"Any willing provider".

Abstract

Before the managed care revolution, we had a costly, fragmented, disjointed, uncoordinated system of healthcare that at one time in our recent history caused the President and his wife to propose massive political reforms. While those reforms were being endlessly debated, the market reformed itself. The electorate reinforced their displeasure over big government by electing a Republican majority in Congress. But, as someone once said, those who forget history are bound to repeat it. At least some of the electorate are forgetting how they originally felt when the Clinton-style big government reforms were rejected. By all accounts, HMOs, integrated health systems, physicians and the general public have a lot to loose, if anti-managed care legislation prevails. The sad fact is that, in states where the issues have been brought to a head, emotions have clearly outpaced facts. Once it hits the "tabloids" it appears that there's no going back. Fears rule actions and the many studies being produced about HMO quality don't seem to make a difference. Perhaps those with the most to lose are the physicians, hospitals and insurers who have gone down that long, difficult and costly road to creating integrated health systems that can actually deliver superior care. The investment in time and talent has been enormous. The existing regulatory hurdles have been steep. Now they face another layer of bureaucracy and complexity in certain states. Given the stakes, it might just be time to fashion "swords into plow shares" as they've done in Colorado. It may beat the alternatives.