OK

First, a story from Kaiser Health News

Many doctors are disturbed they will be paid less -- often a lot less -- to care for the millions of patients projected to buy coverage through the health law’s new insurance marketplaces.

Some have complained to medical associations, including those in New York, California, Connecticut, Texas and Georgia, saying the discounted rates could lead to a two-tiered system in which fewer doctors participate, potentially making it harder for consumers to get the care they need.

I saw this story posted over at Corrente Wire. In the comments, Dromaius, who's been extremely informative on the whole issue of narrow networks and did this helpful survey of the dearth of specialists offered on plans in her state, chimes in with her 2 cents:
I've been saying this all along. Obamacare and its narrow networks have given insurance the power to run the show. It's extortion.

And I've been saying that it's not that those evil hospitals and providers aren't cooperating. It's that insurers are paying less in reimbursements, sometimes a whole lot less than they do with traditional plans. They frequently pay less than Medicare which is already reimbursed pretty low. And unlike Medicare/Medicaid, the reimbursements are NOT regulated.

In my state, the only way insurance companies would agree to participate on the Exchange is if they could offer narrow network plans. I believe that when insurance says they are "under pressure," they are lying.

The Kaiser article backs up her claim about lower reimbursement rates:
Physicians are uncomfortable discussing their rates because of antitrust laws, and insurers say the information is proprietary. But information cobbled together from interviews suggests that if the Medicare pays $90 for an office visit of a complex nature, and a commercial plan pays $100 or more, some exchange plans are offering $60 to $70. Doctors say the insurers have not always clearly spelled out the proposed rate reductions.
This should be surprising. We already know insurance companies are shifting costs onto consumers, per Olenick's spreadsheet of Exchange plan payouts, we shouldn't be surprised they're also shifting costs onto doctors.

Insurance costs are going to continue to rise in this country over the long term (assuming the economy improves). They're already way higher than any other industrialized nation. The reason is clear: the health industry (including not only insurance but also pharmaceutical and medical device companies) is extracting massive profits. The Affordable Care Act bargained away any chance of controlling this rentier behavior, and so it's only chance to control costs comes from shifting them onto us.

We shouldn't have let this happen. We shouldn't continue to let this happen. We need to remove profit from the field of human health; market forces, even if you believe in their efficacy, aren't going to come into play when one economic actor is bargaining for their life. People will pay anything to save their lives or the lives of their loved ones and so, if you allow the bandits-in-suits that make up the for-profit health complex take advantage of them, they will.

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