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Rosenfield on Health Reform

August 09, 1994

The column ("Reform Has Been DOA Since Day One," Commentary, July 29) on health-care reform by Harvey Rosenfield contains serious factual errors regarding the role of Health Net in a lawsuit involving the denial of coverage of an experimental treatment for a patient suffering from an advanced stage of breast cancer.

Health Net is second-largest health-maintenance organization in California. The company's 23,000 physicians and 360 hospitals serve more than 1 million Californians. Our success is a direct result of the high-quality medical care our members receive.

Health Net does not and could not pay its managers bonuses or allow its physicians to receive personal financial gain by denying patients requests for medical coverage. Such behavior would be a violation of state law.

Secondly, the plaintiffs never contended--nor will the facts support such an assertion--that Health Net's decision regarding coverage has any bearing on the patient's eventual death. The treatment sought by the patient was not delayed.

Autologous bone-marrow transplants have been successful in the treatment of some forms of cancer such as leukemia, but the procedure is still considered investigational in the treatment of advanced stages of breast cancer.

Rosenfield's disregard for the facts merely abets the campaigns of various special-interest groups to conceal from the public the real facts: Of all the health-care reform models being discussed today, HMOs are the only one that is already working. Here in California, one out of three people is covered by an HMO.

ROGER F. GREAVES, Chairman

Health Net, Woodland Hills

Rosenfield's health-reform diatribe contains numerous blatant inaccuracies and not one constructive suggestion for reform.

Rosenfield says California's Medical Injury Compensation Reform Act (MICRA) "caps the amount of compensation a jury may award to a malpractice victim." MICRA only caps awards for pain and suffering at $250,000. There is no limit for the amount that can be awarded for actual damages.

Rosenfield contends that research data shows MICRA hasn't lowered malpractice premiums for doctors or health-care costs in California. The truth is, MICRA has a far more dramatic effect on malpractice premiums than Rosenfield's Prop. 103 has had auto insurance rates.

Despite 20 years of inflation, California doctors today pay malpractice premiums that are approximately one-half of what insurers were proposing when MICRA was passed in 1975. California has the lowest cost malpractice insurance of any urban state and doctors across the nation view MICRA as a model for malpractice tort reform.

The most reckless of Rosenfield's untruths is his statement that MICRA's "single effect has been to enrich insurers and allow dangerously doctors to escape justice." Actually, the opposite is true. Most of California's doctors currently buy their malpractice insurance from five companies formed by doctors as a result of the malpractice crisis in 1975. As chairman of the board of one of those companies for eight years, I can say absolutely that these doctor-owned firms are committed to using profits to return premiums to doctors and to lower rates.

While the AMA and the CMA have been pursuing health reform for nearly a decade, Rosenfield cynically suggests that we scrap all efforts this year and start over next year with a reform plan "that puts consumers first." According to UCLA, 2.6 million people in our county have no health insurance. Our uninsured rate is a third higher than California's and nearly twice as high as the rest of the nation. We have more to lose through inaction than anyone else.

ROBERT KARNS MD, President

Los Angeles County Medical Assn.

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