Editorial: Health care reform will get priority

Monday, Feb. 8, 1999 | 12:02 p.m.

After it appeared that public sentiment was significantly shifting in 1998 in favor of HMO reforms, it was disappointing when the insurance lobbyists worked overtime to make sure the legislation died in the Republican-controlled 105th Congress.

The news on the HMO front hasn't been all that encouraging at the beginning of 1999, either. For instance, the New York Times reported last week that a growing number of doctors are being courted by unions as the physicians worry about receiving lower compensation and having to cede more control to HMOs when it comes to treating their patients. In addition, a study published last week by the Journal of the American Medical Association contended that even when patients opt for traditional insurance, they still may not be able to avoid the nasty side effects of managed care. For instance, the study finds that physicians where HMOs are fast-growing tend to order fewer tests even for their patients who are under traditional plans.

All in all, it doesn't seem like there is much to cheer about. But keep your fingers crossed, help may be on the way after all. Members of the 106th Congress are already trying to find common ground on issues so that compromise legislation regulating HMOs can be passed this year. For instance, it seems agreement could be possible on making sure that a health plan will have to pay for a visit to the hospital emergency room if it is considered reasonable. There also is increased hope that patients will be given the right to appeal to an independent arbitrator if an HMO denies care (Sierra Health Services of Nevada announced last week that it would voluntarily permit its members to seek external reviews regarding care).

Not everything will be resolved quickly, though. As the Associated Press noted in a story last week, there are sticking points that will be difficult to resolve, such as whether patients should be allowed to sue their HMOs when care is withheld. Still, it is a good sign that both Democrats and Republicans are talking about HMO reform. Consensus is possible on this issue -- as long as congressmen set aside partisan differences and make top-flight medical care their priority.