They're the underlying themes of two bills sponsored by Sen. Chris Buttars, R-West Jordan, that would give Utahns greater flexibility in choosing their doctors and may drive down health-care costs.

One of Buttars' bills would make it easier for Utahns to "swing out" of their HMOs or PPOs and see the doctors they want.

The other would prohibit hospitals with more than a quarter of the licensed beds in a county from giving discounts to insurance companies in return for restricting where customers can seek care.

Both bills, which were unanimously voted out of the Senate Health and Human Services Committee Tuesday, sparked heated exchanges about health-care reform in Utah.

"The debate - and the war - has begun," said Sen. Allen Christensen, R-North Ogden.

The key questions: Will giving patients the option to see the doctors they want lower costs by creating more competition in the health services market? Or will it push costs up by eroding the discounts insurance companies get by tying patients to a provider network?

"In order for a market to function, you have to have access to customers," said Wendell Gibby, a radiologist who testified in support of the bills. He and others complained that Utah's insurance market is controlled by a handful of companies.

Buttars' first bill would require HMOs and PPOs to reimburse a patient for care from an out-of-network doctor, if the services are covered by the patient's insurance plan.

Doing so, Buttars said, is a win-win situation. Insurance companies would have to reimburse out-of-network providers only 90 percent of what they pay their network doctors. And patients would have more freedom to select their providers.

Patients would pay any charges not covered by their insurance. The total bill could be up to 20 percent more than what an in-network doctor would have charged. They would also still pay their usual co-payments or deductibles.

Gibby believes the changes would make patients more invested in their health care.

"We have created a health-care system in this country where agency has been robbed of people," he said. And "they lose ownership in that process."

But Kelly Atkinson, executive director of the Utah Health Insurance Association, said Buttars' bill removes the incentives for provider discounts.

"Be realistic and say that choice comes with increased costs," he said. "And if you're willing to accept those increased costs, pass the legislation."

Dave Gessel, vice president of government relations and legal affairs for the Utah Hospital and Health Systems Association, objected that Buttars' bill allows doctor choice, but not hospital choice.

"If we're looking for competition, let's have the competition," he said. "But what I see is a bill that goes after the hospitals."

Buttars said the second bill would create more competition in Utah County, for example, where one hospital controls more than 70 percent of the beds. That makes it difficult for surgical centers to compete, he said.

But Gessel said the bill would effectively drain hospitals, which do hundreds of millions of dollars worth of charity care, of surgery dollars that help keep them afloat.

"What the bill does is go after hospitals in an antitrust sense," he said, adding, "I can't imagine a bill that is more anti-hospital."

Despite their approving votes, some senators remained conflicted.

"I'm worried about being wrong," Christensen said. "But the costs [of health care] are going up regardless and I'm willing to step forward and put my foot in it and give change a chance here."

lrosetta@sltrib.com