PATIENTS’ RIGHTS: Panel Divided On Denied-Care Issue
President Clinton's advisory commission on health plan quality was unable to reach consensus yesterday "on ways to compensate patients who suffer harm when their managed care network or other health plan denies them treatment." The Los Angeles Times reports that the panel's "impassioned debate" over this issue -- "which some believe is the single most important right that patients ought to have" -- is a "stark contrast to their consensus on the general patients' 'bill of rights' that they presented to Clinton in November." Failing to come up with definitive answers, the panel did "agree on a statement noting that compensation of victims is a problem and that they should present options to the president for dealing with it." According to the Times, such options "might include allowing patients to sue health plans under state malpractice laws or changing" the federal Employee Retirement Income Security Act, "which limits compensation to the cost of the benefit denied." But some of the commission's 34 members "were leery of going even that far."
Crux Of The Issue
Employers and insurers argue that allowing patients to sue their health plans over treatment denials would cause costs to "skyrocket." But Nan Hunter, a professor at Brooklyn Law School and a commission member, said, "People don't realize how vulnerable they are until they are at the point of severe illness and are denied preauthorization for a treatment that they need. ... Denial of authorization has become denial of treatment -- it's the single most important issue for health care consumers."
"The commission's failure to deal with the controversial question ... leaves Clinton on his own to decide whether patients ... should be able to sue their health plans," the Times reports. One administration official said, "We never expected consensus on this issue but look forward to seeing viable options for the president and the Congress to consider." The official said the administration is also waiting to see what Democrats in Congress include in their patients' rights proposals. The Times reports that House and Senate Democrats "are planning to include a provision allowing patients to sue health plans under state law." The panel's "final report on how to improve the quality of health care and consumer protection is scheduled to go to the president March 30" (Rubin, 2/26).