Clinton's health care 'bill of rights' proposal aims to protect consumers

The Outlook

November 23, 1997|By M. William Salganik

PRESIDENT Clinton endorsed a health care "bill of rights" Thursday that was proposed, with one dissenting vote, by an advisory commission.

If approved by Congress, it would require HMOs and health plans to give patients detailed information about physicians and would establish an independent, outside review panel to handle patient complaints. And Clinton challenged health plans to adopt the standards voluntarily before Congress acts.

"Whether it's traditional health care or managed care, we have to make sure it's not inferior care," the president said.

Would the "bill of rights" represent needed consumer protection, or unnecessary government meddling? Would it improve care or just increase costs?

S. Diane Graham

Chairman and chief executive, Stratco Inc., Leawood, Kan., dissenting member of advisory commission [below are excerpts of her letter to President Clinton]

I believe it is inconsistent with your charge to us, for the Commission to characterize as "consumer rights" -- and thereby imply universal entitlement to -- a detailed list of plan benefits or design attributes which would ultimately increase costs to a prohibitive level, and thereby deny many of the most vulnerable Americans their coverage in entirety. To do so would be to promise "quality care" to a shrinking privileged class for whom cost-of-coverage is less an issue, while denying all coverage to those for whom cost is the driving concern.

I mean to assert that the "there is no such thing as a free lunch" principle applies here with full force. The proposed Consumer Bill of Rights aspires to worthy ideals that would elevate millions of Americans to a higher quality of life and, as such, will be applauded. However, because the costs associated with implementing and sustaining such a plan have not been thoroughly calculated and projected on a long-term basis, I believe that applause will be short-lived.

Gail Shearer

Director of health policy analysis, Consumers Union

There are a lot of loopholes to any state protections, and a lot of people who are not covered by state regulations. The Consumer Bill of Rights is important because it would protect all consumers, and make sure they're treated fairly on the marketplace.

If a consumer felt a health plan was not giving needed treatment, the consumer would be able to go to an outside board of medically trained people that would make an independent decision. They would get a fair review, and not be at the mercy of an HMO that might have a financial incentive to deny care.

What's really important to understand is that this is just a piece of paper. What's missing is any understanding of how it would be enforced. We are calling on Congress to enact legislation so that these rights will become a reality.

Donald W. Moran

Senior vice president and head of health benefits management practice, the Lewin Group

There are certain features of the way health plans operate that people have decided they don't like, and it's not surprising the political system is responding.

What these health plans do is identify areas where scientific and clinical professionals disagree [about the best type of care], and stake themselves on the fiscally conservative side. It's sort of how they make their living. The commission is saying there ought to be an expert panel in these areas, but then they stop. They don't say whether the decision is binding, or what to do if two different urologists disagree. The government might get dragged into taking sides on this type of questions, and then you're on a slippery slope.

It's not clear there's a solution. In the normal course of events, if people were totally miffed, you could make a buck with a different type of product. If you rush in and regulate, you may forestall the development of a product that will make people happy.

Jeff D. Emerson

President and chief executive officer, NYLCare Health Plans of the Mid-Atlantic Inc.

Almost everything that was in the recommendations of the president's commission already exists in most major urban markets, either voluntarily or by mandate of employer groups.

The only thing that might be new is an outside review panel. And already, if you are a federal employee, you can appeal to the Office of Personnel Management and get a binding decision. If you are a resident of the state of Maryland, you can appeal to the Maryland Insurance Administration, which makes a binding decision. That whole system works fine now. If you create another bureaucracy, it further fragments regulatory oversight, and that's problematic from the standpoint of consumers.

This is an issue you can flog from either side of the aisle. You can say you're for consumer protection and motherhood and apple pie, or you can say you're against government intrusion.

This whole issue misses the point entirely: We are spending a trillion dollars on health, and 41 million Americans have no health insurance. How are we going to be able to afford to bring those 41 million under the tent? The rest of us are going to have to sign up for a plan which costs less, or we're going to have to contribute more.

Pub Date: 11/23/97

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