Letter to the editor: Narrow networks carry risks

May 23, 2014

A reader writes that narrow networks may contain costs, but they don't provide value.

The article on narrow networks (“Narrow networks: Obamacare’s broken promise and how doctors and patients can fight back,” March 25, 2014) briefly addressed the risk of imposing narrow networks solely for cost containment in quoting Donald J. Rebhun, MD. But it implied multiple times that tightening costs correlated, or even caused, the delivery of value. Low costs and value are far from synonymous terms, though used as such in the article.

Empirically and experientially, reduced accessibility through narrow networks in socialized systems leads to shortages and waiting lines. This leads to de facto cost-containment, but not value, since patients waiting in line cost the system nothing because they receive nothing in service. A politician can then proclaim, “You’ll have the right to (wait in line for) healthcare, if you vote or me!”

Nurse practitioners and physician assistants will deliver future primary care, which may be OK, but it’s a long leap from, “You get to keep your own doctor, period.”

Stewart Andrews, MD

Bellingham, Washington