# Is the real health care disaster yet to come? **URL:** \ **Category:** Great Debates\ **Created:** [November 19, 2013, 4:54pm UTC](https://boards.straightdope.com/t/is-the-real-health-care-disaster-yet-to-come/674269 "2013-11-19T16:54:14Z")\ **Posts on this page:** 20\ **Page:** 8
**Author:** ![zoid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/zoid/32/336_2.png) [@zoid](https://boards.straightdope.com/u/zoid)\ **Post date:** [December 14, 2013, 5:41am UTC](https://boards.straightdope.com/t/is-the-real-health-care-disaster-yet-to-come/674269/141 "2013-12-14T05:41:12Z")
> [@Terr](#): > > To someone in CA who is an Obamacare enrollee, it doesn’t matter that 80% of doctors in CA accept at least one of the Obamacare plans’ patients. It matters that the doctor he calls accepts _his_ plan. And that chance is less than 30%. Wait, what? So you’re admitting **Lobohan’s** 80% was accurate? Or am I misreading that? ---
**Author:** ![Lobohan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lobohan/32/79_2.png) [@Lobohan](https://boards.straightdope.com/u/Lobohan)\ **Post date:** [December 14, 2013, 5:43am UTC](https://boards.straightdope.com/t/is-the-real-health-care-disaster-yet-to-come/674269/142 "2013-12-14T05:43:40Z")
> [@Terr](#): > > Nope. I told you. My insurance is accepted by every doctor I ever called. And I never checked off a list of approved providers before calling. Your anecdote, like any other singular anecdote, is utterly worthless. Thanks though. > [@](#): > > As for your silly question - I will do you one better. 99% of doctors accept _some_ insurance. So if you want a particular doctor, it’s easy, just get on the insurance he accepts. Bingo, the network problem solved. Until the other doctor you want will not accept the insurance that the first one did. > > To someone in CA who is an Obamacare enrollee, it doesn’t matter that 80% of doctors in CA accept at least one of the Obamacare plans’ patients. It matters that the doctor he calls accepts _his_ plan. And that chance is less than 30%. Do the goalposts look better from there? I hope your didn’t hurt your back carrying them so far. Okay, so we’re both happy, you admit that your cite was utter horseshit, and that 70% of California’s doctors aren’t boycotting Obamacare like you stated earlier in this thread. And I admit to the sin of checking provider lists before I looked for doctors. \<3 ---
**Author:** ![suranyi](https://avatars.discourse-cdn.com/v4/letter/s/e36b37/32.png) [@suranyi](https://boards.straightdope.com/u/suranyi)\ **Post date:** [December 14, 2013, 5:52am UTC](https://boards.straightdope.com/t/is-the-real-health-care-disaster-yet-to-come/674269/143 "2013-12-14T05:52:20Z")
> [@Terr](#): > > Nope. I told you. My insurance is accepted by every doctor I ever called. And I never checked off a list of approved providers before calling. > > As for your silly question - I will do you one better. 99% of doctors accept _some_ insurance. So if you want a particular doctor, it’s easy, just get on the insurance he accepts. Bingo, the network problem solved. Until the other doctor you want will not accept the insurance that the first one did. > > To someone in CA who is an Obamacare enrollee, it doesn’t matter that 80% of doctors in CA accept at least one of the Obamacare plans’ patients. It matters that the doctor he calls accepts _his_ plan. And that chance is less than 30%. Terr, you’re simply wrong. When I had insurance through my employer, ( the insurance was through Aetna), I had to check their list of approved providers to find a doctor who was in their network. For sure no Kaiser doctor would be. So this is nothing new. ---
**Author:** ![PhillyGuy](https://avatars.discourse-cdn.com/v4/letter/p/ed655f/32.png) [@PhillyGuy](https://boards.straightdope.com/u/PhillyGuy)\ **Post date:** [December 14, 2013, 1:51pm UTC](https://boards.straightdope.com/t/is-the-real-health-care-disaster-yet-to-come/674269/144 "2013-12-14T13:51:17Z")
> [@Terr](#): > > It matters that the doctor he calls accepts _his_ plan. And that chance is less than 30%. This sentence doesn’t make sense unless one distinguishes between primary and specialty care. Most American physicians are specialists, an absurd situation that makes finding a good family physician, or associated alternative (nurse practitioner or physician assistant) difficult. This is not so much because of small networks as because lots of the good ones are not accepting new patients regardless