The elements of State regulation appearing in the chart show very little, any, requirements for many of the restrictive acts. Real regulation exists on where a State license is required, coupled with power in the State to suspend a revoke the license. Only partial regulation exists where approval of the contra forms and rates is required without the requirement for license. Only pset. or apparent regulation exists where filing only of contract forms and rates a required, without necessity of a license. This latter situation exists in Day of the States, such as Minnesota, but is not shown specifically on the chart wh is designed to show whether a given State actually exercises some regulat through a license or approval of contract forms or rates. Exemption from :surance laws and from taxation exists in many States. It will be noted t under the classical standards for tax exemption many plans operating mi these special acts did not measure up and have tax exemption only by virtu a section in the special act. The elements of professional control show the decisive provisions which chas acterize the special act as being restrictive in the sense that it may be c only by the organized medical profession. This is obvious where all or at a majority of the incorporators and/or directors must be doctors or persons proved by the medical association. It is less obvious where the special act made part of the pre-existing Blue Cross statute. However, an inquiry the situation in those States will readily show that since the Blue Cross pital plan is under the influence of the medical profession, the Blue Shield r will automatically fall under the same influence. In any event, where the Ea Cross and Blue Shield statutes are combined it is impossible for consumES operate a democratically controlled plan. Where the special act requires ticipation by a specified number of licensed physicians in the area or the S it is obvious that the plan could not operate under such an act without spons ship or endorsement by the county or State medical society, or by both, m the society involved would naturally reserve such endorsement for its own Shield plan. Many of the restrictive acts require free choice of physician as an esseta ingredient in any plan operating under the act. This means that a subscriber the plan would be free to choose a different physician in any part of the State each item of medical service required. At first blush this might seem to bet desirable provision, but on closer inspection it will be found to be the device as by the organized medical profession to perpetuate the fee-for-service method paying for medical services, to the exclusion of all other methods. A plan bodying free choice as narrowly defined by the medical profession is actuarial feasible only if all of the physicians agree to a special fee schedule. Obviong such a uniform fee schedule on a statewide basis could not be effected other th through a State medical association, which would naturally reserve such acti for the exclusive benefit of its own Blue Shield plan. As a practical matter would not be possible for a consumer-sponsored plan to obtain an agreement fr the medical profession on a fee schedule which would constitute the entire ment for the item of medical service rendered to people within the spec income brackets. Since free choice automatically involves a fee schedule, Blue Shield plans necessarily very limited in the number of services or amount of indemnity vided. They often exclude the first items of service and limit the number or e of professional calls available in any illness or contract year. Some are lim to surgery and to calls at the hospital and exclude office and home calls. # for service always involves a pyramiding of costs as specialists care is requi and in every case where more than one physician is involved the overhead each physician adds to the total cost as reflected by the fee schedule. Thus order to have a salable contract, meaning one that would fit the budget of people, the benefits available must necessarily be scaled down. On the other hand, a consumer-sponsored plan usually embodies group prac of medicine with prepayment. The central principle in group practice is th the science of medicine is so vast and complex that it cannot be mastered by ot individual, and that only a balanced group of general and specialist practitione