HMO REFORM: Prospects For The Next Congress

      Writing in yesterday's Roll Call, Morton Kondracke ponders whether the U.S. is "condemned to perpetual argument over patients' rights without resolution." He starts with the given that "nothing conclusive happened" this year and that Congress will "be at it again next year," which, he says, is exactly how both parties wanted it. Republicans were lukewarm on patients' rights to begin with, and therefore passed only a scaled-back bill in the House and nothing in the Senate. Democrats were happy to seize congressional inaction as a campaign issue to use against the GOP in the upcoming elections. Kondracke writes that "the potency of the issue remains unclear." First, Democrats who have attempted to feature the issue in their campaigns have met with mixed results. In addition, a September poll by the Kaiser Family Foundation and Harvard University showed Americans more or less split on the issue of HMO performance. Nevertheless, Kondracke argues that even lacking a broad consensus, Congress may be able to pass significant patients' rights legislation.

A Compromise Plan On The Table
      Kondracke notes that David Kendall of the Progressive Policy Institute has articulated a moderate package of HMO reforms. Under Kendall's plan, a new agency, similar to the Securities and Exchange Commission, could collect data on HMOs and hospitals and disseminate it in the form of "report cards." Companies could provide "health marts" offering a wide menu of health plan options to workers. Arbitration systems could be developed in lieu of allowing patients to sue health plans. Finally, tax credits could help the uninsured gain access to the health marts, "an idea that has been suggested by such ideologically varied Members as conservative Rep. Bill Thomas (R-CA) and liberal Rep. Jim McDermott (D-WA)." Kondracke concludes with one caveat for lawmakers intent on reforming managed care: "Though the public still thinks ill of HMOs in general, 70% in the Kaiser study said they were happy with their own health plan" (10/22).