You don't need a weatherman to tell you which way the wind is blowing. And you don't need anybody to say you need an ear doctor if your ears hurt or to see a heart doctor if your chest aches
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HMO'S and managed care companies say you can't make those decisions.. You need permission. And if some bean counter at your HMO denies your right to go to these specialists and your sickness is aggravated as a result, forget it. You have no right to sue.
Your ability to see specialists and to sue your HMO are part of the "Patients Bill of Rights" which is being hotly debated in Congress. The Democrats generally support these "Rights" and Republicans mostly oppose them because insurance costs will sky rocket and cause employers to drop their employee coverage.
They' re both right.
Let's take a trip down memory lane. Some ten years ago when medical bills were rising rapidly, big corporations began to look for ways to rein in this expense. Remember when car manufacturers said that each car costs about $600 more because of health benefits.
About this time HMOs and managed care insurance became popular. They promised these corporation chiefs that they could provide health care for their entire work force for a fixed amount of money. They would decide what was medically necessary, what surgeries were needed, how long an employee could stay in a hospital and so on. The old "fee for service" by physicians would be out. The new way would be prevention and denial of unnecessary procedures.
The HMO's could pocket the savings. Profit incentives for medical care was turned on its head. Shorter hospital stays, less surgeries, fewer tests, denial of specialist care, meant more money for the HMO.
One story going around at the time was that a much heralded head of an HMO, who was earning some $10 million a year, died and went to heaven. This CEO was famous for cutting hospital stays from an average of five days down to two. St. Peter welcomed him at the gate and told him that he had good news and bad news. He showed the CEO around heaven and all the luxury there. The exuberant CEO said this is really good news. "What's the bad news?" he asked and St. Peter answered, "The bad news is that you can only stay two days."
The HMOS have done the job they were asked to do. They are holding down health costs. They've paid a huge price. On a popularity scale they rank below politicians and used car salesmen.
Sen. Hillary Clinton must be thanking her lucky stars. All this venom being heaped on HMOs, all the horror stories of denial of care, would now be heaped on Hillary's government- run HMO system she tried to pass back in 1993.
Today's patients' rights bill is just a thumb in the dike against the flood of abuses of managed care. But the Republicans are right---health care costs will shoot up. More and more employers will find they can't afford coverage. Since the system is voluntary, they drop out and even more Americans become uninsured.
I'm pulling for passage of the "Patient's Bill of Rights" not only because it helps the little guy but also because it hastens the day when the only sensible solution will become obvious to all-the single payer system. This Canadian and Medicare style solution had more than 100 co-sponsors in 1993, including our Congressman Frank McCloskey. It was never given a fair hearing because the Clintons were afraid of losing corporate support which they lost anyway.
Today some 43 million have no health insurance. Savings from the efficiency of single payer, because it is universal, will pay for covering the uninsured with no increase in overall health care costs. The Canadians and Europeans have shown us how.
Won't it be nice to just show your card to get healthcare? I mean everybody.
