By Stephanie Innes
ARIZONA DAILY STAR, Oct. 20, 2008
A Glendale doctor who believes health-care reform in Arizona is both necessary and inevitable is also determined, via a ballot proposition, to make sure government doesn’t take over the process.
Dr. Eric Novack, an orthopedic surgeon and former Phoenix radio-show host, came up with the idea for Proposition 101, which appears on Arizona’s Nov. 4 election ballot. The measure would amend the state constitution to include language restricting Arizona’s ability to limit or dictate individual health-care choices, and to make government-mandated universal health care illegal.
Officially titled the Freedom of Choice in Health Care Act, Proposition 101 includes four specific health-care changes, including making a single-payer, universal health-care system — like Canada’s, for example — illegal in Arizona.
The exact wording prohibits laws that “restrict (a) person’s choice of private health-care systems or private plans; interfere with (a) 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.”
The proposition is being driven in part by concerns that the continued escalation in health-care costs, and the fact that many people can’t afford even basic care, will eventually push the state to create its own mandatory system guaranteeing everyone the same coverage.
Supporters of the measure fear such a system could give cost-conscious state bureaucrats more power to dictate physician choices and treatment options than the insurance companies and HMOs already wield. Physicians’ practice habits and fees could be locked up by the same bureaucracy, they say.
Their concerns about government involvement are not totally without basis: State lawmaker Phil Lopes, a Tucson Democrat, has unsuccessfully introduced single-payer legislation three times, and indicates he will continue proposing it.
Opponents of Proposition 101, even those who acknowledge the concerns behind the measure, say it’s overkill.
Gov. Janet Napolitano and Tucson pediatrician Dr. Eve Shapiro, who are among those leading the charge against it, say Proposition 101 is worded too broadly and could have consequences Novack doesn’t foresee.
Prohibitions on government interference in patient choice could force the state to pay for whatever patients in government-run programs want, they say — and that would be prohibitively expensive.
It could also block the Legislature’s ability to consider other health-care options, besides universal care, they say.
A recent memo written by Arizona Health Care Cost Containment System director Anthony D. Rodgers said the language prohibiting government from restricting a person’s choice of private health-care systems is so broad a judge could interpret it to include the private contractors used by AHCCCS.
Since AHCCCS, the state’s alternative to Medicaid, works on a managed-care model, it’s not financially possible to allow those in the plan to always choose their providers.
“The mandatory managed-care model under which AHCCCS has been operating successfully since 1982 could be redesigned to a far more costly fee-for-service model,” Rodgers wrote. “The fiscal impact of such an unintended consequence would be astronomical.”
The constitutional amendment is ambiguous, poorly written and will wind up in the courts, critics including Napolitano say.
Other opponents include Tucson-based University Physicians Healthcare, Church Women United in Tucson, the Pima County Medical Society, the Arizona Chapter of the American Academy of Pediatrics, the Tucson Chamber of Commerce, the Arizona Academy of Family Physicians and the Arizona Hospital and Healthcare Association.
Novack insists Proposition 101 would change nothing about the way health care is currently delivered, and would not impose new obligations on AHCCCS.
Such a constitutional amendment is unprecedented — Novack could not find a single model in any other state or jurisdiction.
Instead, he’d like Arizona to provide the model. He believes the nation’s founders erred by not including freedom of health-care choice in the First Amendment, and that Americans are in danger of having that freedom taken away by government interests.
Supporters of Proposition 101 include Tucson car dealer Jim Click, the Arizona Dental Association, the Arizona Restaurant Association, the Arizona Osteopathic Medical Association, the Arizona Chiropractic Society, the Arizona Homeopathic & Integrative Medical Association and the conservative-leaning Goldwater Institute.
The “yes” side sees health-care reform happening soon and views universal health care as a very real possibility. Novack says he wants to prevent that before it happens.
Lopes, the House minority leader, said his effort to get a universal health-care bill through the Legislature could be the sole reason Novack undertook the initiative drive to put the proposition on this year’s ballot.
