More than 70 defenders and critics of health maintenance organizations packed a legislative committee room in Annapolis yesterday for a rancorous debate over bills that would guarantee HMO patients the right to see non-HMO doctors.
Depending on who was testifying, HMOs were described as potentially dangerous to patients or the best quality care for the lowest possible price.
A 51-year-old Baltimore County teacher, Barbara Topper, testified that she almost died several years ago because her HMO refused to let her see the right specialist. But HMO advocates cited studies indicating that the quality of care in HMOs is as good or better than in any other insurance plan.
Each side -- doctors argued for the legislation, while businesses attacked it -- accused the other of trying to profit at the expense of consumers.
"We think this legislation should be called the 'full employment bill' for doctors," charged Ernest B. Crofoot, an AFL-CIO official who co-chairs the business coalition opposing the bills.
Some black physicians and black legislators raised another controversial issue, strongly suggesting that HMOs were hiring disproportionate numbers of white physicians, an assertion that HMO officials deny.
But as the more than three hours of testimony continued, it became clear that the key issue for legislators may be money: How much would it cost to guarantee patients the right to choose any doctor?
Opponents of the legislation say that it would drive up health insurance costs for consumers and employers, including the state of Maryland, which according to one estimate would have to pay $24 million more a year to insure its workers.
Supporters of the bills disputed that allegation and said HMOs' profits are so high that they could afford a small cost increase if one occurred.
HMOs say they can control expenses and quality only by carefully selecting the doctors they hire. If patients can see any -- doctor, the HMOs say they lose some of their ability to weed out incompetent doctors and to manage the care patients receive.
To buttress their case, advocates said HMOs are increasingly popular and are now the plan of choice of more than 30 percent of Marylanders.
Ray Brusca, the vice president for benefits at Black & Decker Corp. in Towson, testified that 95 percent of his workers nationwide have "voluntarily" joined HMOs and that they are overwhelmingly satisfied with their care.
But one of the legislation's sponsors, Del. Kumar Barve, a Montgomery County Democrat, turned that argument around, saying if HMOs are so popular, then few people would want to see outside doctors and there would be little added cost.
Supporters of the bills also noted that they would require patients to pay part of the fees of non-HMO doctors they see, a disincentive likely to make patients think twice about doing so.