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Yesterday, I testified before the House Ways & Means Health Subcommittee, arguing that Obamacare is going to restrict your access to providers.
No, in all likelihood, you can’t keep your doctor.
I found one Obamacare health plan that offers access to only seven pediatricians for a county with 260,000 children. Another Obamacare plan offers access to only nine dermatologists, most 100 miles away. A systematic analysis we did of the plans shows that, on average, their networks include about 40% to 50% of the number of specialists that are available in comparable commercial PPO health plans.
Today, I have an op-ed in the New York Times that I co-wrote with Dr. Zeke Emanuel arguing that – despite the conventional wisdom in the media – Obamacare is unlikely to cause a doctor shortage.
How can these two truths co-exist?
In my view, easily.
While there is unlikely to be a doctor “shortage” for the reasons we argue in the New York Times, that doesn’t mean that the Obamacare plans will enable broad access to these providers.
Quite the opposite.
The Obamcare plans are a throwback to the old HMO model that was soundly rejected in the 1990s in favor of PPO style health plans.
What Obamacare, in effect, tells Americans, is that the White House believes many people made the wrong choice when they rejected those HMOs in favor of PPO plans that offer broader access to providers (often in exchange for slimmed down benefits and, in many cases, higher deductibles).
Obamacare forces consumers to buy a broader menu of primary care benefits, and fixes their co-pays and deductibles at lower levels than many PPO style plans allow.
But the tradeoff is access.To pay for the expanded Obamacare benefits, consumers are forced into narrow networks that limit their choice of doctors. This cheapens the policies enough to offset the other costs.
Some consumers mistakenly believe that if they buy a Silver, Gold, or Platinum plan under Obamacare, they can buy up their benefits. It doesn’t work that way.
Mostly what vary between the different “metal” plans is the co-pays and deductibles. In many cases, the networks are exactly the same as the bronze plan networks.
As for a doctor shortage, don’t count on it. Most of the predictions of a looming shortage make straight-line assumptions from today’s use of doctor resources.
As we argue in the New York Times today, there’s every reason to believe that technology will continue to make the aging process itself (and the treatment of many diseases) a far less resource intensive endeavor – and ones that require fewer physician inputs for a higher level of “outputs” in terms of improved health care.
Moreover, there’s every reason to believe that more non-physician providers will be delivering more services in the future, extending our ranks of doctors.
In the end, if there was a shortage of physicians, it wouldn’t be so easy for the Obamacare health plans to push around doctors and trim their pay.
At some point, the laws of supply and demand take hold, even in the gummed-up market for physician services. If there really were an undersupply of physicians, doctors would have far more commercial leverage than they do right now.
In the future, there will be enough doctors for you to choose from. Problem is, in many cases, the Obamacare health plans won’t pay for you to see them.
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