Obamacare excludes world class hospitals
I recall when my dad had cancer, his insurance plan made it possible for him to be treated at the Mayo Clinic, one of the top cancer treatment centers in the world then and now.
Too bad if you get your insurance via Obamacare, you won't be able to get treatment like that at several distinguished - and life saving - hospitals.
Experts say the move by insurers to limit consumers' choices and steer them away from hospitals that are considered too expensive, or even "inefficient", reflects the new competitive landscape in the insurance industry since the passage of the Affordable Care Act, Barack Obama's 2010 healthcare law.
It could become another source of political controversy for the Obama administration next year, when the plans take effect. Frustrated consumers could then begin to realise what is not always evident when buying a product as complicated as healthcare insurance: that their new plans do not cover many facilities or doctors "in network". In other words, the facilities and doctors are not among the list of approved providers in a certain plan.
Under some US health insurance plans, consumers can elect to visit medical facilities that are "out of network", but they would probably incur high out of pocket costs and may need referrals to prove that such care is medically necessary.
The development is worrying some hospital administrators who see the change as an unintended consequence of the ACA.
"We're very concerned. [Insurers] know patients that are sick come to places like ours. What this is trying to do is redirect those patients elsewhere, but there is a reason why they come here. These patients need what it is that we are capable of providing," says Thomas Priselac, president and chief executive officer of Cedars-Sinai Health System in California.
One of the biggest goals of "Obamacare" was to make subsidised healthcare plans that are being sold on the new exchanges as affordable as possible, while also mandating that certain benefits, like maternity care, were covered and that people with pre-existing medical conditions could not be denied access.
Amid these new regulatory restrictions, says Tim Jost, a health policy expert, insurance companies have had to come up with new ways to cut the cost of their products. In this new era, limiting the availability of certain facilities that are seen as too expensive - in part because they may attract the sickest patients or offer the most cutting edge medical care - is seen as the best way to control costs.
As has been pointed out numerous times, we are heading for a two tiered health care system where the rich - and friends of Barack like unions - will have access to the very best doctors and facilities while the rest of us get whatever is left over.
Winners and losers folks. And guess which one the majority of us are?