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Charles Jaco has written opinion and commentary pieces for dozens of magazines and newspapers. Each week, read and comment on a fresh on-line version. The discussion page enables you to share your view points world wide. If you would like to make a comment go to the " Join the discussion" link below. If you would like to view past editorials visit the Editorial Archive. Editorial: 10/8/99
Health care corporations have managed health care about the same way Jim Riggleman managed the Chicago Cubs---not too well. Unfortunately for the well-meaning Mr. Riggleman, he's out of a job. Unfortunately for health care consumers, the managed care giants are still filling out the lineup card. The Congressional right-wing has endorsed managed care the same way they've endorsed other oxymorons like creation science. But 151 of them still went down with the ship as the House of Representatives overwhelmingly passed the so-called patient's bill of rights by a vote of 275 to 151. The bill sets uniform standards for health care and gives patients the right to sue health insurance plans that cause injury by either providing substandard treatment or denying treatment altogether. The Senate passed a much narrower bill that does not give you the right to sue, so now the two sides have to work out the differences. That conference committee gives the health care industry one more chance to make itself immune to lawsuits. The attitudes of two House Republicans are instructive. First, we have Rep. Anne Northup of Kentucky. She represents Louisville, home to several insurance companies including managed care giant Humana. As the House debated managed care reform, she told me the right to sue "...only means big money for greedy trial attorneys. The only reason doctors are upset with managed care is that they've been making a lot of money ordering the kinds of needless tests that managed care's trying to control." So how to explain the support for reform by the five G.O.P. members of the House who are also doctors, including the co-author of the patient's bill of rights, Rep. Charlie Norwood of Georgia? "Norwood's not a doctor, he's a dentist," she said scornfully. "And of course he'd support something like this. I would imagine dentists will make out like bandits under his bill." This is not especially surprising from someone who's been honored by the U.S. Chamber of Commerce and National Association of Manufacturers, represents the district where Humana provides thousands of jobs, and has access to the Federal Employees Health Benefit Program. That program has contracts with 285 health plans and offers choices among fee-for service plans, HMO's, and plans offering the hybrid point-of-service option. Just a guess, but I imagine this is a lot more choice than your health plan offers. Then, there's Republican Congressman Greg Ganske of Iowa. The folks in his Des Moines district also know him as Dr. Ganske, plastic and reconstructive surgeon. I asked if I should call him Doctor or Congressman. He replied, "Greg." I opted for Congressman. "A doctor's first loyalty is to his or her patients," he told me. "And when a managed- care bureaucrat overrules a physician's decision based on the bottom line, we have a duty to speak out. The problem is, many doctors are forbidden by their HMO's from telling patients about some kinds of treatment options, because the HMO doesn't want to pay for them." That's the part of the Norwood-Dingle reform bill Ganske supported the most--the part that forbids managed care organizations from slapping a gag order on their doctors. But wouldn't allowing patients to sue just drive up the cost of premiums by forcing managed-care groups to defend mammoth lawsuits? "Nonsense," he snorted. "Right now managed care companies are guaranteed immunity from their own mistakes. Holding them accountable for their decisions shouldn't do anything but force them to put patients before profits." This bill didn't pass because wild-eyed health care spendthrifts stormed Congress and demanded that everyone should get an MRI and a CAT scan if they have a cold. It passed because doctors and nurses and patients objected to health care executives putting their stock options and bonuses ahead of medical necessity. Even the stodgy American Medical Association has weighed in, approving doctor's unions. Doctor's unions? Health care worker's unions? That doesn't happen because the people staffing intensive care and the e.r. want to show solidarity with Jimmy Hoffa, Junior. Unions happen in reaction to bad management and poor working conditions. And the patient's bill of rights happened because the same managed-care industry that's slashing staff at hospitals also denied proper care to too many people too many times. So what happens now to the managed-care executives? I hear the Cubs are looking for a new manager.Join the discussion
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