Health care: choice vs. cost

April 04, 1994

There's a knock-down, drag-out fight going on in the hallways of Annapolis over a health-care proposal that epitomizes the kinds of agonizing decisions individuals in our society have to make. Proponents of the bill say it gives patients the absolute right to choose a health-care provider. Opponents say the bill will demolish cost-containment efforts and add hundreds of millions of dollars to the cost of obtaining health care.

In an ideal setting, the proponents' argument would triumph. Americans have been spoiled by a health-care system that has enabled them to pick and choose their physicians at will without much thought about paying for it. After all, insurance paid nearly all the bill. But health-care costs have gotten out of control. Americans are demanding a more cost-conscious system. Workers have to pay an increasing share of their medical expenses. That's why the drive toward "managed care" has picked up so much momentum.

Health maintenance organizations have won increased popularity among both business and labor groups. In Maryland, HMOs now account for roughly 30 percent of the health-care business. Many patients like the low premiums and the stress on preventive care. Yet others rebel against the closed nature of these HMOs: you might have to leave your long-time doctor if you enroll in an HMO, and you have to select a physician who is in that HMO's network.

Discontent over this limited choice led to the current brouhaha in Annapolis. The problem is that an unlimited choice of doctors means higher costs for patients and for their employers. That's the nub of the problem: choice vs. cost.

As amended, the "any willing provider" bill forces HMOs to pay a portion of the cost for an HMO enrollee to pick any health-care provider he or she wishes. It is estimated that HMO expenses will rise by 15 to 20 percent, or about $200 million. State government's medical expenses will also increase, by $15 million to $20 million. Worst of all, patients will foot the bill through two mechanisms. They will see their premiums jump sharply, and they will have to pay heavily out of their own pockets for the right to choose non-HMO doctors.

This bill seriously undercuts Maryland's efforts in recent years to hold down medical costs. It also flies in the face of what is happening in Washington. No wonder so many top officials in Annapolis oppose this measure. We can no longer afford unrestrained medical expenses. Our choices may be narrowed somewhat, but that is the price we have to pay for affordable health care.

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