Editorial: Courts, Congress and HMO worries

Friday, Aug. 14, 1998 | 11:23 a.m.

In an important decision Wednesday a federal appeals court ruled that Medicare patients who are denied services by their health care plans have the right to an appeal if they believe they're not being given adequate treatment.

The 9th U.S. Circuit Court of Appeals upheld a lower court decision that the federal government can't renew contracts with health care companies that refuse care to Medicare patients without giving them a reason and an opportunity to appeal. The court said that because the health care plans act as government surrogates when taking care of Medicare patients, the HMOs must abide by the constitutional guarantee of due process.

The case against the federal government started in 1993 after five older women had health care rejected by an HMO without any reason. Anyone needing evidence that there should be oversight of health care plans only has to look at what happened to some of the plaintiffs.

For example, a woman who had diabetes told doctors of experiencing pain in a foot. Despite her complaint, she didn't get any response from her health plan's doctor. The outcome: She eventually had to have her leg amputated at the knee because care was denied. Even after the surgery she wasn't provided health care at home while receiving intravenous medication.

While a federal court was doing the right thing in granting this protection to an estimated 5.7 million people over 65, Senate Majority Leader Trent Lott, R-Miss., is warning he may kill any health care reform legislation this year.

What set off Lott? President Clinton said this week he will veto the House's version of managed care reform if it crosses his desk. The Senate majority leader said he wants a statement from the president "that indicates your willingness to work with us, not against us."

Despite his protests, Lott is the one who has been playing games with health care reform. He has looked for any excuse to kill meaningful legislation this year, whether it's to put a dent in teen smoking, reform the nation's campaign finance laws or provide patient protection from HMO abuses.

Lott's just trying to deflect attention from his failure to do what's right, hoping that the American public doesn't notice he is doing the bidding of big special interests. Unfortunately for Lott the American people are smarter than he gives them credit for and they will see through these shenanigans.