Tune Critics Out; Plan Has Merit

Lose no sleep, consumers, over the medical industry’s fury at Washington state for ruling that a health insurance carrier may limit the number of doctors it covers.

The limit is in consumers’ best interest. It does not represent much of a change, if any, from the status quo. It will ensure that insurance carriers can continue the fight to contain skyrocketing health care costs. It will provide a tool to press for higher quality care.

And rest assured, the doctors are going to be fine.

So are consumers, including those spooked by an often-heard falsehood from the self-serving foes of health care reform: That reform means consumers will lose access to their favorite physicians.

Actually, under Washington state’s plan, reform will increase access.

Those who lack insurance coverage now - and can’t even get in a doctor’s front door - will have coverage in the future, and at affordable rates not now available. Creation of large insurance purchasing pools will give individual and small-business buyers a price break the status quo doesn’t offer.

In small communities where only one insurance plan may be available, the state’s rules require that any willing care provider - doctor, chiropractor, the works - be a part of it.

In larger communities, though, the rules encourage competition. (Remember that; it’s something the status quo lacks.) Employers must offer workers a choice of three insurance packages. Insurance carriers will compete for business. They’ll get it by offering a combination of the doctors people want to see and the prices people can afford.

Doctors will want to be in the successful plans. To gain admittance, they’ll have to impress carriers with their low fees and their medical effectiveness. Now, doctors vary widely in their procedures, effectiveness and fees. Real competition will give them a motive to learn the most cost-effective methods. A new state data reporting system will show consumers, as well as insurance carriers, which doctors have the best track record. That creates real competition.

Yes, in big-city markets an insurer will be able to turn away a doctor if it chooses, even if the doctor meets the insurer’s criteria. But a good doctor who isn’t in one plan surely will be snapped up by that plan’s competitor. If no one will let a doctor in, the state medical association is organizing its own insurance company which can take all comers if it chooses - though that might lead to expensive insurance premiums.

Any care provider who can’t find a niche in this system probably is one no patient would want to see, anyway.