Health care compromise

The competing health care bills in Congress share enough similarities that it seems inevitable they will eventually be shoved together in some fashion — if members of Congress can decide what to do about liability for HMOs. One answer may please neither side but could work anyway.

Having given up on any sort of comprehensive plan to increase access to health insurance — 41 million Americans lack it — Congress has instead contented itself with legislation that would limit the ways HMOs deny care to consumers. Some of the provisions in the bills — and there are plenty of good and necessary ones — would require insurers to pay for emergency care, remove restrictions on communication between providers and patients and limit the disbursement of genetic information. A major sticking point is whether patients would be given the ability to sue HMOs for improper denial of medical coverage. Democrats want it; Republicans, generally, don’t.

The arugment against letting patients sue is that it will drive up costs, which get passed on to businesses and individuals, and result in even more people being unable to afford health insurance. Better, Republicans argue, to use an independent doctor to hear patient appeals on coverage and rule immediately — getting patients the care they deserve and keeping down litigation.

A person who disagrees with that is Daid Sibley, a Texas state senator who recently identified himself in an commentary in the New York Times as “a lawyer, a board-certified oral and maxillofacial surgeon and a conservative, pro-business Republican.” Dr. Sibley’s view is important because he was part of the legislature that made Texas the first state in the nation to give its citizens the right to sue their HMOs in state court if they are improperly denied treatment.

His conclusion on the potential for litigation adding costs to the health-care system? “In Texas not a single lawsuit has been filed against a managed care plan since the law took effect Sept. 1, 1997. The law has actually diverted lawsuits and saved patients’ legal costs.” One of the reasons for this that the Texas law requires an independent review of patient appeals on decisions made by managed-care plans; about half of those where partially or completely overturned by the review.

In Congress, a combination of the GOP’s version of the swift independent review and the Democrats’ liability provision presents a compromise that better ensures complete care while preventing the current practice, as Dr. Sibley puts it, in which, “HMOs deny care, save money and they let others fight it out in court to see who pays for their negligence.”

Given that any serious attempt at getting universal coverage is impossible this session, such a compromise could get some important reforms passed and better care for those fortunate enough to have insurance.