Limiting your choice of doctors: Is Obamacare to blame?

The specter of loss of choice and freedom to select the doctor you want haunts again. This time it’s being raised on the airwaves with an ad from Americans for Prosperity, a group that advocates limited government and free markets. The ad, an attack on Obamacare, plants doubt in viewers’ minds about whether they can choose their own doctor, a theme that continues to resonate with both the public and politicians.

We hear from Julie, a young mother whose son had seizures two years ago. The medical care he got “meant the world” to me, she says. She is convincing and speaks for every mother worried about her kids. Julie tells us she is paying more attention now to the health system. “I have some questions about Obamacare,” she says. “If we can’t pick our own doctor, how do I know my family’s going to get the medical care we need? Can we really trust the folks in Washington with my family’s health care? We all deserve some answers.”

The pitch is hardly subtle, and viewers no doubt will come away thinking that Obamacare takes away their choice. But the message is misleading and deceptive. There’s nothing in the Affordable Care Act that explicitly prevents patients from choosing their own doctor, and any ad that says or implies it does is just plain wrong.

In reality, the changing health care marketplace has already significantly limited that choice. The notion that every American can choose any doctor they want vanished two decades ago with the growth of HMOs, which required patients to stay in networks and choose from among pre-selected doctors who agreed to the discounts that health plans negotiated. In the early days of managed care, some plans narrowed choice even more by including only providers who met certain quality standards.

While HMOs were becoming more prevalent in health insurance in the early 1990s, opponents of President Clinton’s health reform scheme used the specter of limiting choice to make the public doubt the Clinton plan and fear its consequences, although most had no idea what it was. Harry and Louise, that infamous duo in the TV commercials, worried that the government would force them to pick from a plan designed by government bureaucrats. “Having choices we don’t like is no choice at all,” Louise told TV Land.

Despite a brief backlash against HMO restrictions and grumbling from docs who were left out of some plans that used quality standards, the public came to accept limits on their choice of providers. Insurers now penalize consumers who go out of network by making them pay higher deductibles, copays and coinsurance.

Shoppers in the new insurance exchanges will find their choices of providers restricted even more as insurers offer narrower and narrower networks. The aim is to allow patients to go only to providers who give deep discounts and thus help insurers offer lower-cost premiums.

You can blame Obamacare for this one. Exchanges are supposed to spur competition. Some health plans are doing that by trying to sell policies with the lowest premiums possible. That’s great for the pocketbook, but it means you can’t flit like a butterfly around the health care landscape looking for the best doctor.

The Harry and Louise ads were effective, and the public soured on the Clinton plan. Americans for Prosperity, and others who will use the doubt and fear pitch, are hoping Julie and other characters will do the same.

Here’s where health care consumerism makes some sense. We know you can’t buy health care like cars or canned peas. But you should be skeptical of passionate claims of either pending disaster or salvation, and the political ads for and against Obamacare, which will flood the airwaves as next year’s election approaches, are a good place to start.

Think about it. If you already have limited choice of doctors dictated by employers and insurance companies, what are the ads really telling you?

Trudy Lieberman is a journalist and an adjunct associate professor of public health, Hunter College. She blogs regularly on the Prepared Patient blog.

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  • LaurieMann

    In some areas, it doesn’t seem to matter. We’ve changed our insurance 4 times over the last 20 years, and we still have the same group of doctors. The hospitals we’ve been told to use have changed over time, but, frankly, the hospitals are pretty much equivalent for routine treatment.

  • querywoman

    I had less choice under the old $200 annual deductible system, then get 80% reimbursement. I was constantly having to charge full new patient fees to credit cards.
    I tried an HMO once, Kaiser, an entity that has since been run out of Texas. It took me about 20 years to get my system better after Kaiser eff-Oh’d me.
    I refuse to use an HMO. I have to have a dermatologist and an endocrinologist. When I still worked, I had PPO insurance. I have traditional Medicare now.
    Even with HMO”s, as long as it’s not facility based like Kaiser, you can usually change and get a brand new doc somewhere else once a month.

  • MoRage

    Like heck you can’t buy health like canned peas or cars. There have been at least two articles in the past week alone, showing Americans going abroad to get health care and save thousands of dollars. Then, additionally, there is the YouTube video of a “60 Minutes” segment, also showing the same thing.

    We Americans have the most expensive health care system in the world and our health outcomes are, internationally, some of the worst, statistically. It needs fixing and needs ” Obamacare.”

  • stlevine

    The author’s comments about choice of physicians — then and now — are generally on point. Politicians have learned the dangers of even being perceived to be limiting that choice.
    BUT … to imply that managed care plans somehow “measured quality care” is quite the fantasy. Even today, most insurance companies are struggling to find ways to measure quality with anything other than a charge slip or claim form. Many are “outsourcing” that evaluation to organizations like Bridges to Excellence, which help physicians pull relevant data from their charts to demonstrate the actual quality of care they provide.
    Steve Levine
    VP – Communication
    Texas Medical Association

  • meyati

    The thing here is the plans like to say you can choose your own doctor-OK-many doctors aren’t accepting new patients. Then they say that you can change your doctor if you want-OK-there seems to be a year’s waiting list to get a new doctor. If you get an independent insurance, the doctor you want might not accept it, Here the laboratory gives you a 50% discount if you pay in full within 30 days.

    • querywoman

      Since I won’t use an HMO, I forgot about that “not accepting new patients” thing. Are those docs the kind who spend a lot of time with their patients?
      Even in my local county hospital clinic, a patient can change family doc or internist, but it might take 2 months to get in with someone else!

  • Bob

    Believing Obamacare with the lowest reimbursements will be accepted and participated in by the most important people, doctors and nurses, seems far fetched in the extreme to me. This is especially true as there are severe shortages in physicians and nurses which is getting worse and who are required to enable it, and are increasingly rejecting it?
    So how does this scheme intend to increase physicians and nurses by increasing patients, decreasing reimbursements, while at the same time improving care? I think it is insulting to even suggest that physicians and nurses aren’t now giving the best care they are capable of giving!
    Does anyone believe that potential physicians will spend 10 years and hundreds of thousands in loan money so they can care for the old and needy for the least profit for themselves; rather than take less time and money for careers that are not yet controlled by government? Get real!
    While most don’t even acknowledge a very large percentage of the Physicians and nurses are “Boomers” or Seniors, who are needed to “train and treat” even though many can retire now or shortly, so how are these retained?

  • bill10526

    The popularity of non-traditional medicine shows the fallacy of unfettered consumer choice.

  • querywoman

    My friend is in some Medicare managed care plan. I have traditional Medicare. I took her with me to my endocrinologist, wanting her to go to him for her diabetes,
    She’s seen an NP for years, and never the supervising doctor. She asked her NP for a referral to my endo. The NP said that at 6.8 her A1C was really okay.
    Sometimes, my friend’s fasting sugar is over 200 and she gets really depressed. She’s been having more spells of this.
    Primary care doesn’t treat diabetes aggressively enough. The NP hasn’t even offered to put her on something like metformin. My mother had an NP who put her on metformin with a fasting sugar of 126, after some other high sugars in the prior year. She did fine, and I never saw a need for her to see the endo.
    I cannot have my access to specialists limited!

  • querywoman

    I’m in a large enough area with plenty of doctors for most of the HMOs and PPOs. I don’t know if we even have any facility-based HMO”s like Kaiser.
    Most of the local plans will let a patient go to a minor emergency center if the PCP is booked.

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