A Stirring Anthem

The wonders of Obamacare proceed apace:

Nancy Pippenger and Marcia Perez live thousands of miles apart but have the same complaint: Doctors who treated them last year won't take their insurance now, even though they haven't changed insurers.

"They said, 'We take the old plan, but not the new one,' " says Perez, an attorney in Palo Alto, Calif.

In Plymouth, Ind., Pippenger got similar news from her longtime orthopedic surgeon, so she shelled out $300 from her own pocket to see him.

Both women unwittingly enrolled in policies with limited networks of doctors and hospitals that provide little or no payment for care outside those networks. Such plans existed before the health law, but with its expansion of insurance, they are covering more people — and some are shrinking enrollees' options further than before. The policies' limitations have come as a surprise to some enrollees used to broader job-based coverage or to plans they held before the law took effect.

"It's totally different," said Pippenger, 57, whose new Anthem Blue Cross plan doesn't pay for any care outside its network, although the job-based Anthem plan she had last year did cover some of those costs. "Now I can't find a doctor."

So why is that?

Insurers say they are simply trying to provide low-cost plans in a challenging environment. The new federal health law doesn't let them reject enrollees with health problems or charge them more just because they are sick. So they are using the few tools left to them — contracting with smaller groups of hospitals and doctors willing to accept lower reimbursements; requiring referrals for specialty care; and limiting coverage outside those networks.

It's really a head-scratcher, that the people who ultimately have to pay the bills would try to find ways to cut costs. That never happens in any other sort of enterprise, right?

All the standard aphorisms apply -- you can't get something for nothing. There's no such thing as a free lunch. Something that can't go on, won't go on. Wonkery and Ivy League wizardry notwithstanding, it never made sense to assume that the people who brought you the post office and the Department of Motor Vehicles could somehow do a superior job of delivering health care.

Of course, to use yet another aphorism, there are some things that are so foolish that only an intellectual could believe them. Or, alternatively, it could be this (h/t Stacy McCain):

Meanwhile, Ms. Pippenger, you'll just have to deal with the doctor you can get, not the doctor you want. Change you can believe in.