New Assembly Member and MD Richman ‘Worth Watching’
"There's a doctor in the house," Daniel Weintraub notes in a Sacramento Bee column, referring to Assembly member-elect Dr. Keith Richman (R-Los Angeles), an internist in the San Fernando Valley and chair of the Lakeside Health Care medical group. According to Weintraub, Richman's experience puts him at "ground zero" in the battle over the future of managed care, and while he may "not exactly ... go to war with the HMOs," Richman -- the first physician to serve in the Legislature since 1992 -- will "give them a hard time." Weintraub points out that medical groups, not "dreaded HMOs," make most health care decisions today, and Richman understands "firsthand" the pressures faced by medical groups to provide quality care while holding down costs. Doctors argue that HMOs have squeezed "too hard" and capitation rates have dropped "too low," Weintraub writes, and Richman confirms that argument, pointing out that Lakeside has lost money on most of the group's privately insured patients, and has been buoyed only by higher Medicare payments. Weintraub adds that Richman will arrive in the Assembly at a time when "doctors are pushing the Legislature to intervene in their relationship with health plans." In the last session, lawmakers considered and rejected a plan to regulate the rates that HMOs pay medical groups, but Weintraub suggests that Richman may "revive that quest." In addition, Weintraub argues that Richman will "push a more limited proposal" requiring HMOs to "absorb" the costs of vaccines and prescription drugs rather than passing them to medical groups. Richman says that the "market in medicine is broken" because HMOs have "too much leverage" by controlling the choice of doctors in a community. Meanwhile, HMOs "not surprisingly" argue that doctors have "overstat[ed]" the problem, contending that "[i]t's a market." Richman points out, however, that "medicine is different" because patients do not "shop around and make compromises on their care. ... [T]hey expect the best." Noting that Richman will join 30 other freshman in the Assembly, Weintraub calls him a new member "worth watching" (Weintraub, Sacramento Bee, 12/10)