Obamacare Restricts Choice of Hospitals and Doctors

Life in Occupied Gaza
November 24, 2013
Deal in Geneva: Hold the Cheers
November 24, 2013
Obamacare Restricts Choice of Hospitals and Doctors
by Stephen Lendman
Previous articles explained Obamacare deception. It’s a healthcare rationing scheme. It’s a scam to enrich insurers and other major providers. 
Last August, the Wall Street Journal headlined “Many Health Insurers to Limit Choices of Doctors, Hospitals,” saying:
“(O)nline health-insurance marketplace(s) will present some tough choices for consumers.”
Indiana University Health is the state’s largest provider. Consumers are in for a rude awakening. Many will find doctors they rely on excluded from new plan options. Seeing them requires paying costs out-of-pocket.
Expect much the same nationwide. Details are “emerg(ing) about the coverage available through the new consumer marketplaces created by the federal health law,” said the WSJ.
Many plans “include relatively few choices of doctors and hospitals.” Some have “other limits, such as requirements that patients get referrals to see specialists, or obtain insurer authorization before pricey procedures.”
McKinsey & Co. analyzed 955 consumer exchange plan filings. They’re in 13 states. They’re among the earliest to make them public.
Nearly half were HMOs or similar type operations. “Such plans generally don’t pay for care provided outside their networks.”
Preferred-provider organizations (PPOs) limit hospital and doctor choices. Doing so cuts costs. Sacrificed is proper healthcare when most needed.
The Washington Post highlighted the issue. On November 20, it headlined “Insurers restricting choice of doctors and hospitals to keep costs down.” More on it below.
Obama lied claiming otherwise. “If you like your doctor, you will be able to keep your doctor. Period,” he said. 
“If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.”
He “solemnly sw(ore) (to) execute the office of president of the United States faithfully, and…to the best of (his) ability, preserve, protect, and defend the Constitution of the United States.”
He broke every major promise made. He violated core Bill of Rights protections. He ignored international, constitutional and US statute laws.
He proved he can’t be trusted. He’s a serial law breaker. He’s a moral coward. Impeaching him is a national imperative. Obamacare deception is reason enough to do it. His war on humanity agenda demands it.
October 1 began a new era of healthcare marketplace rules. They include rude awakenings. They offer a confusing array of plans.
They’re privately run. Many leave consumers paying huge deductibles and co-pays. They’re on top of expensive premiums.
They limit choice of providers. Many plans “exclude top-rated hospitals,” said WaPo.
Obamacare prioritizes cost control. It does so at the expense of proper care. Insurers created “networks (much) smaller than what most Americans are accustomed to.”
“Decisions provoked a backlash.” Seattle Children’s Hospital (SCH) is a closely watched case. It sued Washington’s insurance commissioner. It did so “after a number of insurers kept it out of their provider networks.”
SCH senior vice president Sandy Melzer called it “unprecedented (in Seattle) to have major insurance plans exclude” a hospital.
Doing so creates two-tiered healthcare. People buying exchange plans are cheated. Provider choices are restricted. 
Top hospitals like Mayo Clinic, Los Angeles-based Cedars-Sinai, and highly-rated children’s hospitals nationwide are excluded.
Seattle-based Premera Blue Cross (PBC) left SCH out of its provider network. It did so except in cases where care can’t be gotten elsewhere.
PBC spokesman Eric Earling said:
SCH’s “non-unique services were too expensive given the goal of providing affordable coverage for consumers.”
Bottom line priorities come first. Authorizing the least care at the lowest cost benefits insurers.
SCH charges about $23,000 for pediatric appendectomies. It’s much more than another community hospital. 
Melzer said it’s because children it treats often are gravely ill. Even routine tonsillectomies are more complicated.
Families long reliant on SCH face a dilemma. Jeffrey Blank’s daughter was diagnosed with a rare bone disorder. He can’t seek SCH treatment. 
Routine checkups alone aren’t permitted. New doctors replace trusted ones. Imagine the angst when care is most needed.
New Hampshire-based Frisbie Memorial Hospital sued an insurer for excluding it from its marketplace. 
In Missouri, “consumer advocates successfully lobbied an insurer to add a children’s hospital after it unveiled a plan that lacked one,” said WaPo.
Paul Ginsberg heads the Center for Studying Health System Change. He calls academic medical centers “valuable because they are the only place to get certain specific treatments.”
At the same time, community hospitals offer comparable routine care much cheaper.
Providers have their own issues. The Cleveland Clinic uses Ohio exchange plans only. Reimbursement rates are higher. Plans include brand-name insurers.
Healthcare consultant Robert Laszewski said most people buying coverage on exchanges are uninsured.
Insurers “looked at (them) and thought: ‘They don’t care about the Mayo Clinic or the Cleveland Clinic. They will go to community providers.”
Insurers usually cover out-of-network costs only in emergencies. According to Community Service Society of New York health initiatives vice president Elisabeth Benjamin:
“I can’t find you a plan with all the major facilities, but if you give me a hospital I can find a plan participating in it.
