[Ed. – How do you feel about that statement, Mr. President?]
Last spring, a 48-year-old mother of two young girls in Colorado discovered that she had colon cancer. Her surgeon and oncologist disagreed about whether she needed chemotherapy. So a friend recommended she go to MD Anderson Cancer Center in Houston for a second opinion. Just before she booked her plane ticket, a representative from MD Anderson called, informing her that its oncologists were outside her insurance company’s network and that she should bring $10,000 for the consultation.
Many Americans can relate to this. Last year, a Kaiser survey reported that almost all individuals and families with employer-sponsored health insurance have policies that come with at least some network restrictions. These plans steer us toward certain providers and away from others.
This saves a lot of money. Insurance companies can negotiate with in-network physicians and hospitals to accept lower payments in exchange for more patients. They can include in their networks only physicians who are more efficient — who order fewer unnecessary tests, use more generic drugs and tend to keep patients healthier and out of the hospital. As a result, they can ensure that they, and their customers, get more bang for the buck.