Like motherhood and apple pie, protecting consumers from the tightfisted scoundrels running the nation's managed-care plans has a wholesome sound.
Undoubtedly, many physician executives would applaud efforts by the federal government to rein in unscrupulous managed-care plans, which they view as their nemesis. But as is often the case with efforts to revamp our complicated healthcare system, the reality may be quite a bit different from the expectations. Efforts by fear-mongering politicians to legislate quality could end up costing a great deal of money and harm medical organizations in the process.
The scenario that's unfolding in Washington is fairly familiar. Congress, prodded by President Clinton, wants to pass a "bill of rights" to protect consumers from health plans. What's different is rare bipartisan unity in response to anecdotal tales about HMOs that enroll individuals and then unfairly deny them care. While such anecdotes are legion, it's hard to pin down the extent to which horror stories about gag clauses and denied treatment represent a true picture of managed care.
We believe Congress is taking the wrong approach. Sadly, members appear to have forgotten the lesson of the Clinton healthcare reform debacle of 1994. After an ill-fated effort to pass unbelievably complicated legislation, the healthcare industry has worked to transform itself from a fragmented, high-cost system of variable quality to a more coherent and cost-effective quality mechanism.
So why not give managed care the same opportunity to reform itself-with the clear warning that failure of the industry to act quickly will lead to harsh action by the government? The President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry can serve as a road map for providers, insurers and patients.
The heavy-handed approach runs the risk that politicians will craft a cure that is worse than the ailment. With congressional elections less than a year away, politicians won't be talking about cost and quality problems in the old-fee-for service health system. They'll be whipping up the voters by posing as the defenders against HMO abuses.
Clearly, the nation can no longer afford a medical-care system that wastes huge amounts of money. But government meddling isn't going to lead the way to cost-efficient, high-quality medicine.
That will occur when clinicians and other devoted leaders find ways to utilize data gleaned from computerized medical records, expand protocols to guide diagnosis and treatment, and help patients manage their own health problems through Internet-based decision support systems.
It will result from industrywide efforts to reduce errors aided by improved information systems. From disease management programs that promise improved strategies for patient care. And from the elimination of unneeded or questionable treatments.
It would be a shame for the government to thwart such unfolding efforts.