MORE THAN 80 percent of employees are in managed care today. But you and your plan may be on a collision course.
Managed health plans face the same rising costs -- from high-tech medical advances and an aging population -- that overwhelmed fee-for-service plans.
You're either going to pay much more for your medical care or your plan will have to ration care in more aggressive ways.
Is that OK? If not, what's the alternative? We're not going back to fee-for-service medicine. Three-quarters of the nation's employers don't even offer it anymore.
Besides, we're not unreasonable. In return for cost control, we've accepted a certain amount of insecurity and doubt. What's not clear is how much further along this path we're going to have to go. Here's the general state of American health insurance today: In the late 1980s and early 1990s, employers shifted more of the cost of health insurance to their employees. Your expenses rose at a faster rate than your company's did. At the same time, many workers saw their real incomes drop. One result: a decline in the portion of workers who sign up for their company plans -- usually because the premiums cost too much. Young workers and low-wage workers are most likely to do without.
For this and other reasons, the number of uninsured people is rising by roughly 1 million a year, despite seven years of steady growth in the economy, according to the Employee Benefit Research Institute in Washington. At any one time, about 42 million Americans are going bare -- most of them lower-paid workers and their families, especially employees of small companies.
During the July 1990-March 1991 recession, public opinion supported universal health care. Insecure workers worried that they'd lose their jobs and become uninsured themselves. But that feeling waned when the economy picked up. Most of the uninsured -- at risk for their health, even their lives -- are currently off the radar screen.
Individual coverage is so badly broken that it probably can't be fixed. The smallest illness may deprive you of an affordable policy. Under a 1996 law, you're entitled to buy health insurance if you leave a group plan without having another plan to join. But this "right" has become a hollow joke. Some insurers are charging triple or quadruple the normal price, to drive off people that they'd rather not accept.
When patients can't call their doctors, they call their legislators. Thirty-two states now mandate sundry forms of patients' rights. But the states can't help the 48 million people in self-insured company plans, which come under federal jurisdiction.
Rep. Charlie Norwood, a Republican from Georgia, is driving ahead with a federal bill on patients' rights. It provides for a choice of employee plans, better disclosure of what that plan covers, surer access to specialists, the right to see doctors outside the plan (you pay the extra cost), independent review if you're rejected for a particular treatment, and the right to sue your company's plan if you're injured by any of its medical decisions.
In most states, your plan is shielded from liability. That frees careless plans to make careless calls that could damage your health. "Anyone who makes decisions about whether a treatment is necessary should be held responsible," Norwood says.
Norwood's bill would pass if it got to the floor. But key Republican leaders haven't yet signed on. In the Senate, Majority Leader Trent Lott of Mississippi has urged the managed-care industry to bankroll the opposition.
(Lott and the rest of Congress, by the way, got their own patients' rights rules last month. President Clinton mandated various protections for people covered by Medicare, Medicaid and all federal health plans.)
A recent survey by the Kaiser Family Foundation in Menlo Park, Calif., found broad support for patients' rights. But support declines if people think that a law would cause employers to drop their plans, involve the government in health care or drive up premiums. Seizing on this, the opposition warns of huge costs and wholesale cancellation of coverage.
Not a chance. But the bill would cost something. Some people would not be able to pay, mean- ing yet more uninsured. To protect the many, we deep-six the few.
Norwood's bill does not mandate levels of care. He'd help you get any treatment you're entitled to, which an unethical plan might deny. But employers could still ration coverage at will -- and that's where the future battles lie.
PD Who should be sacrificed to the god of limited care? It's one of
the great moral questions of our time.
Pub Date: 4/13/98