Magazine article USA TODAY

Restoring Responsibility to Managed Care: Proposed Legislation Would Curb Health Care Organizations' Ability to Run Roughshod over the Rights of Patients

Magazine article USA TODAY

Restoring Responsibility to Managed Care: Proposed Legislation Would Curb Health Care Organizations' Ability to Run Roughshod over the Rights of Patients

Article excerpt

Proposed legislation would curb health care organizations' ability to run roughshod over the rights of patients.

A two-year-old boy in my home state of Georgia was suffering from a high fever that did not respond to medication. His parents followed the insurance company's instructions for pre-authorization of emergency room care and attempted to drive 42 miles to the preferred hospital in the Atlanta area. The couple passed five emergency rooms on the way and could have stopped at any one for immediate attention, but were compelled by the rules of their managed care plan to use the hospital it had designated.

Before they could reach the authorized hospital, their son went into cardiac arrest and stopped breathing. The child slipped into a coma, developed gangrene in his extremities, and subsequently lost his arms and legs to amputation.

Florence Corcoran of Louisiana was in her second high-risk pregnancy and accordingly was admitted to the hospital under her physician's orders, which called for 24-hours-day fetal monitoring until the child was born. Those orders were revoked and she was discharged after her health insurance company refused to pay, even though those benefits were covered in her health plan.

The plan only would authorize a visiting nurse to check on the woman 10 hours a day at home. During a period when the nurse was absent, the unborn child went into distress and died.

The Corcorans filed suit against the insurance plan for their child's death. However, the court ruled they had no right to sue for damages because the insurance plan was governed under the Federal Employee Retirement Income Security Act (ERISA), which preempts all state law, including medical malpractice.

Should you be able to choose your doctor and hospital? If your health insurance plan overrules your physician's orders and you die as a result, should your family be able to sue for damages? The majority of the members of the House of Representatives say yes to both questions. Lobbyists for the managed care industry say no, while doing everything possible to prevent those questions from being asked. Welcome to the managed care reform debate of 1998, where the lines between political parties and philosophies are all but erased.

When I sold my dental practice in 1994 to run for Congress, one of the major motivating factors was a concern over the future of health care in the U.S. I was appalled at the Clinton Administration's attempt to socialize medicine, something I believe drastically would have reduced the quality of health care for all Americans.

Although our health care industry is far from perfect, it still is the best in the world because it was built by a free market. The ultimate consumer protection in any industry is the ability of the consumer to shop. If enough people don't like a given product or service for any reason, they won't buy it, and the company either will be forced to change or go out of business. Moreover, when business has to compete for consumers, there is the greatest of all incentives to innovate by creating new products and services that outperform existing ones.

For most of our nation's history, this has been the case with health care. A dynamic free market has produced medical breakthroughs that once would have been unimaginable.

If you came to my office a century ago with a bad tooth, I probably would have given you a shot of whiskey and pulled the tooth out with a pair of pliers. Today, I could perform a root canal using modem anesthesia, save the tooth, and likely identify and help you avoid future dental problems as well.

This has come to pass because there was a free-market demand for improved dentistry that provided a financial incentive for technological and medical research. If that incentive were ever removed, we not only will impede medical progress seriously, we likely will take a step back from today's level of health care quality. …

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