New Signs of Life for Patients' Rights

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HMOs are bundling up for what could be a long, cold winter. On Monday, California’s Governor Gray Davis made his the third state to allow patients to sue their managed care plans for failing to provide adequate care. Along with legislation recently enacted in Georgia and Texas, California’s new law wrenches much medical decision-making from the grip of HMOs and hands it back to the patients and their doctors. In most states, HMOs are protected from liability in cases where treatment is withheld or delayed in the interest of economy –- although if congressional Democrats, led by Sen. Edward Kennedy (D-Mass.), prevail in upcoming policy debates, the insurance companies’ medical decisions will be fair game. Fierce anti-HMO public opinion and the AMA’s fat checkbook are making patients’ rights more politically attractive than ever, and despite concerns that opening HMOs to expansive (and expensive) litigation would raise insurance costs, preliminary data from Texas shows virtually no increase in the number of medical lawsuits since that state’s new law was enacted.

These state laws, and the surrounding controversies, run parallel to the national debate on health care: Next week, when the House of Representatives opens what promises to be a heated debate on managed care and the scope of patients’ rights, watch for newly disenfranchised physicians to join forces with powerful –- and unlikely –- political allies. The Wall Street Journal reports that many physicians, fed up with their corroding autonomy, are turning away from their Republican roots and appealing to a new group of allies: liberal Democrats. While politics and medicine have coexisted since the dawn of modern insurance policies, the stranglehold of each on the other has never been more evident than it is today. Not so many years ago, money-hungry doctors were seen as plundering American wallets, and Democrat-friendly HMOs were perceived as the last line of defense for the poor and the working-class. Oh, how times have changed. Doctors, once the most privileged of American workers, now face plummeting incomes and diminishing control over their practices. HMOs, virtually omnipotent in many states, hold the purse strings, and the IVs –- health plans’ accountants exercise more control over medical treatments than some doctors. Hey, M.D., M.B.A. –- what’s the difference?