PATIENTS’ RIGHTS: Health Leaders Square Off On PBS “Newshour”
Last night, PBS' NewsHour took a close look at the issue of patients' rights and managed care regulation, hosting Health Insurance Association of America President Bill Gradison and Rep. Charlie Norwood (R-GA), the lead congressional sponsor of the Patient Access to Responsible Care Act (PARCA). Gradison disputed the need for federal legislation mandating certain health plan practices. "[T]he consumers have said loud and clear, we want quality. And what we see today in health plans all over this country is that they have a higher proportion of board certified physicians than the plans which they have replaced. ... Now our position is very simple; that the market is responding far more quickly and effectively than if Congress passes a lot of laws, the administration writes thousands of pages of regulation, the courts consider many, many cases trying to figure out what the law really means, and large numbers of bureaucrats go about making a judgment of their own, rather than letting the market, the consumer, dictate what should be done in health plans." Norwood, however, asserted, "There is no such thing as a free market in health care today. ... Patients can't choose; doctors are being gagged; they are always having to be told what they can and can't do, frequently by people that are simply not trained to tell them that."
ERISA To Blame?
Norwood said problems in health care today can be tied to the federal law governing self-insured health plans. "[The] Employee Retirement Income Security Act that was passed in 1974 ... threw [the] federal government right in the middle of health care ... and we have gone downhill in quality of care in this country ever since then because people don't have to be responsible for the decisions they make about medical necessity." Gradison objected, "[T]o say that the quality of health care has deteriorated in the United States since 1974, which you just said, is patent nonsense." Norwood responded that since 1974, many people in rural areas have seen local health facilities close, requiring some to travel long distances for care. "That's not what I call good emergency care, and that is not improvement in health care," he said.
Norwood noted that under his managed care regulatory bill, the U.S. Labor Department "would oversee those part[s] of health plans that fall under" the ERISA statute, a fact he conceded "scares all of us to death [because] we'll have to let" Labor Secretary Alexis Herman "work out some of the regs as to how" to implement PARCA. Gradison took particular exception to the enforcement provisions, saying, "Your plan, which I read very carefully, would have the Department of Labor make a determination, a bureaucrat, make the determination whether the [health plan] facilities are conveniently, appropriately located in relationship to where people work and where people live. And I submit to you that that's a decision far better made by the people involved and by the institutions that are offering these plans. If there's a market closer to home, that market's going to be filled" (2/5).