Question: Democrats and Republicans in Congress promise to pass some sort of patients' rights law before this fall. Which version is preferable, the president's Patients Bill of Rights or the less-encompassing Republican plan?
Bonnie Erbe: This is one issue where both parties offer good ideas, and on which both are responding to the will of the people. A recent ABC News poll showed 62 percent of Americans agree health care will be a decisive issue in the November elections. With the economy strong and Washington seeming to matter little in the lives of most Americans, the health care issue is one where Washington can make a difference and have an impact.The public clamor for health care reform comes from the proliferation of HMOs and managed health-care plans. Health-care providers have adopted sneaky and obnoxious habits of routinely denying all sorts of coverage, even when consumers have followed time-consuming pre-authorization procedures in advance (present company included). In addition, many HMOs routinely deny patients access to specialists, even when primary care physicians have recommended it.
Women, for example, are more likely to use obstetrician-gynecologists as primary care physicians. And yet many insurers refuse to cover visits to an ob-gyn without preapproval by a gate-keeper general practitioner. The Democratic plan, the House Republican plan and the Senate Republican plan all offer women the right to go straight to an ob-gyn.
The main difference between the two parties' plans is whether consumers who feel they have been gypped by their insurers have the right to file a lawsuit. Republicans would prefer consumers appeal adverse decisions in-house. But that gives consumers no real muscle. Lawsuits may be costly, but they are the only thing HMOs and insurers truly fear. Without the right to wage legal warfare, or even more importantly, the right to threaten to go to court, consumers may as well sit back and allow themselves to be raped by greedy medical and insurance providers.
Josette Shiner: Many Americans have suffered under a "one-size fits all" system of health maintenance. When our loved ones are denied care by bureaucrats instructed to cut costs, it is understandable that our national leaders feel pressure to find solutions. But throwing more federal regulations into the gears of America's HMOs is not the solution.
Both plans help patients understand their rights when dealing with managed-care institutions. And both plans establish an appeals process for resolving coverage or treatment disputes. But there are crucial differences in achieving these goals.
The president's plan has the courts - and trial lawyers - conducting appeals rather than the independent review panel called for in the Republican plan. The cost of this litigation alone could raise the cost of the average policy by as much as 8.6 percent. The president's plan would also create 359 new federal mandates, 3,828 new federal bureaucrats, $155 million in new federal spending and 59 new sets of federal regulation, according to a recent study. President Clinton's solution - creating more rules, mandates and regulations - only helps build a health-care system dangerously out of touch with individual needs.
How bad is the "health care crisis" the president keeps harping on? In a Hart Research poll of Americans released this week, 35 percent said "improving education" should be the president's top priority, while only 9 percent pointed to "regulating HMOs." Americans understand that our health-care system is the envy of the world; too often, our public schools are an embarrassment.
Long ago, the president made it clear that he would achieve his goal of a massive, national health-care bureaucracy "one step at a time." Republicans should block this latest step. Where there are defects in the system, we should use the successful reform of welfare as a model. We should shift authority to the states and let local authorities tailor HMO regulation to their specific communities and needs.