Proposition 101: Health care freedom of choice defeated in Arizona

During last month’s elections, the citizens of Arizona were asked to vote for or against Proposition 101, a proposal to amend the state constitution to assure the individual’s freedom of choice in choosing health care. The proposition lost by less than 0.04% of the votes cast. If it had passed, it could have helped preserve traditional private practice by protecting the citizens’ rights to make their own health care and health insurance choices.

It also could have impacted future health care reform for all Americans.

I wish the concepts and debates generated by this proposed amendment had been discussed nationwide. It was not mentioned in the presidential debates on the future of health care. Obviously, meaningful and substantial health care reform and all of its proposed “fixes” became smaller issues as the candidates were forced to recognize and make proposals related to the recent significant and deepening economic downturn.

Douglas W. Jackson

What was Proposition 101?

According to the description on the Arizona ballot, Proposition 101 “Prohibits laws that: restrict a person’s choice of private health care systems or private plans; interfere with person’s or entity’s right to pay directly for lawful medical services; impose a penalty or fine for choosing to obtain or decline health care coverage or for participation in any health care system or plan.

“If passed, this would mean no law could prohibit patients in Arizona from electing to pay directly for their medical services, nor could it restrict them from choosing a private health care system.”

George F. Will, the conservative columnist, wrote in the Washington Post in October that opponents of the proposition were “against what it would guarantee, including the right of individuals to pay directly for medical services without needing the permission of a third party. Proposition 101 would emancipate service providers from requirements that they either charge fees set by the state, or charge nothing.”

He said that it would “prevent employer or individual mandates of the sort imposed in Massachusetts. That is, it would prevent ‘pay or play’ systems, under which employers must either pay for employees’ health insurance or pay into a state pool that finances insurance for them.”

The close defeat of this Proposition is a window into what is occurring on the national level and may represent the last gallant attempt to prevent Medicare from requiring physicians to accept Medicare fees if they remain in the program.

If this proposition failed in Arizona, where individual freedoms and responsibilities run deep, what can we expect in other states?

The resistance

Proposition 101 generated significant resistances from many of Arizona’s Democratic leaders. They contended the wording of the proposal, as it read, could have undermined existing state and federal health programs and some HMO plans. Many believed that the proposition’s passage would limit future legislation on mandatory health care, that it would have negative effects on existing programs for the needy and limit the state’s ability to create a future system of providing and ensuring health care access.

The Patient Bill of Rights

It is interesting that many individuals who have supported the Patient Bill of Rights did not see this freedom of choice as a basic patient right. To the majority in Arizona, the freedom to choose a provider and the ability to go outside their system and pay the provider directly did not represent a freedom patients should have.

The sponsors introduced this amendment because of their desires to keep patients in control of their health care, offer alternatives to health care choices dictated by the government and to keep patient freedom at the center of future discussions on health care reform. While many opponents agreed the proposed amendment would assure one’s freedom to choose a personal physician, they opposed how it might prevent the state from creating a system of universal health care.

Some expressed that it would increase the abuses of the current private system and restrict potential future cost-control measures. They also felt the language of the amendment could lead to the courts having to provide the final interpretation once it became law.

Orthopedist-sponsored

It is interesting that the proposal was written and sponsored by an organization called Medical Choice for Arizona. The group’s chairman, Eric Novak, MD, is a practicing orthopedic surgeon, click here to read his article. I was impressed that individual physicians and the coalition they put together tried to preserve something they felt strongly about.

In this current environment of fiscal crises and unprecedented debt inherited by a new administration, changes that may impact health care and the practice of medicine as a whole are coming. The results of this ballot question raised in Arizona may not slow the march to universal health care, increasing government health care programs or the onslaught of further mandates and regulation as methods to fix a fiscally broken system.

This proposition had many in Arizona asking questions related to health care reforms and what maintaining a freedom of choice in health care means to them. The 2010 elections may allow other states and Arizona to re-explore this or proposition. We need to get involved on one side or the other or forever hold our peace.

Douglas W. Jackson, MD
Chief Medical Editor