For starters, insurers are not moving to these narrow networks because they’re easier to manage, enabling patients to get more coordinated care; they’re moving to these networks because the doctors in them are cheaper. It’s true that narrowing your networks gives you more leverage to negotiate prices with doctors — if you’re willing to exclude most of the doctors in the state, you’re in a better bargaining position than you are if doctors know that you’re selling customers the ability to see any doctor they want. But the doctors who are in really high demand can simply refuse to take the lower price. And unfortunately, there does seem to be some correlation between how much we spend on health care and how good the results of treatment are.
But even if it were true that we could get better treatment at a lower cost by restricting peoples’ choices, people would still hate having their choices restricted. Americans love choice! There is a reason that the abortion-rights movement has framed itself around the concept of choice and keeping medical decisions between a woman and her doctor, rather than around a more straight feminist argument about the life limitations imposed by an untimely pregnancy.
If narrow networks could give everyone in the country access to health-care outcomes no worse than 90 percent as good as the folks with the best doctors at 75 percent of the price we’d pay for broader networks, the health-care wonks would jump on that deal as an unbelievable bargain. But I think it’s pretty clear that average folks don’t think like health-care wonks.