If you want broader choice of doctors in the future, you can expect to pay more for it. UnitedHealth Group, the nation’s largest insurer by revenues, recently announced the purchase of the managing arm of a 2,300-physician group in Orange County, California – their third such purchase in that county over the past two years.

UnitedHealth, Wellpoint, Humana and other larger insurers are buying physician management practices in order to stem rising costs by more tightly managing patient care at the front end. Patients who don’t want their care tightly managed and their choice of providers restricted will pay more for the privilege of opting out.

The new health care law sets up accountable care organizations (ACOs) – groups of hospitals and physicians that come together to take responsibility for patients and the financial risk that comes with them. If they cut spending, they get to keep some of the savings. While hospitals are viewed as “natural” leaders of ACOs, health plans clearly plan to play in this arena as well. They have the money and technology to do it.

It’s ironic. The health care law was seen as a way to rein in hungry health plans, but it is spawning even more ways for insurers to control parts of the system. The American public rejected tightly managed care plans in the 1990s, and here they come again, albeit with some important differences. We’ll see if the old refrain is true: Love is better the second time around.