You can almost see it coming.
Managed-care horror stories are exploding in print and across the airwaves. It's just a matter of time until politicians in Washington and in the statehouses rise up to grab their own headlines and score political points by demanding more stringent consumer protections.
The legislative agenda hasn't blossomed yet, but clearly a backlash is developing against HMOs, previously the darlings of alternative healthcare delivery. Stories of patients facing life-and-death choices pitted against heartless health plans will attract politicians like honey attracts flies.
Remember the flap over "drive-through deliveries"? When hospitals started pushing out new mothers after 24-hour stays in response to managed-care pressures, legislators in nearly a dozen states introduced bills requiring a 48-hour maternity stay. At least four states have passed such legislation.
After getting clobbered by anecdotal accounts of service denial by greedy, unfeeling bureaucrats who muzzle conscientious physicians, the HMO industry is starting to counteract the recent negative media barrage. It's a tall challenge.
Simply pointing to high patient satisfaction data and obscure clinical evidence of quality among managed-care plans won't neutralize the heart-rending tales of treatment denied.
Facing a backlash about maternity stays, savvy hospitals, led by University Medical Center at Stony Brook (N.Y.), found ways to let new moms stay an extra 24 hours at no additional charge. Managed-care organizations need to be equally aggressive in responding to this challenge.
Medical directors of four large investor-owned HMOs last week faced the media in California and answered tough questions about what they called the myth of the gag rule, as well as about compensation, patient choice and quality. Similar efforts are needed in other cities. Managed-care proponents also must find physicians working in managed care who are willing to expound on managed care's advantages in improving quality and access.
And they must put a real face on quality. How could the public resist seeing a gaggle of healthy babies born as a result of improved prenatal care and diagnostic screening? How about finding a grandfather of four who avoided serious heart problems or a single mom saved from cancer complications because of preventive efforts by a quality-minded health plan?
Unless they fight fire with fire, managed-care organizations will be seen simply as a way to shift financial risk for medical decisions to gatekeepers and utilization reviewers whose goal is to restrict patient choice.