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I don't know about the author, but I buy my insurance not for my yearly cholesterol checks, but in case I need to hop on a plane and get treatment at a major me

I don't know about the author, but I buy my insurance not for my yearly cholesterol checks, but in case I need to hop on a plane and get treatment at a major medical center. Narrow networks are unequivocally bad for people needing specialist care, which happens to be the main reason for health insurance.

urda 11y ago
I wouldn't be trusting Vox for reporting on anything important like Healthcare. Anyone who tries to sell you the idea that a "narrow network" is better has no idea what they are talking about.
rsync 11y ago
Nobody buys their insurance for yearly cholesterol checks. They think they do, and a lot of the ecosystem (providers, employers, politicians) reinforce that idea, but it's not something that actually exists. That's because regular, routine costs (like new tires for your car) are NOT underwriteable. You can't insure for them, nor can you buy insurance for them. If your insurance company is providing new tires every year or giving you wellness checkups every year, you're paying cash money for that somewhere. Even though they say it's an insurance benefit. It's not. Because math. It's very difficult to have any kind of discussion about this when even this most basic of accounting identities is misunderstood.
- greggyb 11y ago
  To be fair, annual checkups (of many varieties), are not covered solely because people can't math. If an annual checkup reduces the risk of a high-value payout then it makes very much financial sense for the insurance company to pay for the annual checkup for you, as an incentive for you to get one. In fact, if the average insuree is very unlikely to pay directly for an annual checkup and the annual checkup helps to reduce the likelihood of high-dollar-value insurance claims, then it is reasonable for a "free" annual checkup plan to be cheaper than one that does not offer such "free" benefits. Note: I am not disagreeing with your statements that the insuree is definitely paying for regular costs, nor that people don't math well. I am just raising some of the nuance around what behavior makes sense for an insurance company given irrational insurees.
  - obastani 11y ago
    Actually, if the insuree is rational, it especially makes sense for the insurance company to pay for the annual checkup. If the insurance company only covers me when I get really sick, I lose money by going for the annual checkup -- I'm "better off" waiting to get really sick, and then having them cover all of my expenses.
    - maxerickson 11y ago
      You've defined rational as valuing money over health. (the jargon rational economic actor maximizes value, not dollars)
      - greggyb 11y ago
        Just an addition: rationality in economics assumes a logical[0] ordering of preferences and behavior which maximizes value within this ordering. [0] Think transitivity: I prefer A to B and I prefer B to C; I must not prefer C to A. There's more nuance, but this is enough for the intuition. Without this ordering, maximizing value makes no sense.
exelius 11y ago
"Narrow" doesn't mean "inadequate". It just means that instead of having access to 75% of doctors in your area, you only have access to 25%. But you still have multiple specialists in each area, and you still have hospitals you can go to. Most people don't even scroll past the first page of results in a doctor search anyway, so would having access to 200 dermatologists provide much difference versus having access to 50? Very little of what we do in modern medicine can't be done by local hospitals. Most diseases have well-understood treatment protocols that don't vary much between hospitals or doctors. Cutting edge treatments are only necessary in a very small percentage of cases, which often increases costs because if a hospital has a new piece of expensive equipment, they're going to be more inclined to use it, even in cases where it's not necessary and the old technology is better understood. There is a false belief in this country that more health care or more advanced technology actually creates better outcomes for patients. In many cases, all the new technology creates are profits for the hospitals and medical device companies.
- mtVessel 11y ago
  I live 20 minutes outside of New York City. I put up with an extremely high cost of living for easy access to the incredible resources of a great city. In my new, "narrow" plan, I can only see doctors in my home county. Outside of ER visits, I cannot see a single doctor within the confines of NYC. I've never had to make such a choice before. For routine stuff, my local doctor is fine. But when I broke my ankle, I didn't go my local hospital. I went to one of the foremost orthopedic hospitals in the world. That, in a nutshell, is why I live where I live. But I could not do that under my current insurance. Would my outcome have been any different if I'd seen a local doctor, as opposed to a world-class doctor? We'll never know, but I can't stand not having the option.
  - ghufran_syed 11y ago
    Couldn't you just buy your own private health insurance that does cover that doctor or hospital? I'm guessing it might be for the same reason your insurance company (or your employer) doesn't want to: it's too expensive for what you get. I like having options too, I'd really like the option of driving a new mercedes instead of 14 year-old toyota, for the same amount of money, but I don't think it's my employer or anyone else's responsibility to make it happen.

