Health-Plan Options Would Widen Choices

OF all the questions Americans have about health-care reform, among the most personal and persistent is this: Could I still choose my own doctor?

Concern about a potential loss of choice and personal freedom is closely tied in many Americans' minds with the potential deterioration of the quality of health care available to them.

These concerns are at the heart of how the public looks at the fog of complexity around the health-care debate on Capitol Hill. They are also the concerns tapped skillfully by the health insurance industry lobbyists in television commercials showing ``Harry'' and ``Louise'' poring critically over the Clinton health plan.

Under most versions of health-care reform proposed in Congress, according to a range of experts, the choices available to most people would be, if anything, expanded. People would in most cases have the option to continue their current relationships with health-care providers.

Under most plans, however, including the Clinton plan, a full range of choices may become increasingly expensive for consumers. Some experts say that under two of the most prominent Democratic plans, Clinton's and that of Rep. Jim Cooper of Tennessee, the option to subscribe to traditional health insurance without restrictions on choice of providers eventually would become economically unviable.

Even without health-care reform, Americans have been losing their range of choices. Because of the burden of health insurance costs, businesses have been moving to managed-care plans that exert tighter control over when members receive medical care and from whom.

The traditional health-insurance system, where people choose a provider of health care, pay a deductible, and an insurer pays the rest for any covered medical or therapeutic procedure, is fading slowly from the scene. Ed Davey, director of health and welfare consulting services at Buck Consultants, estimates that between 30 and 40 percent of employers no longer offer their employees such plans.

Managed-care plans often have their own medical staffs and clinics. Other plans have networks of preferred providers. Increasingly, the plans are allowing insured people to use providers outside the network, but at an extra cost of 10 to 20 percent.

At least through the 1980s, the proportion of employers that offered more than one choice of insurance plan more than quadrupled, according to the Bureau of Labor Statistics.

That kind of choice - from an array of insurance plans - is likely to increase dramatically under reform in the manner of Clinton or Cooper.

In the Clinton proposal, nearly everyone would belong to regional health alliances, which would offer all the plans that insurers put forward that credibly cover the comprehensive benefits package and cost no more than 20 percent above the average premium in the alliance.

Clinton would also require at least one traditional fee-for-service plan - where choices face the least restriction - in each alliance's offerings. This is expected to be the most expensive option, and it eventually may have trouble fitting under the 20 percent-above-average premium ceiling in many regions.

CONCERN over choice for most people, says Henry Aaron of the Brookings Institution, is ``fear of being pushed out of a situation in which we deal with a physician with whom we've developed a relationship.'' Those relationships need not change quickly even under the Clinton plan, he says.

In states like California and Minnesota, where managed-care systems are widely used, adjustments would be easy, says Paul Feldstein, management professor at the University of California at Irvine. In much of the East, especially the Southeast, and in rural areas, existing relationships might not change for years.

The most unfettered choice comes from single-payer plans or the one reported out of the health subcommittee of the House Ways and Means Committee, a plan that essentially extends Medicare to everyone, says Professor Feldstein. These plans pay straight fees for services and control costs by holding the fees down.

The risk with these plans is that availability or quality of care might erode, says Feldstein.

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