of your plan. Other than getting a recommendation from a medical professional you trust, probably the best way to find a good family practice is to search here for one with Patient Centered Medical Home certification: > **[Health Plan Ratings & Provider Directory - NCQA Report Cards](https://reportcards.ncqa.org/#/practices/list/)** > > Identify the highest-rated health care organizations with NCQA's directory of health plans, practices and other health care orgnanizations. Matching up names from a link, like the one above, to your heath plan’s list, and then finding one who is nearby and accepts new patients, and then sticking with them only if the provider is a good patient listener, can be hard. This isn’t because of ACA, but because of too many specialty residency spots and not enough for family medicine and primary pediatrics. ACA actually has some incentives to help this. Once you do get a good family doc, the likelihood is that specialty physicians who they work with are at the same hospital and accept the same plan. I did say earlier that my wife and I don’t let our family doc tell us which specialist to use. That’s because, five years ago, our family doc moved to Wilmington Delaware to be a health executive, and we followed him! Hardly anyone would do that. As a result, if we need a specialist, we call the much closer prestigious Ivy League hospital and take whomever they give us. This is a bad system that should be discouraged, and we only do it because of the family doc shortage makes us willing to travel a long way, just for the family doc. A better idea would be for us to have care referred out by our Wilmington doc to other Wilmington (actually Christiana Care) docs that know and work with each other, as it should be. There could be another problem if we used a profit-making hospital, as they typically have independent specialists who often have different insurance memberships from other docs at that hospital. This is a bad model. Stick to physicians that are employed by, or at least closely allied to, integrated non-profit health care organizations. See: [All not-for-profit hospitals combined (both church-owned and other) have significantly better patient safety, fewer 30-day mortalities, and better overall patient satisfaction ratings [than for-profit hospitals].](http://www.100tophospitals.com/assets/HOSP_12678_0513_100TopHopPerfOwnershipPaper_RB_WEB.PDF) The number of docs in the network does not matter. What matters is who they are and how they work together. ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [December 14, 2013, 2:25pm UTC](https://boards.straightdope.com/t/is-the-real-health-care-disaster-yet-to-come/674269/145 "2013-12-14T14:25:07Z")
> [@Lobohan](#): > > Do the goalposts look better from there? I hope your didn’t hurt your back carrying them so far. Here is the goalpost from post #76 (and the one which you quoted in your responses): “Yes, and I am sure those tens of thousands of people will be thrilled when they find out that 70% of doctors they call don’t accept Obamacare. And will be really thankful to Democrats.” That’s the goalpost. ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [December 14, 2013, 2:26pm UTC](https://boards.straightdope.com/t/is-the-real-health-care-disaster-yet-to-come/674269/146 "2013-12-14T14:26:33Z")
> [@suranyi](#): > > Terr, you’re simply wrong. When I had insurance through my employer, ( the insurance was through Aetna), I had to check their list of approved providers to find a doctor who was in their network. For sure no Kaiser doctor would be. So this is nothing new. What is new is the fact that only 30% or less of all doctors you can call will be in the new networks of the new Obamacare policies. Never have those networks have been so narrow. ---
**Author:** ![RitterSport](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/rittersport/32/6326_2.png) [@RitterSport](https://boards.straightdope.com/u/RitterSport)\ **Post date:** [December 14, 2013, 2:53pm UTC](https://boards.straightdope.com/t/is-the-real-health-care-disaster-yet-to-come/674269/147 "2013-12-14T14:53:33Z")
> [@Terr](#): > > Here is the goalpost from post #76 (and the one which you quoted in your responses): > > “Yes, and I am sure those tens of thousands of people will be thrilled when they find out that 70% of doctors they call don’t accept Obamacare. And will be really thankful to Democrats.” > > That’s the goalpost. But, that goalpost means that 