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Bush's Spindoctors and Ho-Hum-O's
June 27, 2001
by
Maren L. Hickton

Are you the party of the first part or the second part? Maybe you're the party of the third part or the fourth part. That is, are you the patient, the employer, the HMO/insurance company or the health care provider? - not necessarily in that order.

The discussion in Congress is supposed to be about the Patients' Bill of Rights. It has been reduced to a wildly distorted debate about ambulance chasing, greedy lawyers and all kinds of scary talk about possible liable parties when contracting with health maintenance organizations. But there is no evidence whatsoever to indicate that lawsuits are going to clog the arteries of our judicial system, let alone liable multiple defendants as the result of a new bill that offers patients long-overdue protections when contracting with these groups.

The Democrat Patients' Bill of Rights Plan, the one the majority of Americans favor, has been threatened with a veto by President Bush. Bush's Spindoctors, in the interest of saving this indifferent industry are reporting a variety of concerns. Spin: This plan will drive up costs and leave patients without health care insurance. Fact: A case study in Bush's own state has shown that costs have gone down and more people are covered. Spin: There have been reports that employers and union groups will be sued if the Democratic plan is passed. Fact: What employer or union group in their right mind would get involved in making medical decisions except those interested in collusion which would deserved to be sued. Responsible employers have nothing to fear. Spin: The Democratic plan subjects all physicians and health care professionals to greater liability risk. Fact: Untrue. They obviously haven't read the Democratic plan. I'm getting dizzy.

Most interesting, is the fact that the GOP plan, sponsored by Frist-R/Breaux-D, has completely disavowed their own platform of respecting states rights, including Chief Judge Rehnquist's recommendation that, "in any managed care legislation, the state courts be the primary forum for the resolution of personal injury claims arising from the denial of health care benefits, should Congress determine that such legal recourse is warranted." The GOP plan, instead, contrary to Rehnquist's opinion, mandates that patients seek remedies only on the federal level, while the Democratic plan, sponsored by McCain-R/Kennedy-D, enables patients to seek remedies in their own states - the way it should be.

President Bush, in the huge state of Texas in 1997, passed a Patients' Bill of Rights similar to the McCain-Kennedy plan, yet he contends that the Democratic plan "would overturn 25 years of Federal law..." Yes it would. For the last 25 years, the HMO industry is the only industry that has been awarded special legal protections, insulating them from being held accountable and creating the absolute disaster that brought this HMO matter before Congress. Had they not been exempted from the law, many people may not have suffered and HMOs may not have ended up suffering themselves with the scornful reputation they have today.

Since Bush enacted his own patient protection laws in Texas, only 17 suits have been filed against health plans. The Texas Medical Association reports that none of these lawsuits resulted in huge awards with most settled before going to trial. And although premiums for insurance have gone up everywhere else, there are no reports of increases in Texas or people losing coverage because of increased litigation or as a result of Texas' patient protection law. What does seem to be at issue is the fact that some doctors, fearing liability, provide services or order unnecessary tests which insurers claim drive up the cost of medicine. Doctors in Texas argue that this is not true; they are now permitted to practice medicine with less interference by the HMOs. The findings in Texas seem to be that while this is still an area for debate, HMOs have come to realize that medical necessity decisions aren't always in their best interests and HMOs have lightened up on restrictions.

Despite the Texas model, the GOP plan in congress wants to continue to allow insurance companies to offer doctors incentives to not offer treatment. If this remains part of the GOP plan, Frist/Breaux might as well take their plan off the negotiating table. While fiscal responsibility is of utmost importance, this is a gaping loophole, ripe for foul-play. This Bill would not be before Congress in the first place but for the fact of denial of treatment ending up in all of the patient horror stories. In Texas, premiums decreased and those insured increased by over 200,000, despite no incentives to doctors.

While Congress continues the debate on HMOs, the insurance industry already recognizes a trend of employers exploring alternatives to managed care and choosing Preferred Provider Organizations, PPOs, over HMOs. Market forces - people not wanting to buy into heavily-managed health maintenance organizations, patients wanting the right to choose doctors and health care facilities even if it costs more - not legal liability, is the reason stated for this trend.

I have a less-complicated theory for this trend. How about most HMOs are no damn good?

I hope that as Congress proceeds with this important legislation that they take the time to protect our interests watching out for alphabet soup. The Patients' Bill of Rights should extend to related forms of health care insurance as the "managed care" label - HMO - can easily be replaced tomorrow with new monograms representing alternative health insurance packages designed to get around this legislation, with plans probably already in the works.

Simultaneously, I hope that business groups, such as the National Restaurant Association and others, will get beyond their talking points and conduct some investigation of managed care legislation which already exists in several states rather than participating in unfounded hysterics. Congress is indeed close to bringing forth a bipartisan bill that will provide meaningful health care to employees - something that is long overdue. Employees are worth it.


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