___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
___ 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
___ 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,
___ 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.