By THOMAS O'ROURKE
There is general agreement that Americans love choice, be it internet providers, cable TV options or even ice cream, exemplified by Baskin Robbins' 31 choices.
Ditto for pizza, be it thick or thin crust, with toppings ranging from sausage or peperoni to pineapple and avocado. No way the idea of "one size fits all" flies in the U.S. Choice is a fundamental American value and an integral part of our identity.
This is clearly evidenced in the ongoing health care debate that has received renewed interest in the media, especially with several proposals to create a universal "Medicare for All" publically financed, single-payer health plan.
A recent Kaiser Family Foundation poll showed that 56 percent of Americans support the idea of a new federal health care program. However, that support quickly evaporates when tradeoffs such as the loss of private insurance options were included. With respect to private health insurance, closer examination shows that consumer choice is more illusory than actual, more fantasy than real.
The private health insurance industry is a mix of for-profit and nonprofit companies of various sizes. Most Americans who have insurance obtain it through employer-sponsored or group health insurance plans.
About 155 million Americans get private health coverage through a public or private-sector employer. Although there are about 850 health insurers, most handle just a small regional area. In contrast, the five biggest health insurance companies, WellPoint, CIGNA, Aetna, Humana and United Healthcare, insure approximately half of the insured population.
From the get go, employees are not the ones who make health care coverage decisions. While there are millions of plans offered by employers throughout the country, if your company even offers coverage through an employer-sponsored plans, your only choice is from your employer.
Employers, not employees, choose insurers and what plan(s) they wish to offer. In turn, the insurers determine the providers you can use, the treatments you can or can't receive and the prescription drugs you can take. Annually, you can be forced to change provider networks, benefits, out-of-pocket costs and insurers.
Quickly, many employees find that they may have a very limited choice of plans in terms of benefits, costs and choice of physicians or hospitals. Even if you like your insurance, hardly anyone gets to keep the same insurance throughout their life. The only constant is that insurance changes all the time. For those with employer-based health insurance, think back about the insurance you had over the past decade. Odds are it isn't the same today or maybe even last year.
There are many reasons for this. Private health insurance tied to employment often is not stable as the economy constantly is changing. Change jobs and every aspect of your health insurance changes. Good luck if you leave the job market. You are on your own.
To counter rising health care costs, employers annually may change their employee benefits or change their insurers. Increasingly, employers are requiring employees to pay higher premiums and cost sharing in the form of deductibles and co-payments.
This cost shifting may result in loss of coverage or access due to an inability to pay or result in employees choosing "stripped down" plans with less coverage, resulting in potentially greater exposure to unaffordable costs.
Changes in insurer-provider networks happen all the time and can result in individuals losing their usual sources of care. Employees may be restricted to managed care plans or put into narrower networks with significantly higher costs for going out of network or for care previously available in network.
While choice is a cherished American value, it doesn't carry over with respect to employer-sponsored private health insurance where effective choice and consumer sovereignty are more fiction than fact.
In the current health care reform debate, beware of proposals ensuring consumer choice by preserving and expanding private health insurance. Based on past and current experience, the saying "If you like your health care plan, you can keep it" rings hollow indeed.
Thomas O'Rourke is professor emeritus of community health at the University of Illinois.