PATIENTS’ RIGHTS: Clinton Renews Call For Legislation
Accepting and endorsing the recommendations of his commission on health care quality, President Clinton Friday "pressed anew ... for legislation ensuring a 'Patients' Bill of Rights.'" The AP/Baltimore Sun reports that the president also endorsed the commission's call for a "new system that would gather information about the best medical practices, set goals for quality in American health care and monitor progress in meeting them." Clinton "ordered the establishment of two" new task forces to carry out these goals, one of which would be in charge of disseminating research information about best practices in care (Meckler, 3/14). Clinton said, "For all its strengths, our health care system still is plagued by avoidable errors -- overused and underused procedures and gaps in the quality of care. ... [O]ur nation must develop uniform national standards so that health plans can compete on quality, not just cost." Touting his order last month that applied the quality commission's patients' rights package to persons covered under federal health plans, Clinton called on Congress "in the remaining 68 days of this congressional session, [to] take the next step and make the Patients' Bill of Rights the law of the land" (White House release, 3/13).
I Sue You, You Sue Me ...
Today's Philadelphia Inquirer reports that one of the "toughest questions" in the managed care reform debate "is whether to allow patients to sue the managed care companies for compensatory and punitive damages." Since enactment of the 1974 Employee Retirement Income Security Act (ERISA), such lawsuits are limited to recovery of costs associated with treatment. The most ambitious reform proposal, Rep. Charlie Norwood's (R-GA) Patient Access to Responsible Care Act, would overturn this portion of ERISA, establishing unlimited liability for insurers. "So contentious" is the issue that Clinton's health care quality commission is "split over it." The biggest question is how much impact the expanded liability would have on health care costs. The industry claims the "Norwood plan could boost premium costs by up to 23%." Don White, spokesperson for the American Association of Health Plans, said, "[The Norwood bill] has gone beyond consumer protection and is telling the health plans how to do their business." Consumer groups, however, differ with this figure, "citing one study indicating that premiums would rise only 2 or 3%" (Hess, 3/16).
Capitol Hill Outlook
The Los Angeles Times reports that the "outlook for congressional action is cloudy, reflecting public uncertainty." Harvard University health policy professor Robert Blendon said, "Public opinion is formed on what's wrong with managed care, but they haven't given a lot of thought to what government ought to do about this problem." Blendon contends that "discontent with managed care will grow, particularly in California, where almost all consumers are enrolled in managed care plans." He said, "Californians are unhappier campers than the rest of the country, which suggests that employers' argument that this is just a transitional problem as people adjust to managed care is off the mark" (Rubin, 3/14).
Weighing In Against Haste
An editorial in the Washington Post calls on Congress and the president to take a more sensible look at the necessity of proposed managed care reforms. While the Post says much of the patients' rights package endorsed by the president is "basic consumer protection and benign," the editorial warns against government involvement in specific care decisions and the doctor-insurer relationship. The editorial contends that managed care plans "need to preserve a voice in the kinds of tests and treatments the doctors with whom they deal prescribe, or at any rate, the kinds they will pay for. The entire concept of managed care depends on the maintenance of such constraints. It's right to insist that they not be arbitrary, wrong to remove them entirely." The Post concludes, "First do no harm is the first rule of medicine. It should be the rule for legislating on medicine as well" (3/16). Likewise, an editorial in the Greensboro News & Record agrees with growing criticism of "middlemen ... nameless, faceless and possibly clueless clerks making important decisions about what medical services and care people can get." Calling the bill of rights and the right to sue a "rational response," the editorial nevertheless cautions that such mandates would "add yet another cost to the delivery of health care." The editorial closes with a call for a "simple, straightforward universal health care system," one that "minimizes the hurdles between patient and physician and delivers a high level of basic care without a lot of fanfare" (3/15).