Hate Obama, Love Obamacare

How a skeptical Ohio family found plenty to like in health care reform

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Claudia Susana for TIME

When Sean Recchi was diagnosed with cancer, he and his wife Stephanie were billed $83,900 by the hospital, in advance. Now he has insurance.

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Understanding the limits of what consumers are buying puts another damper on the Recchis' story: their insurance--whether Medicaid for now or the plan they are likely to transition to later this year--is not going to cover them at MD Anderson in Houston. No Ohio plan will. In fact, only two of 79 plans offered in Texas on its federally run Obamacare exchange include coverage at MD Anderson.

MD Anderson is extravagantly expensive. With its well-deserved international brand name, it has more than enough business without letting insurance companies negotiate for discounts in exchange for being included in their networks.

More generally, one of the ways insurance companies have tried to limit their costs and the premiums they are charging on the Obama exchanges is to have relatively narrow networks that are limited to the hospitals, doctors and other providers who offer the companies relatively cost-effective prices. Because there is frequently little or no relationship between cost and quality in the dysfunctional world of health care economics, this does not necessarily mean patients will receive inferior care, though it might. But it does mean that, contrary to a promise Obama made in promoting Obamacare, patients will often not be able to be treated by the doctor they want or at the hospital they want.

As with his vow that Americans could keep their insurance if they liked it, this is a promise the President should not have made. He can't control insurance companies' decisions about their networks, nor should he want to. Costs might come down and quality might go up when insurance companies can make hospitals and doctors compete on quality and price to be in their networks.

In other words, expanding coverage to people like the Recchis while trying to control premium costs is going to mean that not everyone gets the platinum care they want and that others will. When it comes to health care, as opposed to buying a car, that's difficult for anyone to accept. "No, we don't get MD Anderson, but we do get the Cleveland Clinic and lots of other good care," Stephanie says. "We understand that." Amid the likely attacks from his opponents that he's taking away patients' favorite doctors and hospitals, Obama has to hope that others come to share her attitude.

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