Monday, September 23, 2013

Fwd: qotd: New York Times exposes the injustices of private insurers' narrow networks

Quote-of-the-day mailing list

-------- Original Message --------
Subject: qotd: New York Times exposes the injustices of private
insurers' narrow networks
Date: Mon, 23 Sep 2013 10:52:43 -0700
From: Don McCanne <>
To: Quote-of-the-Day <>

The New York Times
September 22, 2013
Lower Health Insurance Premiums to Come at Cost of Fewer Choices
By Robert Pear

Federal officials often say that health insurance will cost consumers
less than expected under President Obama's health care law. But they
rarely mention one big reason: many insurers are significantly limiting
the choices of doctors and hospitals available to consumers.

From California to Illinois to New Hampshire, and in many states in
between, insurers are driving down premiums by restricting the number of
providers who will treat patients in their new health plans.

Some consumer advocates and health care providers are increasingly
concerned. Decades of experience with Medicaid, the program for
low-income people, show that having an insurance card does not guarantee
access to specialists or other providers.

Consumers should be prepared for "much tighter, narrower networks" of
doctors and hospitals, said Adam M. Linker, a health policy analyst at
the North Carolina Justice Center, a statewide advocacy group.

Insurers say that with a smaller array of doctors and hospitals, they
can offer lower-cost policies and have more control over the quality of
health care providers. They also say that having insurance with a
limited network of providers is better than having no coverage at all.

In a new study, the Health Research Institute of PricewaterhouseCoopers,
the consulting company, says that "insurers passed over major medical
centers" when selecting providers in California, Illinois, Indiana,
Kentucky and Tennessee, among other states.

"Doing so enables health plans to offer lower premiums," the study said.
"But the use of narrow networks may also lead to higher out-of-pocket
expenses, especially if a patient has a complex medical problem that's
being treated at a hospital that has been excluded from their health plan."

In California, the statewide Blue Shield plan has developed a network
specifically for consumers shopping in the insurance exchange. Juan
Carlos Davila, an executive vice president of Blue Shield of California…
said the new network did not include the five medical centers of the
University of California or the Cedars-Sinai Medical Center near Beverly

Daniel R. Hawkins Jr., a senior vice president of the National
Association of Community Health Centers, which represents 9,000 clinics
around the country, said: "We serve the very population that will gain
coverage — low-income, working class uninsured people. But insurers have
shown little interest in including us in their provider networks."

Dr. Bruce Siegel, the president of America's Essential Hospitals,
formerly known as the National Association of Public Hospitals and
Health Systems, said insurers were telling his members: "We don't want
you in our network. We are worried about having your patients, who are
sick and have complicated conditions."

"If a health plan has a narrow network that excludes many doctors, that
may shoo away patients with expensive pre-existing conditions who have
established relationships with doctors," said Mark E. Rust, the chairman
of the national health care practice at Barnes & Thornburg, a law firm.
"Some insurers do not want those patients who, for medical reasons,
require a broad network of providers."

NYT reader response:

Don McCanne
San Juan Capistrano, CA

By designing reform that leaves the private insurers in charge, it was
inevitable that their business model would be directed to selling their
own insurance product by trying to keep their premiums competitive.
Instead of controlling health care costs, they are shifting the costs to
people who actually need health care - defeating the purpose of insurance.

Private insurers will continue to search for innovative ways to keep
their premiums competitive, such as narrow networks, high deductibles,
and selling in only healthy, profitable markets. Their waste of our
health care dollars can be demonstrated by last week's report from the
Office of the Actuary of CMS that projects that, in 2022, government
administrative costs for health care (Medicare, Medicaid, CHIP, VA, IHS,
Department of Defense, etc.) will be $70 billion, whereas the
administrative costs of the private insurers will be $313 billion! (That
doesn't even include the cost of the tremendous administrative burden
placed on the health care delivery system.) What a waste!

We need to throw out the outrageously priced and administratively
burdensome private insurance industry that merely screws up our health
care and replace it with an improved version of Medicare that covers

Comment: This article featured prominently in The New York Times
explains the adverse consequences of the private insurers' decisions to
restrict access to narrow networks of physicians and hospitals. When you
look at the very large number of responses to this article, it is
somewhat reassuring that the responses endorsed by the readers
acknowledge that we need to replace the private insurers with a single
payer system.

Use the link above to read the full article, and then clink on "Reader
Picks." We need to translate this into citizen action.

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