(5 of 5)
Last year 35 states passed 56 laws to "regulate or weaken HMOs," according to Thomas Bodenheimer of the University of San Francisco School of Medicine. Women in Government, an organization of state legislators and appointed officials, is coordinating efforts to go further this year. It has drafted a model Managed-Care Consumer Protection bill, which has been introduced in Colorado, Georgia, Kansas, New Jersey, Ohio, Oregon, Tennessee and Texas; Alaska and Delaware are next. Some provisions: a ban on gag rules, easier patient access to specialists, guaranteed "access to all FDA-approved drugs."
Alixe Glen, spokeswoman for the blue Cross and Blue Shield Association, decries "legislation by anecdote that leads ultimately to bad policy." And there is a more fundamental reply to the backlash: for all its faults, managed care has contributed to a stunning reduction in medical inflation.
In the late 1970s and early '80s, medical costs were rising at a rate that straight mathematical projection indicated would eventually consume the entire gross national product. Last year medical costs rose a piddling 2.5%, less than the 3.3% rise in all consumer prices. That could not have been done, say HMO executives, without such crackdowns as those much hated limits on hospital stays.
Well, maybe. But the co-payments that most HMO patients make when they visit doctors have been rising, offsetting some of the savings on premiums. Premiums are going up again too, raising suspicion of a devil's bargain: ruthless restrictions on patient care and higher costs as well.
Moreover, people who can see only a choice between tough limits on care and renewed medical inflation may select a drastic third option. In a poll conducted by the nonpartisan National Coalition on Health Care, 80% of respondents said they believed the quality of medical care is often compromised by insurance companies to save money. And 69% thought the Federal Government could play an important role in making health care better and more affordable. If public anger grows, the future of health care may be determined by political emotions and government intervention, rather than by a marketplace competition that offers consumers more attractive choices.
--Reported by Sam Allis/Boston, John F. Dickerson/Washington, Cathy Booth and Jeanne McDowell/Los Angeles, with other bureaus