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.