How Maryland Got Health Care Reform

CONFLICTING INTERESTS

May 23, 1993|By JOHN W. FRECE

Just as a groom's family usually sits to one side of the church and the bride's family to the other, so it was in the House Economic Matters Committee this past legislative session.

There, Chairman Casper R. Taylor Jr., a former tavern owner from Allegany County, spent the session trying to marry up the disparate parties of Maryland's health care industry in the hopes of producing an acceptable health care reform bill.

On most days, the insurance lobbyists sat on the right side of Mr. Taylor's hearing room, representing large and small commercial insurers, the state's two non-profit Blue Cross and Blue Shield plans and an assortment of health maintenance organizations (HMOs).

A bigger group sat to the left. They were the lobbyists for the "health care providers:" the state medical society; specialty physicians such as anesthesiologists, pathologists, emergency room doctors and pediatricians; dentists; nurses; the Maryland Hospital Association; the Johns Hopkins Hospital; pharmacists; drug manufacturers; psychologists; and chiropractors.

Hovering somewhere in between were the match-makers: representatives of the Chamber of Commerce, of organized labor, of small businesses, of insurance brokers and agents, the state health department and the staff of Gov. William Donald Schaefer.

Many of the parties didn't want to be there, but with so much at stake, none of them could take the chance of not being there.

In the end, it was a shotgun wedding. The two sides were pushed together out of (political) necessity, but essentially against their will.

Now, like so many expectant parents, the health care and insurance industries are nervously waiting for Gov. William Donald Schaefer to make the critically important appointments to the powerful seven-member commission that will implement the new health care reform law. A decision is expected this coming week or the next.

Had it not been for a fortuitous confluence of events, the marriage might not have come off at all. When the session started, hardly anyone thought such a union was possible. Many of the parties were happy going it alone; and some were afraid of what marriage might do to their free-wheeling ways. Others, however, saw the benefits of settling down to a more rational health care system.

Doctors agreed the high cost of health care was a problem, but said the fault was not theirs alone and that capping their fees would only drive physicians out of Maryland.

Emergency room docs, weary of being sued, pushed for a provision to protect them from malpractice claims, arguing that the mere threat of such litigation prompts unnecessary procedures that drive up the cost of medicine.

Any such protection, of course, made lawyers angry. Pity the poor patient, they said, who might not be able to sue a doctor who did something wrong.

Insurance companies didn't want change, either, unless the legislature forced all insurers to change at the same time. After all, they had perfected a profitable system in which they insured the healthy and excluded the sick.

Smaller insurers were worried about being squeezed out of the market by a system that would spread the insurance risk among all policyholders and which, proportionately, could saddle them with more risk than they could handle.

Insurers large and small were concerned the legislation would push premiums so high so fast that consumers would be hit with "sticker shock" and back away from buying any insurance.

Blue Cross lobbyists saw the health insurance reform part of the bill as an opportunity for the Blues to get back to what they were originally set up to do: provide insurance, rather than administer the self-financed insurance policies of others.

HMOs, beneficiaries of the trend toward more cost-controlling "managed care," massaged the process to minimize some of the underwriting advantages that traditional insurers had over HMOs. The result was that HMOs were left in a more favorable competitive position.

Psychologists worried that the new standard benefits package insurers would have to offer small companies would not include sufficient coverage for mental illnesses. They, like the doctors, said their primary concern was for the patients. But a reduction in insurance coverage also would mean a decrease in demand for their services, a direct hit to their pocketbooks.

Chiropractors fought to be included anywhere in the bill, similarly hoping to assure their future business.

The hospitals, whose costs are already controlled by a state regulatory commission, played the role of adviser and interested observer, prodding the process along in the hope that increased availability of health insurance, at the least, would cut down on the amount of charity care they now provide.

Organized labor and big business, adversaries on so many other issues, continued to share their mutual concern about runaway health care costs, which have eaten into worker paychecks and company bottom lines.

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