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'Patient Protection' Is Policy Malpractice

November 1, 1999

Patient protection. Public opinion supports it and politicians claim to be its champion. Now both houses of Congress have passed different bills to advance the noble-sounding cause. Many are already celebrating their expectant victory.

stethoscope and insurance docs

Patient protection. Public opinion supports it and politicians claim to be its champion. Now both houses of Congress have passed different bills to advance the noble-sounding cause. Many are already celebrating their expectant victory.

Meanwhile, advocates of a national health care system slyly wink at each other, knowing they have scored another victory. The stage is set for another major assault on independent, free market, and charitable medicine. All it took were two little words dangled before a desperate public: patient protection.

The move to nationalize health care has gone so smoothly. First, the nation was enticed to believe the Clinton plan died a sure death in 1994. Then, bipartisan measures in 1996 advanced national medical databases, electronic medical records, computer chip smart cards, and police power over doctors, all under the guise of promoting insurance portability and Medical Savings Accounts. Measures to expand Medicaid into the middle class, limit care for nursing home residents, and encourage senior citizens to enroll in HMOs were quickly enacted in 1997 as part of a children's health insurance bill. (After all, who can say no to kids?) Federal regulation of the entire health insurance industry is near at hand.

Even smart lawyers haven't figured out how harmful this latest bill will be to their future. Oh yes, they'll be sitting pretty with one-seventh of the American economy at their fingertips . . . for a while. Federal regulation of HMOs is a major move toward full-fledged public-private partnerships with HMOs (or as President Clinton prefers, "regional alliances"). Few lawyers have considered how difficult it will be to sue for health care claims, once most of the nation's health care services are provided by government-regulated (and -protected) HMOs.

The Problem Is the Solution?

HMOs are bad. Patient protection is good. Members of a frightened public--fearing the effects of being caught in a bureaucratic maze--clamor for patient protection. Unfortunately, too many believe they will obtain this from the recent legislation. Ignorant of the fact that it was Congress that first propelled the nation's patients into HMOs, the public now places its trust in this same body.

In 1973, Congress passed the HMO Act, forcing employers to offer HMOs. It also gave HMOs millions of dollars in federal subsidies, which they used to undercut the premiums of traditional plans. The hopes was that HMOs would eventually grow large enough to take over the market, and limit the cost of two government-run programs, Medicaid and Medicare. Over 25 years later, a few large HMOs have swallowed up much of the insurance industry, many smaller HMOs, thousands of hospitals and clinics, a great percentage of the employed public, Medicaid, and a growing portion of Medicare.

Much of the population has now been trained to grudgingly accept rationed health care practices, which include delays, limited access to doctors, and outside controls. In December 1997, the actuarial firm Milliman and Robertson concluded: "As more individuals who currently are covered by managed care plans retire, there should be less public disagreement on further changing Medicare to resemble a managed care system."

True Protection

The sick and injured know that true patient protection means a non-managed care option and open access to their health care dollars. Patient protection does not come from the right to pursue stressful, time-consuming litigation and outside appeal processes. Legal maneuvering--contacting attorneys, accessing supporting documentation, and arguing about medical necessity--will simply be another way that HMOs can delay payment, not a guarantee of protection.

Unless the public is free to choose a non-managed care option, the words "patient protection" are only black ink scratches on white paper. Patients must be free from tax policies that encase them in prepaid, care-withholding, managed care corporations, and they must be free from government-endorsed rationing under medical necessity definitions.

Unfortunately, Congressional leaders cannot and will not fix this system. They are counting on a few chosen HMOs to limit their Medicaid and Medicare expenses. So before a jubilant public bestows accolades on their self-proclaimed protectors, citizens need to realize that these two words hide a ruse worse than today's piecemeal protections. In this next step to fully advance government regulated managed care upon the public, the elimination of patient protection is all but guaranteed.

Public health nurse Twila Brase is president of Citizens' Council on Health Care.

For more information ...

New Era of Health Care Regulation. What are the effects of patient protection measures and other mandates at the state level? (American Legislative Exchange Council, December 1998, 9pp.)

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Health Care
Twila Brase is the president of the Citizens' Council for Health Freedom. @twilabrase