The American Medical Association last week called for insurers to fully disclose their coverage terms to consumers and said physicians should not be barred from participation in health plans for economic reasons.
The wide-ranging proposal, dubbed the Patient Protection Act, would require health plans to:
Give physicians a voice in medical policymaking and the establishment of quality-of-care criteria.
Provide consumers with a list of covered and excluded services.
Offer three insurance options, including traditional fee-for-service, and give patients the option of seeing a physician outside the plan.
The plan also would bar insurers from excluding physicians from a plan "for giving patients the care they need."
The heart of the AMA's message was that gigantic, coldhearted managed-care and insurance companies will control all healthcare in a reformed system. Their proposal is designed to ensure that economic security and physician control are components of any health reform plan Congress enacts.
"If we don't keep the health plans honest, some anonymous clerk sitting at the end of a 1-800 number is going to take over for your doctor," warned Lonnie Bristow, chairman of the AMA.
"Patients, families, the physicians who care for them-we all need protection before the big money-makers take over the healthcare system, leaving patients with fewer choices and less control over their healthcare treatment decisions," he said.
But critics of the AMA campaign charged the organization with pursuing its own interests.
Richard Coorsh, a spokesman for the Health Insurance Association of America, said the proposal "appears to be an attempt by the AMA to push for full employment for physicians, to the detriment of consumers." He referred to the provision of the proposal that would prohibit health plans from taking costs into consideration when making decisions on physician contracting.
The objective of managed care is to create "incentives for high-quality care at the lowest cost," Mr. Coorsh said. Like every other industry, healthcare has been affected by economic concerns, he added. But the AMA leadership wants legislation to assure physicians that they'll be "protected from these considerations."
The AMA proposal did win support from Sen. Paul Wellstone (D-Minn.), who said he would introduce some of its elements as amendments to the health reform plan being drafted by the Senate Labor and Human Resources Committee.
"People, consumers and doctors alike are unhappy, frustrated and frightened as a result of the merger of giant insurance plans that have left the healthcare market in the hands of an oligopoly," he said.