Narrow networks are unequivocally bad for people needing specialist care, which happens to be the main reason for health insurance.
They think they do, and a lot of the ecosystem (providers, employers, politicians) reinforce that idea, but it's not something that actually exists.
That's because regular, routine costs (like new tires for your car) are NOT underwriteable. You can't insure for them, nor can you buy insurance for them.
If your insurance company is providing new tires every year or giving you wellness checkups every year, you're paying cash money for that somewhere. Even though they say it's an insurance benefit. It's not. Because math.
It's very difficult to have any kind of discussion about this when even this most basic of accounting identities is misunderstood.
If an annual checkup reduces the risk of a high-value payout then it makes very much financial sense for the insurance company to pay for the annual checkup for you, as an incentive for you to get one.
In fact, if the average insuree is very unlikely to pay directly for an annual checkup and the annual checkup helps to reduce the likelihood of high-dollar-value insurance claims, then it is reasonable for a "free" annual checkup plan to be cheaper than one that does not offer such "free" benefits.
Note: I am not disagreeing with your statements that the insuree is definitely paying for regular costs, nor that people don't math well. I am just raising some of the nuance around what behavior makes sense for an insurance company given irrational insurees.
(the jargon rational economic actor maximizes value, not dollars)
[0] Think transitivity: I prefer A to B and I prefer B to C; I must not prefer C to A. There's more nuance, but this is enough for the intuition. Without this ordering, maximizing value makes no sense.
Very little of what we do in modern medicine can't be done by local hospitals. Most diseases have well-understood treatment protocols that don't vary much between hospitals or doctors. Cutting edge treatments are only necessary in a very small percentage of cases, which often increases costs because if a hospital has a new piece of expensive equipment, they're going to be more inclined to use it, even in cases where it's not necessary and the old technology is better understood.
There is a false belief in this country that more health care or more advanced technology actually creates better outcomes for patients. In many cases, all the new technology creates are profits for the hospitals and medical device companies.
For routine stuff, my local doctor is fine. But when I broke my ankle, I didn't go my local hospital. I went to one of the foremost orthopedic hospitals in the world. That, in a nutshell, is why I live where I live. But I could not do that under my current insurance.
Would my outcome have been any different if I'd seen a local doctor, as opposed to a world-class doctor? We'll never know, but I can't stand not having the option.
It's simply not sustainable to have every person in the NY metro area all want to go to the same hospital when they break their ankle.
But if you want to understand the real problem, ask yourself by what criteria is the "foremost orthopedic hospital" considered better? I know this will sound insane, but most medical quality metrics for hospitals and doctors don't take patient outcomes into account. Due to a combination of HIPAA rules and the way follow-up care is often performed by practitioners from multiple hospitals/private practices/therapists, it's nearly impossible to track patient outcomes even if you wanted to.
So if the quality of a hospital isn't determined by patient outcomes, what is it determined by? The government uses a combination of patient volume, malpractice claims, accident rate, rate of hospital acquired infections, cost efficiency, scheduling availability and survey data (they're more concerned about cost effectiveness as it relates to Medicare than anything else). For any other source, the hospital probably just paid a bunch of money to be listed in the top spot on a "top orthopedic hospitals" list.
In my case, a family member went to a local oncologist who prescribed a series of treatments. She went for a second opinion to MD Anderson in Houston (a few states away) and was told by their team this treatment was ludicrous and they prescribed an entirely different series of treatments. My family member is now just fine, but if they had stayed with the local specialist who knows. But if I get sick I want access to places with the best long term survival rates, not whichever doctor happened to move next door.
And yes, Obamacare did increase costs for young, healthy people. But one day, those young, healthy people are not going to be so young or healthy; and the system will need new young, healthy people to help subsidize the cost of health care for the old and sick.
Or to put it another way: if we as a society don't want to deny life-saving health care based on a person's ability to pay, we have to make everyone pay all the time. And honestly, it's cheaper overall if people have less hesitation to go to the doctor and get their medical issues treated before they become serious and life-threatening, so we should pay to treat the non life-threatening conditions as well because it's a better use of money.