HMOs vs. a "Patient's Bill of Rights"


Those wonderful folks who brought you those dreadfully misleading "Harry and Louise" ads a few years back are at it again.

Now the head of the Health Insurance Association of America (HIAA) and the creator of that shamefully deceitful spot, William Gradison, was for nearly 20 years the Republican congressman from Ohio. He has joined forces with the American Association of Health Plans to spend over $3.2 million to buy the lobbying effort and Congressmen they need to keep this small but very needed change in the law from even being discussed.

What is the new threat to the poor, defenseless HMOs and the rest of the health insurance industry? Several states, as well as President Clinton, have suggested enacting a "Patient's Bill of Rights" which would, among other things, allow patients to sue their health plans for malpractice, increase patient access to emergency services, end restrictions on what doctors can tell their patients about treatment options, expedite patient visits to specialists, facilitate patient appeals of health plans' denial of treatment and protect the privacy of medical records (Multinational Monitor, Jan./Feb. 98).

The industry claims that any such rights on the part of their patients would not only drive up health insurance costs but would force 200,000 to 400,000 people to lose their insurance for every 1% increase in costs. The industry was quite silent, however, on the source or precision of those figures.

Obviously, the most important issue the industry raises is whether patients should be allowed to sue when care is delayed or denied, especially when those delays or denials result in the death of the patient. Since the entire industry has chosen to place corporate profit far ahead of patient care, this is a valid concern for them. The industry is attempting to derail the move by relying on its claim that such a law would "remove money from the pool available to provide additional services for consumers and it could jeopardize the financial stability of a carrier by depleting its financial reserves."

Let's take a closer look at that particular argument, shall we?

To begin with, the major problem seems to be that the health insurance industry resents being told how to provide medical care to their "consumers" (note that you are not considered a patient or person in the above quote). The dreadful practice known in the industry as "med-lining", where the cost of a procedure is paramount and the patient's medical needs are secondary to corporate profit, is the basic reason these rights are even being considered seriously. This practice removes the physician's power to provide the best medical care, as well, since his care decisions can easily be over ruled by a low paid clerk with no medical training whatsoever thousands of miles away. The industry practice of having your doctor recommend a series of steps towards regaining health for his patients which can be refused due to profit concerns of the insurance provider and their contractually barring that doctor from discussing the refusal puts the insurance company or HMO in the position of being your actual medical provider due to their power to veto necessary but expensive care.

In 1996, Florida was on the verge of passing legislation which would have allowed patients to sue insurance providers in cases where care was denied after a health plan's doctor deemed the treatment necessary. It is very instructive to learn who fought the passage of this bill in order to see whose interests are being protected (Hint! It isn't yours). Florida's health industry and big business groups like the Associated Industries of Florida were at the forefront against the bill while trial lawyers (boo!!!) and consumer groups (Yea!) fought for its passage. After moving through both legislative houses with unanimous votes, the bill seemed to be unstoppable. Nevertheless, late and heavy lobbying by HMOs and business alliances were able to convince Gov. Lawton Chiles to derail any possibility of enacting this consumer protection.

Folks, this is just one example of Corporate America's ability to destroy any possibilities for consumer protection laws to ever again be enacted. While the Republican Congress spends its time watering down the few protections consumers and workers and children and the elderly have, Corporate America is staying busy insuring that you health and safety doesn't interfere with their obscene profits. As has been the case since 1980, you lose and Corporate America wins. Aren't you tired of it yet?

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Copyright 4/6/98