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Senate Should Put Patients, Not the Big Insurers, First

October 10, 2000|D. TED LEWERS | D. Ted Lewers, MD, is chair of the American Medical Assn.'s board of trustees

Twice in the past year, a narrow majority in the U.S. Senate voted against a patients' bill of rights designed to protect Americans from managed-care abuses. Instead, the Senate passed, with a one-vote margin, legislation that might be more aptly named "The HMO Protection Act."

There is still time for this Senate, in this Congress, to give patients the protections they deserve. The American Medical Assn. believes that a majority of senators would vote to pass a real patients' bill of rights if the Senate Republican leadership would allow the bill to come to a vote.

The House already has passed such legislation by an overwhelming bipartisan majority. But while the Senate sits on the bill, almost 50,000 patients per day have their health care delayed or denied because of problems with their insurance companies.

So why won't the Senate follow the example of the House? Why has meaningful patient protection legislation been allowed to languish in the Senate when four out of five registered voters support the bill, as do both our presidential candidates?

The answer: Big insurance. The industry has spent more than $100 million to kill patients' rights legislation. Health insurance executives making more than $10 million a year do not want to pay for medical tests that might lower profits. And they do not want to be held accountable either.

The Senate should not be dissuaded by flawed arguments from an insurance industry that is putting corporate profits ahead of every patient's fundamental rights. We challenge the Senate Republican leadership to drop threats to use partisan delay tactics and to bring this legislation to a vote immediately. Patients deserve legislation that will:

1) Ensure physicians--not bean counters--make medical decisions;

2) Give patients an independent, timely appeals process if care is delayed or denied;

3) Hold health plans accountable when their decisions harm patients.

All that stands between patients and these fundamental rights are myths about cost, litigation and liability.

The HMO lobby asserts that patient protections will increase costs and cause the ranks of the uninsured to swell. These "Chicken Little" scare tactics attempt to obscure the strong evidence against such claims that can be found in the health care market itself. A Kaiser Family Foundation study reported that insurers raised premiums by 8.3%--the largest increase in premiums in seven years--yet the percentage of employers offering health benefits has actually increased.

Further critical evidence comes from newly released figures from the U.S. Census Bureau, which show the number of uninsured Americans declined despite a two-year rise in average health insurance premiums.

The insurance industry also predicts a litigation explosion. But in the eight states, including Texas, that permit patients to hold health insurance companies accountable, only a handful of cases have been filed. The vast majority of disputes would be resolved through an independent external appeals process.

However, if HMOs choose to ignore the findings of external reviewers, patients must have the right to legal recourse.

Opponents of patients' rights also argue that holding HMOs accountable will expose employers to liability. Some suggest that employers would drop employee health insurance coverage for fear of being sued. This is a red herring. The House bill protects employers from liability risks, unless the employer makes medical treatment decisions. Since the majority of employers do not make these decisions, the risk to employers is negligible.

A patients' bill of rights would help to restore faith in our health care system and demonstrate that Congress can legislate, and not just debate, health care issues. All that is required is for the Senate to muster the will and commitment.

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