GOP dilemma on health care

Internal conflict: Attempt to pass weak patients' protection bill stirs revolt among doctor-lawmakers.

August 05, 1999

DEFENDING managed-care health organizations is a tough sell, as House Republican leaders are discovering.

The GOP's own doctor-legislators are threatening to side with Democrats on passage of a strong bill giving patients protections from arbitrary HMO rulings.

This puts the GOP in a bind, caught between two loyal constituencies -- physicians and insurance executives. It also pits the GOP's more pragmatic, problem-solving lawmakers against the party's more rigidly ideological members.

Republican House leaders want a minimal patients' protection bill that does not expose health insurers to lawsuits. This has run into vehement opposition from Republican doctor-lawmakers, who live in the real world, outside the Washington beltway, where dissatisfaction with health-insurance denials of medical services is rising.

All Americans covered by health plans should be guaranteed emergency-room care, the right to receive proper treatment and tests, and immediate appeals to an outside arbiter of treatment denials.

Maryland's new system, which allows patients to question decisions by health insurers might be a model. Appeals are given prompt attention and are usually resolved through mediation. The state law also gives the insurance commissioner power to reverse HMO decisions and to impose stiff fines, which he has done.

Polls indicate consumers are fed up with the uncaring "bedside manner" of managed-care insurers and their cut-rate prescriptions for the sick. Republicans would do well to approve federal legislation that treats this disease with strong, effective medicine.

Pub Date: 8/05/99

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