70% of doctors don’t accept any Obamacare plans, not that they accept one plan but not another plan. That is, if the patients called and asked whether a physician takes any Obamacare plans at all, you’re position is that 70% of those doctors called would say no. This is clearly untrue. I also find it bizarre that you look for doctors at random from a phonebook or something. I have Blue Cross/Blue Shield at work and I always start with their online provider listing, because starting with random doctors and asking whether they take BCBS would be silly. I think that if I were lied to this blatantly by the news sources I follow, I would find different news sources. Live and learn – that’s my philosophy. What’s yours? ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [December 14, 2013, 2:56pm UTC](https://boards.straightdope.com/t/is-the-real-health-care-disaster-yet-to-come/674269/148 "2013-12-14T14:56:51Z")
> [@RitterSport](#): > > But, that goalpost means that 70% of doctors don’t accept any Obamacare plans, not that they accept one plan but not another plan. No, it means that for that particular person who’s calling the doctors, 70% of the doctors do not accept his plan. As in (I quote again) “Yes, and I am sure those tens of thousands of people will be thrilled when they find out that 70% of doctors they call don’t accept Obamacare. And will be really thankful to Democrats.” Because it is utterly not important or relevant to the person calling whether the doctor he calls accepts some other Obamacare insurance. It is important whether the doctor accepts his Obamacare insurance. > [@](#): > > I also find it bizarre that you look for doctors at random from a phonebook or something. I have Blue Cross/Blue Shield at work and I always start with their online provider listing, because starting with random doctors and asking whether they take BCBS would be silly. I don’t call doctors at random. I ask people to recommend doctors, then call them. I have yet to find one that does not accept my insurance. ---
**Author:** ![Lobohan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lobohan/32/79_2.png) [@Lobohan](https://boards.straightdope.com/u/Lobohan)\ **Post date:** [December 14, 2013, 3:10pm UTC](https://boards.straightdope.com/t/is-the-real-health-care-disaster-yet-to-come/674269/149 "2013-12-14T15:10:09Z")
> [@Terr](#): > > It’s going to be fun watching the liberals trying to spin things when the newly-minted Obamacare participants next year, eager to use their benefits, will frantically try to find doctors who accept their plans and fail. > > [http://washingtonexaminer.com/doctors-boycotting-californias-obamacare-exchange/article/2540272](http://washingtonexaminer.com/doctors-boycotting-californias-obamacare-exchange/article/2540272) > > Independent insurance brokers who work with both insurance companies and doctor networks estimate that about 70 percent of California’s 104,000 licensed doctors are boycotting the exchange. Here is a moved goalpost. Then you slip into your ignorant 30% for an individual plan nonsense. ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [December 14, 2013, 3:19pm UTC](https://boards.straightdope.com/t/is-the-real-health-care-disaster-yet-to-come/674269/150 "2013-12-14T15:19:10Z")
> [@Lobohan](#): > > Here is a moved goalpost. > > Then you slip into your ignorant 30% for an individual plan nonsense. You ignore both my preamble and the other articles I posted. From Bloomberg, Forbes and CNN. I reiterate the goalpost: “It’s going to be fun watching the liberals trying to spin things when the newly-minted Obamacare participants next year, eager to use their benefits, will frantically try to find doctors who accept their plans and fail.” ---
**Author:** ![Lobohan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lobohan/32/79_2.png) [@Lobohan](https://boards.straightdope.com/u/Lobohan)\ **Post date:** [December 14, 2013, 3:24pm UTC](https://boards.straightdope.com/t/is-the-real-health-care-disaster-yet-to-come/674269/151 "2013-12-14T15:24:05Z")
> [@Terr](#): > > No, it means that for that particular person who’s calling the doctors, 70% of the doctors do not accept his plan. As in (I quote again) > > “Yes, and I am sure those tens of thousands of people will be thrilled when they find out that 70% of doctors they call don’t accept Obamacare. And will be really thankful to Democrats.” > > Because it is utterly not important or relevant to the person calling whether the