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Show Hinckley Journal of Politics 2006 Any Willing Provider: An Unacceptable Risk for a Marginal Gain Samuel Sutton It is no secret that many Americans are less than happy with their health care coverage - either due to a total lack of coverage or simply a lack of choice and flexibility within their current plan. The latter objection is often a feature of the coverage afforded by Managed Care Organizations (MCOs), also commonly known as Health Maintenance Organizations (HMOs). These plans usually restrict a patient's choice of doctors in exchange for lower monthly premiums. In response to frustrated patients and citizens, legislation titled Any Willing Provider has been introduced in several states, which aims to curb the ability of an HMO to control patient access to the healthcare market. While the goals of this type of legislation seem noble and logical on their face - allowing patients to have their choice of doctors and not allowing companies to restrict access to the market - the unintended consequences of these laws could easily outweigh their benefits. B31 undermining an HMO's cost-saving techniques, America runs the risk of increasing the number of uninsured citizens. This report will outline the issues and debates surrounding the MCO/HMO industry in America as well as the Any Willing Provider movement. It will then argue that this kind of legislation, while desirable on its surface, demonstrates a potential for negative consequences, which may be too much of a risk to our healthcare system. Introduction The United States healthcare system is among the most envied in the world. People who can afford to go anywhere for care come to America first; even patients from Canada, where healthcare is free for citizens, often jump across the border to get specialized treatments in the U.S., despite the high cost. So how could the healthcare system in the U.S. rank 37th in the world in overall performance, according to the World Health Organization's (WHO) 2000 Report (World Health Organization, 2000)? The problem is not the healthcare itself, but rather the sheer lack of accessibility. Healthcare in the United States is also the most expensive in the world, both per capita and as a Percentage of GDP, and while this translates into exceptional care for those who can afford it, those who cannot are often left with less than desirable coverage, if any at all. Roughly 16% of Americans now find themselves uninsured (about 45 Million people as of 2003), and the cost for a business to pro-vide health coverage for an individual employee has risen to almost $7,000 annually (By the numbers insurers/managed care, 2004, p. 38). This makes for a burdensome overhead which falls squarely on the shoulders of American companies - a feature that is rather unique among industrialized coun-tries. Addressing some of these issues has been the primary mission of the Managed Care Organization (MCO) movement in the United States; to offer adequate healthcare or health insurance for a more affordable price. Unfortunately, no system is perfect, and with the lower costs associated with MCOs come some inevitable trade-offs, most notably patients' lack of choice about which doctors they can see. Many patients, doctors, and politicians have therefore striven to mitigate this (and other) problems by pushing for the enactment of Any Willing Provider (AWP) legislation, which restricts MCOs from forming the highly exclusive networks that save money, but exclude doctors and restrict patient choice. This report will first outline the history, impact and general structure of the American MCO industry, as well as their benefits and drawbacks. It will then describe how Any Willing Provider laws work, what they are designed to achieve, and the legal history and challenges they have faced. Arguments for both sides of the issue will then be presented, followed by a summary of available evidence and a discussion and analysis of the issue in order to determine what kind of effects these kind of laws can be expected to have, if any. Much like the system, no solution is perfect, and this essay will contend that the unintended consequences of forcing patient choice on the MCO industry are likely to only make healthcare more expensive in the United States, forc- 73 |