How Care Can Be Rationed in a Health Insurance Exchange

The government will coerce doctor and patient both through their efforts at "tiering" physicians based on compliance with guidelines and rationing. This already exists through some private insurers but in the health insurance exchange government pressure will add to the tyranny. If your doctor is not compliant or complicit with the guidelines you will pay more to see that doctor. Different tiers are tied to variable co-pays patients must ante up. Since these tiers are also tied to utilization and cost, doctors who see sicker patients will be tiered lower and their patients likewise penalized with higher co-pays. This shows why (despite President Obama's promise) you may not necessarily get to keep your own doctor or your own plan.

Comments (5)

Trackback URL | Comments RSS Feed

  1. Linda Gorman says:

    It doesn’t matter if you can pick your own doctor if the government controls the treatments he can give you.

  2. Brian says:

    And it doesn’t matter if you can pick your own doctor,( which under insurance you cannot), if insurance controls the treatments he/she can give you.

    The only diffenerce here is who do you want to control your healthcare?
    Do you want someone who is looking at how to take your money and escape paying out anything for benefits, someone who is looking into your medical past to link any illness to a concieved “pre-existing” condition. Someone who is looking for ANY reason to drop coverage.
    You really want to hand your pay-checks over to these people and trust that they will provide a servioce for which you have paid? Good luck with that.

  3. Devon Herrick says:

    The plans will be based on managed competition, where coverage is guaranteed to all that apply at community-rated premiums. This suggests savvy insurers will compete by over-providing care to the healthy and under-providing care to the sick. This could be done by offering free amenities to health-conscious members (health club memberships, wellness programs) while signing up fewer specialists (e.g. cardiologists, oncologists, etc) to practice in-network.

  4. Linda Gorman says:

    People pick their own doctor with insurance all the time. They may have to pay more, but millions of people think it is worth it.

    If an insurer says no to a treatment, people can still pay for it out of an HSA or savings or with a loan. Insurers have an incentive not to say no too often or they lose business. This is why people like PPOs.

    If the government says no, as in Canada, you still have to pay, but you must also travel abroad.

  5. Brian says:

    You would be more correct in saying that people with insurance “pick” their doctor form a list of one or two. When you join insurance you recieve a book listing “approved” doctors and hospitals. If your current Doctor isn’t in the insurance program then you have to switch. No choice there.

    Insurers have no incentive against saying no. They hold a product that is neccessary for life. You have one choice. Live in poverty or pay what they demand. Go elsewhere? other insurance? Same rules apply. Their way or the highway. They tell your doctor what treatment to use, what drugs to prescribe, how long a doctor visit will be, how long a hospitalization will be…… and on and on.

    The plain truth is the system NOW is broken, ruled by money and the drive to get more. It isn’t just broken for the un-insured but broken for small-buisness, broken for those who are under-insured, broken for hospitals, broken for children.