doctor he calls accepts some other Obamacare insurance. It is important whether the doctor accepts his Obamacare insurance. Only someone who doesn’t understand how insurance works in America would call doctors at random. Everyone who has dealt with insurance, looks at a list of providers. If anecdotes suddenly have power, every time I’ve gotten insurance, I was given a list or a link to find providers that accept it. Narrow Networks are a cost-saving measure. It’s been happening for awhile. > [@](#): > > I don’t call doctors at random. I ask people to recommend doctors, then call them. I have yet to find one that does not accept my insurance. Either your memory is faulty, you got lucky, or you asked people you work with, so they have the same insurance. Good on you, for successfully blundering through the world of insurance. ---
**Author:** ![Lobohan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lobohan/32/79_2.png) [@Lobohan](https://boards.straightdope.com/u/Lobohan)\ **Post date:** [December 14, 2013, 3:25pm UTC](https://boards.straightdope.com/t/is-the-real-health-care-disaster-yet-to-come/674269/152 "2013-12-14T15:25:14Z")
> [@Terr](#): > > You ignore both my preamble and the other articles I posted. From Bloomberg, Forbes and CNN. > > I reiterate the goalpost: > > “It’s going to be fun watching the liberals trying to spin things when the newly-minted Obamacare participants next year, eager to use their benefits, will frantically try to find doctors who accept their plans and fail.” So you typed that line for no reason? Just slipped? Didn’t have no nothin’ to do with the point of your post? Well, shucks! ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [December 14, 2013, 3:30pm UTC](https://boards.straightdope.com/t/is-the-real-health-care-disaster-yet-to-come/674269/153 "2013-12-14T15:30:44Z")
> [@Lobohan](#): > > Only someone who doesn’t understand how insurance works in America would call doctors at random. Everyone who has dealt with insurance, looks at a list of providers. Again, I dealt with insurance all my life. With my current insurance, I have yet to call a doc who doesn’t accept it. If less than 3 out of 10 doctors accepted my insurance, I would certainly be disappointed with it. ---
**Author:** ![Grumman](https://avatars.discourse-cdn.com/v4/letter/g/43a26b/32.png) [@Grumman](https://boards.straightdope.com/u/Grumman)\ **Post date:** [December 14, 2013, 3:47pm UTC](https://boards.straightdope.com/t/is-the-real-health-care-disaster-yet-to-come/674269/154 "2013-12-14T15:47:15Z")
> [@Lobohan](#): > > Only someone who doesn’t understand how insurance works in America would call doctors at random. Everyone who has dealt with insurance, looks at a list of providers. And it hasn’t occurred to you that there might be some overlap between people who haven’t dealt with the American health insurance industry before and people who are being forced to deal with the American health insurance industry by government mandate? ---
**Author:** ![Lobohan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lobohan/32/79_2.png) [@Lobohan](https://boards.straightdope.com/u/Lobohan)\ **Post date:** [December 14, 2013, 3:57pm UTC](https://boards.straightdope.com/t/is-the-real-health-care-disaster-yet-to-come/674269/155 "2013-12-14T15:57:03Z")
> [@Grumman](#): > > And it hasn’t occurred to you that there might be some overlap between people who haven’t dealt with the American health insurance industry before and people who are being forced to deal with the American health insurance industry by government mandate? Even a novice should be able to follow directions. The first time I had insurance, I chose from a list of providers, because a list of providers was given to me. I suspect most people could manage that. Terr is claiming expertise and demonstrating ignorance. Forced is a strong word, by the way. Feel free to not have insurance. Just pay your fine and hope for the best. ---
