalmologist and can be reached on Twitter @retinaldoctor.  This article originally appeared in American Thinker.

Prev

Responsible public relations for health study findings

June 7, 2014 Kevin 0
…
Next

Is medicine for the suits or the white coats?

June 7, 2014 Kevin 25
…

ADVERTISEMENT

Tagged as: Hospital-Based Medicine, Public Health & Policy

Post navigation

< Previous Post
Responsible public relations for health study findings
Next Post >
Is medicine for the suits or the white coats?

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Brian C. Joondeph, MD

  • Ophthalmology in the era of COVID-19

    Brian C. Joondeph, MD
  • An ophthalmologist analyzes Joe Biden’s red eye

    Brian C. Joondeph, MD
  • When medical science becomes fake news

    Brian C. Joondeph, MD

More in Policy

  • How locum tenens work helps physicians and APPs reclaim control

    Brian Sutter
  • Why Medicaid cuts should alarm every doctor

    Ilan Shapiro, MD
  • Why physician voices matter in the fight against anti-LGBTQ+ laws

    BJ Ferguson
  • The silent toll of ICE raids on U.S. patient care

    Carlin Lockwood
  • What Adam Smith would say about America’s for-profit health care

    M. Bennet Broner, PhD
  • The lab behind the lens: Equity begins with diagnosis

    Michael Misialek, MD
  • Most Popular

  • Past Week

    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • In a fractured world, Brian Wilson’s message still heals

      Arthur Lazarus, MD, MBA | Physician
    • How home-based AI can reduce health inequities in underserved communities [PODCAST]

      The Podcast by KevinMD | Podcast
    • How doctors took back control from hospital executives

      Gene Uzawa Dorio, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
  • Recent Posts

    • How home-based AI can reduce health inequities in underserved communities [PODCAST]

      The Podcast by KevinMD | Podcast
    • Adriana Smith’s story: a medical tragedy under heartbeat laws

      Nicole M. King, MD | Physician
    • What if medicine had an exit interview?

      Lynn McComas, DNP, ANP-C | Conditions
    • Why U.S. health care pricing is so confusing—and how to fix it

      Ashish Mandavia, MD | Physician
    • From survival to sovereignty: What 35 years in the ER taught me about identity, mortality, and redemption

      Kenneth Ro, MD | Physician
    • When doctors forget how to examine: the danger of lost clinical skills

      Mike Stillman, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 15 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • In a fractured world, Brian Wilson’s message still heals

      Arthur Lazarus, MD, MBA | Physician
    • How home-based AI can reduce health inequities in underserved communities [PODCAST]

      The Podcast by KevinMD | Podcast
    • How doctors took back control from hospital executives

      Gene Uzawa Dorio, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
  • Recent Posts

    • How home-based AI can reduce health inequities in underserved communities [PODCAST]

      The Podcast by KevinMD | Podcast
    • Adriana Smith’s story: a medical tragedy under heartbeat laws

      Nicole M. King, MD | Physician
    • What if medicine had an exit interview?

      Lynn McComas, DNP, ANP-C | Conditions
    • Why U.S. health care pricing is so confusing—and how to fix it

      Ashish Mandavia, MD | Physician
    • From survival to sovereignty: What 35 years in the ER taught me about identity, mortality, and redemption

      Kenneth Ro, MD | Physician
    • When doctors forget how to examine: the danger of lost clinical skills

      Mike Stillman, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Walter White and the narrow networks of Obamacare
15 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...