Patients of health maintenance organizations are falling victim to the system. Under pressure to meet insurance quotas, doctors are denying patients access to expensive drugs and hospital stays. The quality of care suffers under the strict budgets, and it is time for Washington to pass federal legislation to give patients a way to combat the policies of money-driven HMOs. Both Democrats and Republicans in Congress have designed bills that give patients new ways to protest against HMO giants. Neither bill manages to provide a complete solution for patients, but the Republican plan allows HMO patient disputes to be settled out of court.
The Democratic proposal includes a measure allowing patients to sue not only HMOs, but also the employers that provide their health care plans. The Republican plan does not allow for litigation against HMOs. The effect of financial strain from the Democratic plan could actually penalize those who it is intended to protect. Many employers who provide health care are leery of the Democratic proposal, which HMOs predict could raise premiums by as much as 23 percent. If employers drop coverage because of increased cost and the threat of liability, many more Americans will be without health care.
The issue carries tremendous weight because a large percentage of Americans participate in the HMO system. Created as a response to rapidly rising medical costs in the ’70s and ’80s, HMOs offered the country a new form of medical treatment. Health care turned away from a system of treatment and direct billing and migrated under large HMO umbrellas. In this new system, doctors are accountable to the companies that employ them. HMOs have total control over patient treatment, often refusing access to specialists and expensive drugs. Stories abound of doctors who lie to providers to give their patients the treatment they need.
Patients have little recourse when denied treatment. In Minnesota, many angry patients turn to the state Department of Health, where three employees are responsible for investigating more than 500 health care complaints a year. Workers who use HMO plans like those provided by Dayton-Hudson and 3M have even fewer options. Plans provided by these Minnesota behemoths do not allow employees to complain to the health department. Their only recourse is to file a complaint with their employer or go to court.
The Democratic plan that allows patients to sue their HMOs and even their employers will not further the rights of patients. Premiums are sure to rise for most HMOs as litigation-happy lawyers bite into the health care giants, taking an average of 43 cents out of every settlement dollar. Republicans have the right idea when it comes to patients’ rights. Instead of litigation, the Republican plan calls for an independent medical expert to rule on patient complaints. This allows patients to present their cases to a medically informed mediator outside of the HMO system without dragging the health system into court. Neither plan is perfect, but Americans need to be protected by federal legislation. The GOP plan is at least a step in the right direction by addressing patients’ rights without incurring major costs.