Newspaper article The Christian Science Monitor

HMO Battleground: Patients' Right to Sue in Competing Reform Bills, Accountability Is Key Question When Health Plans Deny Care

Newspaper article The Christian Science Monitor

HMO Battleground: Patients' Right to Sue in Competing Reform Bills, Accountability Is Key Question When Health Plans Deny Care

Article excerpt

In the churning debate over reform of managed health care, one controversy keeps rising to the surface: Should patients be able to sue their health-maintenance organization if it wrongly denies them treatment?

Democrats say yes. Most Republicans say no. The question could be the thorniest of the many that separate the parties as they consider managed-care reform.

Other issues this year - such as tobacco legislation - have produced a similar partisan divide. Democrats tend to side with their trial-lawyer contributors, while Republicans generally defend their business allies.

But this controversy goes deeper. It poses the question of how HMOs and preferred-provider organizations (PPOs) can be held accountable for mistakes without destroying managed care, thus making health-care insurance less affordable for millions of Americans. Under current law, plans covering 125 million Americans are protected against high-damage awards in lawsuits brought by patients who say they've been harmed by a denial to pay for treatment.

Democrats, backed by President Clinton, the American Medical Association, and the AFL-CIO, insist that people must have the right to sue. They have waged a war by anecdote, parading patients before the cameras to tell their stories of treatment delayed or denied. "Can't we ... hold health-maintenance organizations as accountable as doctors and nurses and hospitals?" asks Senate minority leader Tom Daschle (D) of South Dakota. "Why is it we only give immunity to diplomats and HMOs?"

Consumer groups say allowing patients to sue is the only way to force managed-care organizations to clean up their act. But business groups and managed-care officials say that cure would be worse than the illness.

"We absolutely oppose the Democratic bill.... We think {it} is a horrendous bill that will have the effect of pricing millions out of coverage," says Neil Trautwein, health-care lobbyist for the US Chamber of Commerce. …

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