The following is an excerpt from OpinionJournal.com’s “Best of the Web” written by the editor, James Taranto.
‘The Choice Habit’
The Daily Caller’s Sarah Hurtubise takes note of a revealing statement about the so-called Patient Protection and Affordable Care Act:
Health insurers are now openly admitting that with Obamacare’s reforms, patient choice can no longer be a priority for Americans.
“We have to break people away from the choice habit that everyone has,” Marcus Merz, CEO of Minnesota insurer PreferredOne, told The New York Times Tuesday. “We’re all trying to break away from this fixation on open access and broad networks.”
The quote comes from Reed Abelson’s column in yesterday’s Times, titled “More Insured, but the Choices Are Narrowing.”
KUOW, a Seattle public radio station, has an example. Two-year-old Micah Clark “was rushed last month to the emergency room at Seattle Children’s Hospital for severe groin pain.” The boy was diagnosed with a hernia, a common but potentially life-threatening condition “in which the intestines bulge through the muscle wall near the groin.”
His intestines retracted, so he was out of immediate danger. But doctors said the boy would need surgery lest the condition recur. “The situation became complicated” when Micah’s mother, Jenni Clark, “learned that Seattle Children’s was not part of their network,” reports KUOW:
“We went to Seattle Children’s assuming we were covered, and later we found out we weren’t,” Clark said. That meant the family needed pre-approval from their health carrier, LifeWise, for surgery at Children’s. So Clark put in the request.
But before she got a response, Micah was already back in the ER for the same problem. Clark then learned that her request for surgery at Seattle Children’s was denied. LifeWise said it would cover the surgery if Micah used an in-network surgeon in Auburn [a suburb 40 minutes away].
“We found out that he doesn’t typically do surgeries on young children; he primarily operates on adults,” Clark said. “And, even if he did, he wouldn’t do it because we’re covered by LifeWise, and where he does surgery is not contracted with LifeWise.”
Clark looked into two hospitals that were in her plan, but neither had pediatric surgeons. She appealed the denial, a process that can take up to 30 days.
Micah got his surgery thanks to the generosity of Seattle Children’s, which expedited the case. Mark Del Beccaro, a physician who is the hospital’s vice president of medical affairs, says that when presented with such cases, “we’ll see [the patients] without knowing whether or not we’ll get paid or anything.” He adds: “We just tell families we’ll do that because it’s important and it’s an urgent case.” Relying on hospitals to give free care obviously is not an economically viable approach.
Seattle Children’s has sued the state insurance commissioner’s office. Its argument is that plans like the one the Clarks were sold should never have been approved because they “fall short under the Affordable Care Act.”
But Eric Earling, a spokesman for the Clarks’ insurer, tells the station that “we continue to hear from consumers that affordability is a big issue”:
Affordability is why providers like Seattle Children’s were excluded.
“The reality is, there are some providers that are more expensive than others,” Earling said. “And in the case of Children’s, simply too expensive to provide full in-network coverage for all their services and still be able to offer [at as] affordable [a] price as possible to all consumers.”
In campaigning for ObamaCare, the president acknowledged no such trade-offs. He famously said in 2009: “If you like your doctor, you will be able to keep your doctor. Period. If you like your health-care plan, you will be able to keep your health-care plan. Period. No one will take it away.”
That’s a long way from the the reality of ObamaCare, in which even small children are expected to “break . . . the choice habit.” The selling of ObamaCare was a massive fraud, the human consequences of which continue to unfold.
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