Health - Patients' Bill of Rights

Patients´ Bill of Rights

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Which Way on Managed Care?
July 17, 1998

Washington Post Editorial

THE PRESIDENT and Congress are in a position to perform an important service with regard to managed care. They can help to make a useful industry more so -- or they can squander the opportunity by turning the issue into a prop for the fall campaign. That's the threshold question as they begin debating how to regulate this industry, which is itself a kind of regulator of health care: Do they legislate seriously, or do they try, both parties, mainly to score political points? With not that many legislative weeks remaining before they adjourn, it isn't clear what the answer will be.

Managed care just now is the principal instrument in the society for controlling health care costs. It is not a miserly function. The less the society can safely spend on health care, the more it has available for other purposes, the lower the cost of care and the greater the general access in that more people can afford it. The trick is to keep the process from going too far; a balance needs to be maintained, so that the pursuit of savings doesn't encroach unduly on the quality of care. The so-called patient's bill of rights that the president and others are urging on Congress is an effort to achieve that balance. Our sense is that, in the end, done right, the regulation will strengthen the industry that is resisting it.

The problem is that passing a balanced bill is not what everyone has in mind. Some Democrats would rather have the issue. They would love nothing more than to be able to say to the voters this fall that the Republicans killed a bill to protect sick people from accountants. Some Republicans likewise would be just as happy to have no bill, so long as they could avoid the blame. They're averse to the regulation; their goal is to seem to be in favor of a bill just strong enough to bear the label of reform and weak enough that the Democrats vote it down.

In fact, this one shouldn't be that hard. There are some pretty basic ground rules that ought to be set, and will do no harm, particularly since the industry claims already to abide by most of them. Patients should be fully informed not just about the benefits of health plans but the limits on benefits and the costs. Plans should be required to disclose whether they are paying doctors or other providers according to the money they save. A plan should have enough doctors available, including specialists, to meet its patients' needs; should not be allowed to gag its doctors, in the sense of forbidding them to discuss expensive treatment with patients; should be required to pay for reasonable emergency care; and should have to maintain an appeals system, first internal, then external, in cases where care is denied.

Senate Republicans, in the bill they laid out this week, would provide only some of these basic protections, and for only some plans. That's wrong, a kind of false economy; they ought not be so chary. Senate and House Republicans also have in their bills assorted tax breaks and other favors for particular constituencies that Democrats rightly resist and that ought to be dropped; the bill is complicated enough as it is. Democrats, meanwhile, are insisting that patients claiming to have been harmed by the denial of care be allowed to take their insurers to court. We think that, too, should be dropped for now. The less litigation the better; first see if a vigorous appeals process can be made to work.

They can put together a decent bill if they want one, though there's not a lot of time left. The question is whether they legislate or posture.