Editorial: It’s time to move on managed care

Tuesday, Sept. 1, 1998 | 9:55 a.m.

THE Senate returned to work Monday after its summer recess and the House comes back next week to face a number of important -- and unresolved -- issues. Reforming managed health care tops the list.

As it stands now, patients are at the mercy of their health plans, often with little or no recourse to question whether their HMO is giving them sound medical care. Managed care was intended to reduce costs and provide quality care, but along the way medical care has become a distant second to the first priority -- pursuit of profits.

Senate Democrats have offered a reasonable plan that will restore some balance again by placing limits on health plans that restrict patient choices to cut costs. The Democratic plan would let patients appeal denials to an independent panel, allow better access to specialists and guarantee coverage of emergency room visits even if a patient's reasonable fears later turn out to be unfounded. A key provision of the bill also would give patients the right to sue for actual and punitive damages if benefits are denied unfairly.

Just before it took its break, the House passed a plan that embraced some of the Democratic proposals. It was a major improvement on what little Senate Republicans are offering, but it falls far short of what is needed. Sorely missing from the House Republican plan is the ability for patients to sue their health plans.

There is no reason why managed care should be the only industry exempt from damages they inflict upon consumers. President Clinton has done the right thing in vowing to veto the House Republican plan because it doesn't go far enough in protecting patients' rights.

With November's general elections right around the corner, Republicans have already started blaming Clinton for the failure of Congress to act on critical issues, such as managed care reform. The Republican leadership is suggesting he hasn't been in Washington enough and has been distracted by the Monica Lewinsky scandal. "The president has been absent without leave all year," Rep. John Boehner, R-Ohio, told USA Today.

That's a cop-out. Earlier this year Congress had ample time to address these issues but decided to stall, fearing that passing managed care reform might hurt HMOs -- big contributors to GOP campaigns. The fact that Republicans are playing the blame game already, with several weeks still to go before they adjourn in early October, shows that they are not serious about enacting reform.

If the GOP-controlled Congress blows this golden opportunity to pass significant reforms, the real losers will be the millions of Americans who will continue to be held hostage to the whims of their health plans.