Obamacare includes vague mandates. On the one hand, it requires insurers to provide enough doctors and hospitals to ensure quality care.
On the other, explicit guidance is excluded. Doing so gives insurers lots of wiggle room. They’re experts at gaming the system for profit. They take full advantage. Obamacare permits it.
New Hampshire exchange users have one choice – Anthem BlueCross BlueShield. No other insurer joined the exchange. 
Anthem’s network includes access to only 16 of New Hampshire 26 acute-care hospitals. Doing so forces consumers to leave doctors they trust.
Jeffrey Blank faces another painful choice. He’s one of millions told their coverage is cancelled effective January 1.
On November 14, Obama responded to growing anger. He said insurers can maintain current noncompliant plans through 2014. Consumers can keep them another year.
Washington’s insurance commissioner said he won’t permit extension. Other states may say the same thing. 
Insurers may or may not tell cancelled policyholders they’re reinstated. Consumers face painful options. Obamacare offers few good ones.
Universal healthcare alone delivers as promised. Profit-driven care scams consumers for profit. Fast food care substitutes for high quality.
Healthcare is a fundamental human right. Martin Luther King called healthcare injustice “the most shocking and inhumane (form) of inequality.”
Obamacare is byzantine in complexity. It’s rife with inequities. Cost control means exclusion from top-ranked hospitals. Out-of-network preferred doctors are shut out.
Two-tiered healthcare is the new normal. Affluent Americans can have whatever they wish. Ordinary people can only get what they can afford.
At issue is a private insurance-based system. Universal single-payer saves about $400 billion annually. It’s enough to provide everyone top quality care. 
It reinstates healthcare as a fundamental human right. It’s double the cost of other developed countries. It’s increasingly less affordable. 
It leaves millions uninsured. It leaves millions more woefully underinsured. It leaves them one major illness away from personal bankruptcy.
Fast food healthcare doesn’t work. It benefits providers, not people. Inability to access expensive treatments when most needed assures pain, suffering and early death. 
Obamacare’s dark side delivers all three. It bears repeating. It’s a healthcare rationing scheme. It enriches insurers and other providers. 
It prioritizes profits over vitally needed care. It denies a fundamental human right. Industry giants wrote the law. They planned it that way. 
Obama is a willing co-conspirator. He’s a corporate tool writ large. He’s that and much more. He bears full responsibility. He denied quality affordable care to growing millions.
He places profits above human need. He made America’s broken healthcare system more than ever dysfunctional. It’s all downhill from here.
A Final Comment
On November 21, the Wall Street Journal headlined “Insurers Cut Doctors’ Fees in New Health-Care Plans. Move Sparks Worries Plans Will Attract Fewer Doctors.”
Corporate giant UnitedHealth Group (UHG) ranks 17th among Fortune’s top 500 companies. It “sent some New York City physicians contract amendments,” said the WSJ.
Confidential documents it got showed lower rates than doctors normally receive. Brooklyn ophthalmologist Sam Unterricht is Medical Society of the State of New York president.
“We have heard from a lot of physicians the rates (insurers) are offering them are very low, and (they’re) questioning whether they are going to participate,” he said.
Some UHG rates approximate what New York pays for Medicaid services. They’re less than half normal doctor fees.
Dr. Steven Levine declined Wellpoint’s offer. It’s “not what a reasonable person would consider acceptable,” he said.
By 2016, exchange plans are expected to cover about 20 million people. Many may lose trusted physicians if they opt out over fees they consider too low. According to the WSJ:
“More physicians may leave the plans as awareness of the new rates spread, doctors and experts said.”
Obamacare “doesn’t include any requirements limiting physicians’ payments or restricting insurers’ arrangements with doctors.”
Expect insurers to take full advantage. “Experts worry (about) a stratified system,” said the WSJ. Millions may lose access to long relied on providers.
Obamacare is the new normal. Treatment received depends on what people can afford. Thousands may die for lack of proper coverage. Expect things ahead to go from bad to worse.
Stephen Lendman lives in Chicago. He can be reached at lendmanstephen@sbcglobal.net
His new book is titled “Banker Occupation: Waging Financial War on Humanity.”
Visit his blog site at sjlendman.blogspot.com
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Stephen Lendman
Stephen Lendman
Stephen Lendman was born in 1934 in Boston, MA. In 1956, he received a BA from Harvard University. Two years of US Army service followed, then an MBA from the Wharton School at the University of Pennsylvania in 1960. After working seven years as a marketing research analyst, he joined the Lendman Group family business in 1967. He remained there until retiring at year end 1999. Writing on major world and national issues began in summer 2005. In early 2007, radio hosting followed. Lendman now hosts the Progressive Radio News Hour on the Progressive Radio Network three times weekly. Distinguished guests are featured. Listen live or archived. Major world and national issues are discussed. Lendman is a 2008 Project Censored winner and 2011 Mexican Journalists Club international journalism award recipient.