November 1, 1997 in Nation/World

Patient Choice Has A Price, Say Initiative’s Foes Measure’s Backers Want To Keep Doctors When They Change Jobs

By The Spokesman-Review
 

For 20 years, Jenilee Whitney has paid the price of picking her own doctor.

She’s visited her chiropractor regularly, and not one of the five insurance companies she’s belonged to has covered his services.

Whitney, who is 59, would like to change that. She supports Initiative 673, also called the patient-choice initiative.

“I have no complaints about the doctors I’ve been referred to,” said Whitney, a Spokane woman who’s worked in nursing all her life. “My concern is that I don’t have the choices to make on my own. I’m referred to a doctor, and that’s the one I must see.”

Initiative 673 would allow people to keep their doctors when they change jobs or health plans, and would require insurance companies to disclose how much premium money goes to actual health care.

The proposal also would make insurance companies open their arms to any provider - from naturopaths to optometrists - who meets certain standards.

Opponents say the proposal would be a nightmare for insurance companies, businesses and the working poor. Health insurance costs would jump, they say, making insurance too costly for many people.

Supporters and opponents alike consider the initiative a referendum on managed care, which tries to blend cost containment with preventive health care.

Opponents say Initiative 673 lobs a hand grenade at managed care plans, which usually contract with a limited number of doctors. Patients can choose from that panel of doctors or pay extra to select their own.

“Sure, there are problems with managed care, but this is not the way to fix them,” said Dan Kirschner, spokesman for the Spokane Chamber of Commerce, which unanimously voted to oppose the measure. “To attack it and destroy it is not the way to fix it.”

Initiative 673 is perhaps the most confusing measure on this year’s ballot. The convoluted title inspires yawns. The initiative is only three paragraphs long, but packed with insurance terminology. Even proponents say the details of the initiative would be worked out after it passes.

Managed care was born in the 1930s, but hit maturity in the 1980s as a cure for runaway health care costs. Since then, critics have accused managed care companies of sacrificing patient care to boost profits.

About 80 percent of American workers in large and medium companies are insured by managed-care companies, which range from tightly managed health maintenance organizations to looser preferred provider organizations.

The rest are in traditional “fee-for-service” plans, blamed for the spiraling health care costs and praised for giving patients choice in doctors.

Teresa Wippel, the initiative’s campaign manager, said the measure wouldn’t eliminate managed care. Health care providers, from chiropractors to optometrists, would have to meet insurance company standards to be included in the plans.

“We’re basically taking managed care and injecting it with choice,” Wippel said.

The proponents, including chiropractors, podiatrists and optometrists, call themselves the Patient Choice Coalition.

“Patients have suffered,” said Timothy Day, a Spokane chiropractor. “People are tired of it. The insurance costs have steadily gone up. Profits have soared. It’s just time to return the health care decisions to the consumer, not the insurance company. We have the tail wagging the dog.”

Initiative opponents say the clock can’t be rolled back to the days of house calls and unlimited tests.

Dr. Jack Dutzar, medical director for Group Health Northwest in Spokane, said his company links various providers to prevent diseases such as breast cancer and diabetes.

Health care coverage needs to balance quality, cost and patient access, he said.

“We recognize that choice is important to patients,” Dutzar said. “But choice should be in the context of understanding that if you have total choice, there’s a decrease in quality.”

Opponents say the measure would increase health care costs two ways - by allowing people to keep their doctors even if they switch plans, and by requiring health plans to open their coverage to all willing practitioners.

The group leading the fight against I-673 is called the Coalition for Affordable Healthcare, fueled mostly by managed care companies.

“The taxpayer and consumer and employers and everybody pays big money for this one,” Kirschner said. “The fact is, choice costs money.”

The proposal would increase premiums by about 12 percent, says the anti-673 coalition.

The coalition hired the Arthur Andersen accounting firm to take that figure and analyze how much that increase would actually affect people.

Based on the coalition’s figures, the accounting firm said a single person would pay an extra $195 a year for coverage. A family would pay an extra $546 a year.

“A lot of this is kind of crystal-ball economic forecasting,” admitted Dr. Peter McGough, past-president of the Washington State Medical Association. “But premium costs are getting ready to move up for a whole host of reasons. Essentially what 673 would do is add gasoline to that fire.”

Initiative supporters question the accuracy of the cost predictions. “It’s a very convenient and very scary smoke screen,” Wippel said.

Chiropractors had donated two-thirds of the $373,800 given to the campaign as of Thursday. Most contributions were small, with the 2,454 contributions averaging $152 each.

Only 92 contributions had been made to fight the initiative as of Thursday. But the effort had raised more than $1.6 million, with an average donation of $18,000.

Regence Washington Health gave about $230,000, Blue Cross of Washington and Alaska gave $200,000, Group Health Cooperative gave about $208,000 and PacificCare gave about $178,000.

, DataTimes MEMO: For a summary and the full text of Initiative 673, log on to The Spokesman-Review’s Web site, Virtually Northwest, at www.virtuallyNW.com, and click on “Election Central.”

For a summary and the full text of Initiative 673, log on to The Spokesman-Review’s Web site, Virtually Northwest, at www.virtuallyNW.com, and click on “Election Central.”

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