Is choice of health plans what any American wants, asks Austin Frakt in a New York Times piece. Or do people simply want affordable choice of doctors and hospitals?
Why would anyone want choice of health plans might be a better question. The principal reason people need choice today is financial–to be able to afford their care. But, what everyone should want is the knowledge that they can see the doctors they want to see when they want to see them, without worry about the cost. And no private health insurance plan offers them that choice.
Put differently, it is valuable to have a health plan that delivers you the care you want at a price you can afford each and every time you need care, no matter what care you need or where you need it. If no health plan offers you that choice, what does choice give you?
Take Medicare Advantage, private health insurance plans that offer Medicare benefits. People with Medicare have the choice of many Medicare Advantage plans. But, none offer them an open network of doctors at low or no out-of-pocket cost. In fact, people’s costs are not even predictable. Some Medicare Advantage plans deny care inappropriately and often. Who wants these choices?
Many people sign up for Medicare Advantage plans because they do not understand what they might be giving up when they do–access to the care they need when they need it at a price they can afford. Or, they are willing to gamble that they will not need a lot of care so that they can save money. Traditional Medicare gives people the choice of almost any doctor anywhere in the country. But, it has no out-of-pocket cap. Unless you have Medicaid or retiree coverage, you must buy supplemental coverage in order to protect yourself from high out-of-pocket costs if you need care. And, supplemental coverage is pricey.
Frakt notes that when you are choosing among private health plans, each with their own cost structure and restricted network of health care providers, it is easy to make a mistake. You can pick a plan that ends up keeping you from seeing the doctors you want to see and charging you more for your care than you ever would have imagined. People do not want to be gambling in that way if they do not need to.
Frakt makes the wrong point. There is no way to avoid making mistakes when choosing a health plan, so long as Congress allows private health plans to offer people poor health plan choices. And, it allows health plans to keep people from knowing the ways they restrict care until they need care.
For people to choose a health plan that meets their needs, Congress would have to determine people’s provider networks, coverage rules, and out-of-pocket costs. Congress would need to protect Americans from insurers that would otherwise not cover the care they need. Congress does not do that today, nor do the states.
Frakt suggests that with some assistance, people could understand their health plan choices. That’s a myth. No amount of assistance will ensure people make a good health plan choice; that’s only possible if there are good choices. But, for-profit private health insurers have a disincentive to offer people good health plan choices, since giving people with costly conditions the care they need at a price they can afford would eat into private health insurer profits.
Frakt does recognize that choice of health insurance brings with it poor health plan choices and unaffordable choices. He just doesn’t recognize that there is no way to know whether there is a good health plan choice.
Like traditional Medicare, Medicare for All gives people the freedom to know that they will be guaranteed affordable health care coverage and be able to see the doctors they want to see. Everyone would have a good health plan choice.
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