free to consult with each other, and practicing medicine as a group are best a to combine the knowledge and skills in order to effect the best diagnosis an treatment. "Free choice" as narrowly defined by the medical profession, art as such made a mandatory part of a State law, would make group practis impossible. In the broad sense free choice should include in its meaning the right of a consumer of medical services to freely choose to seek care from a solo practi oner or a group of practitioners practicing as a clinic, as well as freedom to n or to quit a group-practice plan. Incidentally, the State laws containing the pical free choice section as narrowly defined, actually or tend to make imssible the operation of group practice plans, worthwhile as they may be. perimentation for all types of plans with different methods of prepayment, ferent types of benefits, and with or without group practice, would be desirable a free economy where public acceptance should be the ultimate test for success. iny State special acts restrict experimentation, and some actually limit activity the field to one stereotyped plan. This situation is undesirable and should not tolerated in a democracy. Any Federal plan designed to make more and better medical care available more people should not be drafted without considering the limiting effect of se special State acts. Further, any proposal for a Federal-aid plan should consider that it may have possible effect of endorsing the existing restricted situation, an of adding ength to a trend toward class domination of the field of medical economics, because of the underlying basis created by existing State legislation. In the summary under restrictive acts, Illinois, Massachusetts, and Wisconsin not included since a parallel separate act permits consumer-sponsored plans. us the States listed under restrictive acts have no provision for consumeronsored plans by either a separate or open act.) Restrictive acts: SUMMARY bama (1945): Ala. Ann. Code t. 28–304. zona (1945): Ariz. Code Ann. Sec. 53–421. ifornia (1941): Cal. Corp. Code. Sec. 9201. orado (1951): Colo. Stat. Ann. Code c. 109, Sec. 23 (17) (m). rida (1945): Fla. Stat. Ann. c. 641. orgia (1950): Ga. Code Ann. c. 99–10A, Sec. 99-1001a. ho (1947): Idaho Code 41-1701. za (1945): Ia. Code Ann. c. 514.1. nsas (1:45): Kans. Gen. Stat. Ann. 1949, Sec. 40-1901. atucky (1946): Ky. Rev. Stat. 1953, Sec. 303.160. isiana (1948): La. Rev. Stat. 22: 1661. ine (1951): Me. Rev. Stat. c. 56, Sec. 218, as amended c. 47, L. '51. higan (1939): Mich. Comp. Laws, Sec. 550.31 or 17 MSA 24,591. mesota (1945): Minn. MSA c. 159. ntana (1947): Rev. Code of Mont. c. 15-1401 (d). w Hampshire (1943) : N. H. Laws '43 c. 166, as amended L. '45, c. 96 and L. 47, .55. * Jersey (1940): N. J. S. A. 17: 48A. rth Dakota (1945): N. D. Rev. Code, Sec. 26–2701. io (1941): Ohio Gen. Code, Sec. 669–14. ansylvania (1939): Pa. Stat. Ann. t. 15, Sec. 2851-1503. ode Island (1945) : R. I. Acts 1945 c. 1598. uth Carolina (1948): S. C. 1952 Code of Laws, Sec. 307-1101. nnessee (1945): Wm's. Tenn. Code Sec. 4186.18. rmont (1939): Vt. Rev. Stat.. t. 26, c. 261. ginia (1940): Code of Va., 1950, Sec. 32–168. est Virginia (1943): W. Va. Code Ann. 1949 Sec. 3242 (1954). Open acts nnecticut (1939): Conn. Rev. Gen. Stat. Sec. 5281. iryland (1945): Md. Ann. Code Gen. Laws art 48A, Sec. 301. sissippi (1946): Miss. Code Ann. Sec. 5615-01. orth Carolina (1943): Gen. Stat. c. 57. w Mexico (1947): N. M. Stat. Ann. Sec. 60-1401 et seq. w York (1939): 27 Con. Laws of N. Y. Sec. 250, lahoma (1949): Okla. Stat. Ann. t. 36, Sec. 841. egon (1917): Comp. Laws Ann. Sec. 101--901. ashington (1947): Wash. Rev. Code 48.44.010. Separate acts inois (1951): Stat. Ann. c. 32, Sec. 595. assachusetts (1941): Ann. Laws c. 176C. sconsin (1947): Wis. Stat. Sec. 185.25. 39087-54-pt. 6- 29 4. Apparent authority for lay plans South Dakota (1949): S. D. Code Sec. 11.1101 (1939). Texas (1945): Tex. Rev. Civ. Stat. Ann. art 1302–2A. 5. No special acts Arkansas Delaware Indiana Missouri Nebraska Nevada Utah Wyoming I= corporators must be doetors (no lay participation). D= Directors must be doctors or approved by medical society, at least majority. D D D D H = Hospital plan, part of H H H H P= Participation of doctors (see footnote to reference). F= Free choice required. F F F F F F F See footnotes at end of table, 1783 |