Of course, we typically hear the term "pro-choice" in an entirely different context. Just using the term raises appreciation in some, upset in others, and has influenced everything from personal relationships to election outcomes.
Today the term "pro-choice" takes on an entirely different meaning. Pro-choice, in the context of healthcare reform, now means the choice between insurance plans -- a plan that does, or does not let you choose the doctor you want to see.
So where does this new concept of pro-choice come from? If we harken back to the days pre-health care reform, you'll remember that we were promised that "if you like your doctor, you can keep your doctor." And -- that's still true. But the part of the claim that was missing was, "as long as you're willing to pay to see your doctor."
Your choice of insurance plans will limit, or expand, your choice of doctors.
As anticipated, insurers are tightening their belts even further, and more than ever before, they are limiting their customers' access to doctors by limiting the doctors who are a part of any given health plan. Between the new exchanges that are being set up for individuals who will need to purchase their own insurance, and the new plans being developed for employers to provide to their employees come fall, the most affordable plans will limit patients to seeing the doctors who charge the least.
There's really nothing new about that -- limiting the doctors patients can see through any given policy has been a long-standing approach by insurers. However, those lists of possible doctors are getting shorter and shorter, and that means a few things we need to be aware of:
1. By limiting the choices of doctors to those who charge the least, those less-expensive doctors' appointment calendars will become even more overloaded than they already are - meaning - that even if you have insurance that says you can see that doctor, it doesn't mean you'll be able to get an appointment.
2. Expanding your list of doctors so you can get to see one you'd like to see (if that doctor is not on the list of least-expensive) will mean you need to pony up more money for your policy. To get the care you want, those less expensive policies won't be a choice you can make.
3. Some doctors who charge "too much" for those basic policies will begin to see their appointment calendars empty out (meaning they'll need to begin charging less to fill their appointment calendars again) or, for the first time in a long time, just the right number of patients will be calling for appointments. Just because insurers are putting the squeeze on doctors to limit their pricing doesn't mean it makes sense for all those doctors to do so.
4. A trend we are already beginning to see is those doctors who have just had it -- and won't put up with it anymore. They are closing their practices, either retiring or selling or simply locking the door and walking away. Others are changing their practices to a concierge or boutique model. Still others are shifting to patient advocacy instead of medical practice. Yes -- doctors are pro-choice when it comes to making decisions for their own practices.
5. A reminder to us all that expensive does not always equal better. Some of the very best doctors will be available even to those who have the least expensive policies, and some real doctor-duds will continue to charge way more than they are worth. However -- those very best but not-expensive doctors will become so overburdened that it will affect the quality of their service.
So what does that mean to us patients? It means we have some hard choices to make. Paying more for our care, or paying less for doctors we might not care so much about but who might be able to help us, looking for people who can help us coordinate our care, or moving to another country where healthcare is considered a right of citizenship where these questions - and choices - are foreign concepts.
Even with this change in context, pro-choice will continue to influence personal relationships and election outcomes, too.
Are you pro-choice?
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Thanks, Trisha. This is quite a comprehensive explanation of the situation. I can think of two noteworthy aspects of this choice problem.
First, for everyone who decried the possibility of the government taking over healthcare, if the publlic option had been made available, we’d have had some leverage against the insurance companies. They would have had to compete with a cheaper system, and they likely would have used choice as their lever: stay with us and have a choice of doctors. Ah well, spilt milk.
Second, the Patient Protection and Affordable Care Act (PPACA) will begin putting limits on the insurance companies later this year. After 2014, they have to get rid of the annual spending caps that have bankrupted so many cancer patients, and they won’t be able to discriminate against anyone based on pre-existing conditions. So, in order to scoop up some income in the interim, they claim the medical system is crippling them (a lie) and offer a bunch of insurance scams like high deductibles or tightly limited choice for lower monthly rates.
My advice, for everyone’s sake, stick with the plans that give you doctor choice. If enough of us insist on doctor choice, they won’t sell the cheap plans. If they don’t sell enough of them, the cheap plans will be pulled for the betterment of all concerned.
So, short answer: we should all be pro-choice on insurance.
If that insults anyone’s sensibilities, we can call it pro-choices.
Since we are stuck with the so-called “health care reform”, I would have to say I am pro-choice. However, I firmly believe that this is yet another opportunity on the part of the for-profit health non-care system to squeeze even more money from its victims–the patients–similar to what happened with Medicare Part D. To read the hidden truth about our health non-care system, please read chapters 21-23 of Free Lunch by David Cay Johnston. The amount of money insurance companies make by denying care to patients is absolutely staggering, and the new law will make those numbers even larger.