Freedom of Choice

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Walk down the typical grocery store aisle, and the choice can be literally overwhelming.  Who knew there were so many ways to put sugar and a variety of processed grains and “food-like substances” together into so many different shapes and sizes, in so many different packages, taking up almost 1000 linear feet of shelf space?  But is that really choice?  All of them likely contribute to the high rate of type II diabetes, which is skyrocketing among children.  Does it really matter which one you pick?

Americans place a great value on freedom of choice; one of the huge criticisms of the Soviet economy was the lack of selection of consumer products.  But how much choice does one really need?  The real problem is the fact that what few consumer products were available in Leningrad were of poor quality.  Conversely, all those breakfast items are just variations on the same theme.  There is apparent variation, but little actual diversity.  We’d be better off with fewer junk cereals, and at least a few real foods.

Choice is emerging as a huge issue in health care.  Specifically, the move (blamed by many on the Affordable Care Act but in reality an acceleration of a long-standing trend) toward so-called “narrow networks.”  The idea is that an insurer will offer a narrower selection of providers (including doctors and hospitals), at a lower cost.  Because the plan only includes providers willing to accept lower payments, it can be offered for less.  It turns out, many consumers – not only those buying insurance on the new exchanges, but some of the nation’s largest employers – are making that trade-off of less choice for lower cost.

Hence the outcry from people like Dr. Monica Wehby, a pediatric neurosurgeon running for senate in Oregon under the slogan “Keep your doctor. Change your senator.”  It’s certainly understandable that individuals who have a long-standing relationship with a provider would be reluctant to have to switch because that provider is not included in a new health plan.  (Although I should point out that it’s no different than what happens if one changes jobs.  Someone really concerned about ensuring universal choice in providers would support universal health coverage.  Just sayin’.)  But how bad is it to have a narrower choice?  Emmanuel Ezekiel argues that in this case, choice among providers is not too different from choice among breakfast cereals.  There is little actual difference among most providers.  The real issue is to make sure that a network includes high quality providers.

To be included in narrow network plans, though, providers will need to be not just high quality, but high value.  Every insurance executive I’ve ever spoke to is willing to admit that while they care about quality, they’re really just looking for quality that’s good enough; what really matters to them is price.  At least they’re honest.

I consider providers like Children’s Hospital of Wisconsin and its doctors and nurses to be like the high quality, whole grain, unsweetened, delicious yet nutritious cereal frequently not found in the breakfast aisle.  They are often relegated to an “organic” specialty store.  So far consumer, and insurers, have recognized that we are indispensable to the community.  We’ve been there in the cereal aisle.  We need to make sure that we remain available in all the markets – which means being sufficiently competitive not just on quality but on price – so that families will have a real choice.

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