Health-Care Landmark

April 09, 1993

Chalk one up for the public. Passage yesterday of Maryland's landmark health-care reform package would not have been possible without the widespread public concern over the high cost and inadequacies of this state's medical delivery system. The package enacted in Annapolis is far from perfect, but it gives Maryland a giant head start on the health-care changes that are likely to come from Washington later this year.

In a sense, legislators are taking a chance that some of these steps will save consumers money and also give Marylanders better medical care. No one knows, for instance, whether the plan to analyze and cap excessive medical charges will work. We do know, though, that a somewhat similar state plan aimed at curbing hospital costs has worked exceptionally well for over 15 years. But this latest effort is far more complex.

We do not know whether the plan's limitation on the use of out-of-state expert witnesses will curb the explosion of medical malpractice cases. It might even backfire, denying legitimate claims against influential local doctors. The legislature was taking a shot in the dark on this one.

The main sections of this plan, though, hold considerable promise. Small businesses should find it easier and more affordable to obtain a basic medical package for workers. This should go a long way toward giving health-care coverage to a large percentage of the 600,000 Marylanders who are now uninsured. The required basic insurance package should create a more competitive insurance climate, too.

Since premiums will be based on the health-care experiences of an entire community, many small-business customers should see declines in their insurance premiums. And if this works well among small businesses, larger companies can opt in at a later date.

Setting up a data-collection commission, with the power to cap medical fees in extreme cases, is a crucial element of the package. Only by examining and analyzing all fees charged by physicians, pharmacists and medical offices can we know for certain if the amounts being billed are reasonable or outrageous. The pressure on doctors to keep their costs down will increase as this state commission gears up for action.

Del. Casper R. Taylor of Cumberland deserves special credit for helping to craft and push through this complicated and controversial bill that drew the ire of so many powerful special interests. He was determined to heed the public's demand for sweeping health-care change. He has succeeded.

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