Modest step forward

___For 20 years, the Arkansas legislature has been a battleground between managed-care insurers and big industries on one hand, and hospitals, doctors and pharmacists on the other over a principle called "any willing provider."
___For the second time, the legislature seems about to side with the second group, the providers of medical care. The Public Health, Welfare and Labor Committee of the House of Representatives endorsed two bills reinstating the any-willing-provider concept by a vote of 12-7, and that seems to represent the prevailing sentiment in the full House. Ten years ago, the last time the issue was seriously debated, the Senate voted for any willing provider, too.
___ The relative clout of the behemoth interests on both sides seems not to have budged much. The act of 1995 was quickly invalidated by a federal judge because federal law – the omnipresent Employee Retirement Incomes Security Act (ERISA) – prohibited states from regulating the field.
___ Not necessarily, the U. S. Supreme Court said last year, so the state is back tweaking the law so that it will withstand judicial scrutiny. Despite the sound and fury accompanying the deliberations and the invocation of what's good for the poor patient by both sides, the rest of us have only a marginal concern with the outcome.
___ When titans clash over what's in our best interest, you can bet that it's their best interests, not ours, that is at stake. There are an unusually large number of health-care bills in this legislature, which at least acknowledges the gravity of the crisis, but like the any-willing-provider bills all merely nibble at the edges of the problem of mushrooming costs and shrinking access and coverage.
___ But we all have some interest in the outcome, even if it is entirely accidental that the public interest happens to prevail in such a clash of economic powers. Managed-care networks like health-maintenance organizations provide their insured members limited options on hospitals, physicians and pharmacies, which abide by certain rules, including fees. In exchange for giving up the freedom to choose who provides their care and medicine, patients and their employers are supposed to enjoy lower premiums.
___ Any-willing-provider laws open the networks to any provider who will agree to the same rules. The insurance companies and big employers with managed-care plans say this destroys the incentives and will raise costs because the participating doctors would no longer be guaranteed full waiting rooms and would have no reason to keep their fees down. The same would apply for hospitals and pharmacies. It is, they say, the immutable law of supply and demand.
___ The theory is hoary but the evidence is not convincing that open access produces significantly higher costs.
___ Were the networks run by agencies backed by the force of law rather than a private company, we could be more certain of economies, but even Blue Cross Blue Shield has sufficient market power to enforce at least the efficiency that it achieves with the closed networks.
___ For most consumers in big cities the closed networks work fine, but for some of them and for many others outside the metropolis closed networks often mean the hardships of travel and getting into packed offices. Medical care needs to be more accessible, not less.
___ If we are going to follow honored economic theories, what about market freedom and competition?
___ We would wish for much higher stakes, but any willing provider seems to be a modestly good deal for consumers.