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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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