It didn’t take long. The health insurance companies didn’t wait before looking for ways to cut corners at the patient and doctors’ expense. Remember the campaign promises that the government wouldn’t tell you what physician you can see… and that’s true. The government won’t be doing it. Your insurance company will.

The first round? Lower premiums are being offered to companies that will accept specific physicians — and only those doctors — for their employees’ care. Been with your family doctor for a decade or more, know and trust him? Too bad. Unless he’s on that little list, you’ll be dealing with your choice of those doctors the insurance company has approved. By what criteria? It doesn’t take much to figure out we’re talking about the least-common-denominator; Whichever physicians are willing to work for whatever peanuts the insurance company is willing to pay.

Some would say this is the free market at work. That’s simply not so. A Free Market solution would be to say that you get X dollars towards your medical insurance from your employer as part of your compensation, and if it will cost more, you’ll have to pay out of pocket for that difference. THEN you could keep your doctor (if you could still afford to.) This isn’t Free Market, because the choice isn’t being made by the patients. Rather, their employers (also profit-motivated corporations) will make the choices. And isn’t that exactly what everyone was afraid of — losing control of their choices on their own health and well-being?

According to the New York Times, these health care plans are being tested in San Diego, New York and Chicago. The idea was that they’d appeal to small business owners. But any time there’s a chance to save a buck, whatever it may cost, you can count on the big companies jumping in with both feet. The allure of reducing premiums by up to 15 percent is simply too tempting. The employers, of course, see it differently. Peter Skoda of the Haro Bicycle Corporation, says that the new plans will “eliminate the Gucci doctors.” That’s the story being told. But it doesn’t matter if you wear Guccis or flip-flops. If your patient wants be seen by you and you’re not on the list, your patient will have to pay the entire bill.

This isn’t the first time this approach has been attempted. Last time, the patients were none to impressed at the results. Nevertheless, Aetna, Cigna, the UnitedHealth Group and WellPoint are all pushing forward with plans that will limit a patient’s choice of physician. So long as they can claim to save money, they expect the plan to be wildly popular, especially with companies that don’t have to compete for the best caliber employees in specialized fields. The more expertise needed, the less restrictive the benefit package will have to be to entice and keep that employee. Translation: once again, the little guy is taking the brunt of it. This time, though, their physicians are taking the hit too. No matter how sweetly they try to lure employers to the lower-risk plans, their bottom line is still the bottom line.