The managed-care industry has only itself to blame for the public backlash that has fed the desire of many on Capitol Hill to pass broad patient protection legislation.
Still, physicians should remember an old maxim as Congress attempts to reach agreement on a "bill of rights" for patients: Be careful what you ask for.
Organized medicine has been a major force behind approval of strong House legislation to expand rights of patients in dealing with health plans, including the unrestricted right of consumers to sue over treatment denials.
But adoption of the House version of the patient protection bill by the full Congress would be ill-advised. Such a law could open the door to frivolous liability lawsuits, involving medical practitioners in defensive maneuvering to avoid costly judgments. Furthermore, if employers decide to avoid the financial expense and legal exposure and drop coverage or increase employee contributions as result of the legislation, the number of uninsured could grow, which would be a public health tragedy.
Managed care became the dominant form of health insurance in the nation because employers and other payers were frustrated by out-of-control medical costs. For most enrollees, managed care provides good care at reasonable cost. But the public outcry about treatment denials and physician frustration over stingy payments and micromanagement has left Congress with little choice but to act.
Fortunately, a conference committee will work to reconcile the House bill with more modest legislation passed by the Senate. Here is a chance to come up with compromise legislation that requires individuals to seek mandatory external review of contested HMO decisions by a third-party before litigation can be initiated. Such legislation should also include caps on punitive damages.
Such compromise legislation can help assure patient protections and provide inducements for greater HMO responsiveness to consumer and physician concerns. By favoring this approach, medical leaders may find that although they may not get what they want--they'll get what they need.