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In a medical crisis, you want decisions to
be made by your doctor and your family. You don’t want to have to
argue with an HMO over whether they will allow your child to go the emergency
room…or whether your elderly parent is allowed to see a specialist.
In 1997, determined to put a stop to HMO horror stories, Missouri Governor
Mel Carnahan signed one of the most comprehensive
HMO consumer protection laws in the country.
The insurance lobby vigorously opposed the Missouri law—just like
they now oppose the Patients’ Bill of Rights under consideration
in Congress. They said many Missourians would lose their health coverage.
They were wrong. In fact, the number of people with insurance increased.
They predicted a flood of lawsuits. Wrong again. There has only been one
lawsuit under Missouri’s patients’ rights law. That’s right—one.
The Missouri law has become a model for national HMO reform efforts. But
not everyone in Missouri is covered by our HMO law. And many states have
no protections at all. That’s why this year the U.S. Senate passed
the McCain-Edwards-Kennedy bill—a Patients Bill of Rights that will
protect all Americans.
The House of Representatives has passed a weaker
alternative. In fact, the House bill would actually weaken Missouri’s
Patients’ Bill of Rights. There are other significant
differences between our two proposals. On every major issue, they side
with HMOs and we side with patients.
Our bipartisan plan prohibits doctors from being rewarded for denying
care. Theirs doesn’t.
Our plan guarantees access to breast cancer treatments. Theirs doesn’t.
Our plan gives you access to a fair, independent review by a medical professional
when you’re denied care. Theirs doesn’t.
Our plan protects all Americans who have insurance. Theirs doesn’t.
Most importantly, our plan holds HMOs accountable when they hurt patients.
Theirs doesn’t.
The Patients’ Bill of Rights has been debated for five years. It’s
time to agree on a bill with strong protections
for patients like McCain-Kennedy-Edwards.
Jean Carnahan is a United States
Senator from Missouri.
She can be reached in Washington, D.C. at 202.224.6154
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Special interests and their policymakers
have spent large amounts of time and money to convince Americans that
suing their health plans will bring better health care. Yet, as recently
as last month, polls indicated that most Americans believe that access
and the problem of the uninsured were more important than lawsuits. Even
in a poll of physicians, three out of four said that independent appeals
processes are a better way to resolve health-care disputes than litigation.
Proponents maintain that the “patients’ bill of rights”
addresses key issues, such as open access to specialists and review of
denial of coverage decisions. But health plans already have provided easier
access to obstetricians and pediatricians across the board. And, in Missouri,
patients can request an external review of health-plan decisions by independent
physicians who can resolve patients’ issues in as few as 72 hours.
No lawsuit could get results faster than that.
Managed-care health plans have improved the quality of care by providing
more opportunities for preventive health measures through coverage of
cancer screenings and cardiovascular risk assessment and care. And none
of those improvements were mandated by the “patients’ bill of
rights.”
Right now, access to quality health care eludes more than 40 million Americans.
Focusing on ways to punish HMOs for perceived shortcomings in health plans
does nothing at all to alleviate this crucial problem. Moreover, encouraging
patients to sue their health plans only promotes defensive medicine, increases
costs and creates more people who are uninsured.
We need public policy that is positive—like tax credits for the purchase
of private health insurance. Let’s give the public what they really
need. Let’s give them the true “patient right” of affordable,
quality health care and abandon the goal of dragging every HMO out of
the health-care system and into the court system.
Catherine R. Edwards, Ph.D., is
the Executive Director of the Missouri Association of Health Plans (MAHP).
She can be reached at 573.556.6552 or at moahp@earthlink.net
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