Patient protection has overtaken sex, scandal and the Internal Revenue Service as the nation's most potent political issue.
And the action is bound to get hotter and heavier now that both parties have introduced viable legislative proposals. Not only will managed-care regulation dominate debate on Capitol Hill, it's likely to play a major role in determining winners in the November congressional elections. The outcome also could set the tone for the direction of healthcare delivery in the 21st century.
Despite the complexity of the issue, healthcare providers should take an intellectual stand so that staff, the media and patients are clear on the benefits and drawbacks of government regulation.
When it comes to healthcare, nobody wants to say no. That's especially true in a time of economic plenty. But there was a time when employers were determined to slow the upward spiral of medical costs. They turned to managed care to perform the dirty deed.
Now, federal and state governments are using the same strategy for their budget-busting Medicare and Medicaid programs. With managed care taking root in public health programs, politicians curry favor by whipping the whipping boy. Not only is managed-care bashing convenient, it's virtually risk free.
At its best, managed care slows spending by carefully monitoring and evaluating healthcare utilization. Even then, providers and patients find it suffocating. But HMOs have further darkened the picture with a series of misguided coverage decisions, ill-advised policies and mystifying public relations blunders. Rules and regulations are coming; it's just a matter of timing and extent.
While the American Hospital Association was correct to prefer a private-sector solution to protect patients' rights, the issue has moved far beyond free-market philosophy. The AHA's implicit support of the House Republican task force proposal is a vivid example of the odd linkages forming over managed-care regulation. The AHA, which typically sides with the Democrats, has come out in favor of the Republican House plan, while the American Medical Association has joined forces with the feared trial lawyers in supporting the more onerous Democratic proposal.
As far as the private-sector solution, look no further than the recent policy decision by the American Arbitration Association to halt participation in mandatory arbitration programs. An AAA spokesman told the Wall Street Journal that the group is opting out of mandatory arbitration because "with a consumer it might be a computer or a house that's at stake, but here it's someone's life." Even people trained and paid to make tough calls don't want to make those kinds of decisions.
But providers have to make them every day. As community leaders, healthcare executives should carefully provide facts that help patients overcome their confusion and anxiety about managed care. Hospital managers are especially well-positioned to conduct civilized debate on the issue. Above all, they should argue against allowing patients to sue health plans. Opening more doors for trial lawyers is neither progressive nor protective reform.