Novack began his career in medicine as an emergency medical technician answering 911 calls in Bridgeport, Conn., “the innermost of inner cities,” he said. He earned his medical degree from University of California, San Francisco, in 1996 and has practiced medicine in Arizona since 2001.
He came up with Proposition 101 after spending 2005 to 2007 hosting a Phoenix radio program about health care.
“That was like getting an advanced degree in health-care policy,” Novack said. “We need health-care reform. No reasonable person doesn’t think that. And there is no larger thing in this country than health care when it comes to money.”
The measure has already hit the courts: Supporters from the yes on 101 campaign, called Medical Choice for Arizona, have filed a court action against AHCCCS. Novack’s camp wants an injunction against the state agency, saying it should not be using taxpayer money to campaign against a ballot proposition.
AHCCCS officials maintain they have done nothing wrong.
“We have a responsibility to the taxpayers we serve to educate them,” AHCCCS spokeswoman Rainey Daye Holloway said of Rodgers’ memo, adding that the agency has not yet seen the court action filed against it.
Napolitano said in a prepared statement, “We simply can’t afford the unintended consequences of Proposition 101, which could take away benefits from thousands of Arizona families and drive up costs for taxpayers.”
Novack says he feels as though his plan is being railroaded by people who want to protect government interests in health care.
“It allows the option to opt out of any government-controlled health-care scheme,” Novack said. “This amendment will help every single person in Arizona regardless of how they got to Arizona. The only ones who will get hurt are the government bureaucrats who have more interest in political power than in the decisions and control you and I have over our own health care…
“There is nothing in this that makes me or any doctors more money.”
But Shapiro, a longtime local advocate of health-care reform, and a critic of the proposition, said amending the constitution is an extremely serious step.
“It ties the hands of the Legislature. It limits options instead of giving us freedom of choice,” said Shapiro, who also sits on the board of the Arizona Medical Association.
She, and other critics, say the open-ended language in the measure is a big red flag.
“I don’t see how it would benefit anybody. I’ve been in practice for 30 years and I know that patients want freedom to choose their doctor, not their insurance plans,” Shapiro said. “It solves a problem that doesn’t really exist and pu
ts something in the constitution that will be incredibly difficult to overturn.”
If 101 does pass, there is a potential problem: If Congress were to adopt a national health-care program with a single-payer system, it could trump Arizona law on medical choice and make the state amendment meaningless.
Proposition 101 by the numbers
• Money raised by supporters through Medical Choice for Arizona: $483,631 as of Sept. 22.
• Contributors include: Tucson car dealer Jim Click, $25,000; Houston developer Charles Burnett, $20,000; New Jersey investors Frayda and Ken Levy, $100,000; Norman McClelland, Phoenix resident and chairman of Shamrock Foods, $15,000; Oro Valley financial manager Paul Clifton of the Robert A. Hansen Family Trust, $15,000; and The Benjamin Rush League, a non-profit corporation formed by 101 backers Dr. Eric Novack and Dr. Jeffrey Singer, $42,000. (Benjamin Rush, a Pennsylvania physician, was a signer of the Declaration of Independence.)
• Money raised by opponents: None as of the end of the last official reporting period. However, the “no” campaign officially launched Oct. 14 and officials say they’ve raised about $250,000 so far, to be reported in the next filing period for campaign-finance records, including bigger donations from University Physicians Healthcare in Tucson and the Greater Phoenix Chamber of Commerce.
• A previous No on 101 committee was terminated and its only contribution of $50,000 from California-based SCAN Health Care was refunded, records from the Arizona Secretary of State’s Office show.
What Prop. 101 says
Would amend the Arizona Constitution to mandate that Arizona law may not:
1. Restrict a person’s freedom to choose a private health-care plan or system of their choice.
2. Interfere with a person’s or entity’s right to pay directly for lawful medical services.
3. Impose a penalty or fine, of any type, for choosing to obtain or decline health-care coverage.
4. Impose a penalty or fine, of any type, for participation in any particular health-care system or plan.
The yes side
The no side
● Contact reporter Stephanie Innes at 573-4134 or at email@example.com.