Here at the office we’ve been watching Obamacare unfold. I’ve reported to you some of the successes: decreased premiums, closing of a medical charity due to decreased need. While it seems likely that more Americans will have access to health insurance, this isn’t the same as access to care.
In general I don’t work with HMOs, but for a variety of reasons I’ve stuck with BCN, Blue Cross Blue Shield’s HMO. They are reasonably easy to work with and my patients seem satisfied with them. But some of my patients who signed up for BCN this year are finding out I’m not on their plan. When the Affordable Care Act kicked in, BCBS created a bunch of new insurance products that have similar names, and some of my patients picked the one I’m not part of. I asked a patient to send me information on which doctors he can see.
If a patient even bothers to read the list of doctors, there is no way for them to know what I saw immediately: their new health care plan is basically a private version of Medicaid. The list of doctors had many specialists and hospitalists but few primary care doctors. Most of the primary care providers who were listed were clinical supervisors, overseeing resident doctors in training.
Blue Cross is being smart by limiting which doctors the patients can see. This will help them control costs. It also means that these patients will have limited access to their doctors compared to pricier plans. The upside is that patients who were previously uninsured can now be covered well enough. People accustomed to similarly-named plans from previous years may be in for a shock. In exchange for lower premiums, they’ve given up a lot of choice.
As more Americans get insurance, they are going to see what our shortage of primary care doctors means in the trenches. If we’re serious about caring for more people, we have to get serious about creating more of the right kind of doctor.
Peter A. Lipson, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. After graduating from Rush Medical College in Chicago, he completed his internal medicine residency at Northwestern Memorial Hospital. This post first appeared at his blog at Forbes. His blog, which has been around in various forms since 2007, offers "musings on the intersection of science, medicine, and culture." His writing focuses on the difference between science-based medicine and "everything else," but also speaks to the day-to-day practice of medicine, fatherhood, and whatever else migrates from his head to his keyboard.