I currently have a PPO (Preferred Provider Organization). I (and my doctor) am in control.
I decide when, where and with whom. I don't need referrals. I don't have to play "may I." If I feel I need an allergist, I choose one. I may stay in plan or go out of plan. The doctors are paid for the services I request when I request them.
According to The Wall Street Journal, section 202 (pages 91-92) of the House bill passed last weekend dictates that I must switch to a "qualified plan" as determined by the U.S. Secretary of Human Services. This would be along the guidelines of an HMO (Health Maintenance Organization). In the HMO, a doctor gets paid a monthly fee (whether or not I see him). His job is to "manage" (limit) my health care. If I want to see a specialist, I need his permission (referral).
A "qualified plan" does not equal "quality care." The less access I have to specialists, the more the primary care physician makes. I know President Obama has promised us we can keep our plan if we have one, but then why the "grace period" for converting to a "qualified plan." According to p 92, within five years the employment-based plan must meet the requirements of the "qualified plan."
According to the Congressional Budget Office, the estimated annual cost of a family plan would be $15,000. The total combined cost (employer and employee) of my PPO is less than $10,000. Under the "Nobama" plan, my cost would increase 50 percent while my benefits would decrease.
PATRICK BROWN
Tampa
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