**Author:** ![PhillyGuy](https://avatars.discourse-cdn.com/v4/letter/p/ed655f/32.png) [@PhillyGuy](https://boards.straightdope.com/u/PhillyGuy)\ **Post date:** [December 14, 2013, 10:32pm UTC](https://boards.straightdope.com/t/is-the-real-health-care-disaster-yet-to-come/674269/156 "2013-12-14T22:32:53Z")
> [@Lobohan](#): > > If anecdotes suddenly have power, every time I’ve gotten insurance, I was given a list or a link to find providers that accept it. This means you are not in an HMO. Right now, I am not, either. However, most of the Pennsylvania exchange plans are HMO’s, at least in the sense that you need a referral from your primary provider for a specialist visit. So the patient doesn’t get the specialist’s name off a list – the name is given to the patient. There are better and worse HMO’s, just as there are better and worse primary care providers. But the basic idea – that your family doc should be coordinating your care, working as a team with any needed consultants AKA specialists – is all to the good. ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [December 14, 2013, 10:46pm UTC](https://boards.straightdope.com/t/is-the-real-health-care-disaster-yet-to-come/674269/157 "2013-12-14T22:46:30Z")
> [@PhillyGuy](#): > > But the basic idea – that your family doc should be coordinating your care, working as a team with any needed consultants AKA specialists – is all to the good. No thank you. I always avoided HMOs like a plague. I pick my doctors. I pick my GP. And I pick my specialists. I may take GP’s advice, but I will not allow him to limit my choice. ---
**Author:** ![IvoryTowerDenizen](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ivorytowerdenizen/32/17937_2.png) [@IvoryTowerDenizen](https://boards.straightdope.com/u/IvoryTowerDenizen)\ **Post date:** [December 14, 2013, 10:55pm UTC](https://boards.straightdope.com/t/is-the-real-health-care-disaster-yet-to-come/674269/158 "2013-12-14T22:55:26Z")
> [@PhillyGuy](#): > > This means you are not in an HMO. Right now, I am not, either. > > However, most of the Pennsylvania exchange plans are HMO’s, at least in the sense that you need a referral from your primary provider for a specialist visit. So the patient doesn’t get the specialist’s name off a list – the name is given to the patient. > > There are better and worse HMO’s, just as there are better and worse primary care providers. But the basic idea – that your family doc should be coordinating your care, working as a team with any needed consultants AKA specialists – is all to the good. Not all HMOs pick the referral. You can still pick from a list of providers that work with the insurance company. The referral simply means the PCP agrees you need the specialist and approves the visit to the doctor you choose (perhaps from a list of approved participants). > [@Terr](#): > > No thank you. I always avoided HMOs like a plague. I pick my doctors. I pick my GP. And I pick my specialists. I may take GP’s advice, but I will not allow him to limit my choice. If you use any insurance you are generally limited to participating providers if you want the insurance to pay. A PCP coordinating your care doesn’t always mean they pick the docs. My mom has PCP coordinate her care, for example, to make sure someone is looking over all her different meds to make sure she’s not being over medicated. Her PCP is a gerontologist. ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [December 14, 2013, 11:10pm UTC](https://boards.straightdope.com/t/is-the-real-health-care-disaster-yet-to-come/674269/159 "2013-12-14T23:10:02Z")
> [@IvoryTowerDenizen](#): > > If you use any insurance you are generally limited to participating providers if you want the insurance to pay. A PCP coordinating your care doesn’t always mean they pick the docs. As I mentioned before, so far I have been picking my specialists myself, and I have not come across one yet that didn’t take my insurance. When you call a doc to make an appointment for the first time, what insurance you have is the first thing they ask. If, as with the California’s Obamacare policies, my “success rate” in such calls was less than 30% (instead of the 100% now), I’d certainly be disappointed with my insurance. ---
**Author:** ![Grim\_Render](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@Grim\_Render](https://boards.straightdope.com/u/Grim_Render)\ **Post date:** [December 14, 2013, 11:11pm UTC](https://boards.straightdope.com/t/is-the-real-health-care-disaster-yet-to-come/674269/160 "2013-12-14T23:11:10Z")
> [@Terr](#): > > No thank you. I always avoided HMOs like a plague. I pick my doctors. I pick my GP. And I pick my specialists. I may take GP’s advice, but I will not allow him to limit my choice. Sounds like youre in a Single Payer system. [Previous page](https://boards.straightdope.com/t/is-the-real-health-care-disaster-yet-to-come/674269.md?page=7) [Next page](https://boards.straightdope.com/t/is-the-real-health-care-disaster-yet-to-come/674269.md?page=9)