The growing number of private health plans that are giving consumers fewer choices among doctors surprises proponents of Mr. Obama's health care reform.

The latest window into this growing phenomenon comes courtesy of a front page story by health care reporter Reed Abelson in the Sunday, July 17 edition of the New York Times, titled, "Insurers Push Plans Limiting Patient Choice of Doctors."

But consumers should expect more health plans to offer increasingly slim rosters of "in network" doctors and hospitals to choose from, with large co-pays for going "outside" to doctors that don't contract with a plan. Some insurers will demand patients pick up the full cost for seeing doctor outside a health plan's network.

If this sounds like a throwback to the managed care model of the late 1980s and early 1990s, it is. That was the approach to managing care that consumers despised and overturned. The revolt led, in part, to passage of the "Patients Bill of Rights."

Today's reversion to that old HMO model is direct consequence of the peculiar economics set in motion by the Obama health care plan.

The Obama law tightly regulates the health benefits that plans must offer, but also the premiums they can charge. At first premiums are fixed through political jawboning, but more direct controls are just around the legislative corner.

In so doing, the Obama health plan creates a market where insurers will have both their costs and their revenues controlled by the federal government.

In this kind of economic model, the only way to control expenses is to lower the cost of the product that's actually being delivered--in this case, the cost of insurance coverage. In turn, the most efficient way to cheapen the cost of health insurance is to maintain tight reigns on the doctors who are delivering the health care.

That means maintaining tight networks so that insurers can provide close supervision (leverage) over the decisions physicians make. Health plans will employ this control to cut down on excessive use of costly services like radiology scans. In many cases, keeping networks small won't provide enough leverage. Health plans will go one step further and purchase provider groups outright, owning the doctors.

This model will also bleed into the large group market for employer sponsored health coverage. As Ms. Abelson writes in today's New York Times: "Even large employers, worried that the new law will result in higher prices for care as government programs pay less, are reconsidering their earlier stance. When Cigna informally asked some of its clients about their interest in these plans before the legislation passed, very few were receptive. But that has changed"

Indeed, health plans with very tight networks of providers to choose amongst will be the mainstay of the health "exchanges" that the Obama plan stands up in 2014.

The Obama health care czar Nancy-Ann DeParle warns that "any plan sold in the exchanges will have to meet standards developed to make sure patients have enough choice of doctors and hospitals." Good luck enforcing the threat. Having set in motion these economic forces, the Obama team will have to live with the result.

Scott Gottlieb, M.D., is a resident fellow at AEI.

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