urda 11y ago

I wouldn't be trusting Vox for reporting on anything important like Healthcare. Anyone who tries to sell you the idea that a "narrow network" is better has no idea what they are talking about.

rsync 11y ago

Nobody buys their insurance for yearly cholesterol checks. They think they do, and a lot of the ecosystem (providers, employers, politicians) reinforce that idea, but it's not something that actually exists. That's because regular, routine costs (like new tires for your car) are NOT underwriteable. You can't insure for them, nor can you buy insurance for them. If your insurance company is providing new tires every year or giving you wellness checkups every year, you're paying cash money for that somewhere. Even though they say it's an insurance benefit. It's not. Because math. It's very difficult to have any kind of discussion about this when even this most basic of accounting identities is misunderstood.

greggyb 11y ago
To be fair, annual checkups (of many varieties), are not covered solely because people can't math. If an annual checkup reduces the risk of a high-value payout then it makes very much financial sense for the insurance company to pay for the annual checkup for you, as an incentive for you to get one. In fact, if the average insuree is very unlikely to pay directly for an annual checkup and the annual checkup helps to reduce the likelihood of high-dollar-value insurance claims, then it is reasonable for a "free" annual checkup plan to be cheaper than one that does not offer such "free" benefits. Note: I am not disagreeing with your statements that the insuree is definitely paying for regular costs, nor that people don't math well. I am just raising some of the nuance around what behavior makes sense for an insurance company given irrational insurees.
- obastani 11y ago
  Actually, if the insuree is rational, it especially makes sense for the insurance company to pay for the annual checkup. If the insurance company only covers me when I get really sick, I lose money by going for the annual checkup -- I'm "better off" waiting to get really sick, and then having them cover all of my expenses.
  - maxerickson 11y ago
    You've defined rational as valuing money over health. (the jargon rational economic actor maximizes value, not dollars)
    - greggyb 11y ago
      Just an addition: rationality in economics assumes a logical[0] ordering of preferences and behavior which maximizes value within this ordering. [0] Think transitivity: I prefer A to B and I prefer B to C; I must not prefer C to A. There's more nuance, but this is enough for the intuition. Without this ordering, maximizing value makes no sense.

exelius 11y ago

"Narrow" doesn't mean "inadequate". It just means that instead of having access to 75% of doctors in your area, you only have access to 25%. But you still have multiple specialists in each area, and you still have hospitals you can go to. Most people don't even scroll past the first page of results in a doctor search anyway, so would having access to 200 dermatologists provide much difference versus having access to 50? Very little of what we do in modern medicine can't be done by local hospitals. Most diseases have well-understood treatment protocols that don't vary much between hospitals or doctors. Cutting edge treatments are only necessary in a very small percentage of cases, which often increases costs because if a hospital has a new piece of expensive equipment, they're going to be more inclined to use it, even in cases where it's not necessary and the old technology is better understood. There is a false belief in this country that more health care or more advanced technology actually creates better outcomes for patients. In many cases, all the new technology creates are profits for the hospitals and medical device companies.

mtVessel 11y ago
I live 20 minutes outside of New York City. I put up with an extremely high cost of living for easy access to the incredible resources of a great city. In my new, "narrow" plan, I can only see doctors in my home county. Outside of ER visits, I cannot see a single doctor within the confines of NYC. I've never had to make such a choice before. For routine stuff, my local doctor is fine. But when I broke my ankle, I didn't go my local hospital. I went to one of the foremost orthopedic hospitals in the world. That, in a nutshell, is why I live where I live. But I could not do that under my current insurance. Would my outcome have been any different if I'd seen a local doctor, as opposed to a world-class doctor? We'll never know, but I can't stand not having the option.
- ghufran_syed 11y ago
  Couldn't you just buy your own private health insurance that does cover that doctor or hospital? I'm guessing it might be for the same reason your insurance company (or your employer) doesn't want to: it's too expensive for what you get. I like having options too, I'd really like the option of driving a new mercedes instead of 14 year-old toyota, for the same amount of money, but I don't think it's my employer or anyone else's responsibility to make it happen.