Editorial: HMO’s ruling shows urgency for reform

Sunday, March 5, 2000 | 9:09 a.m.

When Ian McDonald was born last year, his Everett, Wash., parents say that complications during delivery resulted in him being brain-damaged. Christine McDonald, Ian's mother, told the Seattle Times newspaper in January that her child can't swallow, so that his lungs must be suctioned hourly. Also, he has to be fed through a tube attached to his stomach. The pain the baby feels is so intense that he needs to take medication in order to fall asleep.

Christine McDonald and her husband, Dylan, had been trying to get their health insurer, Aetna, to pay for the costs of a nurse to take care of the infant for 12 hours a day. But Aetna refused to pay the $220,000 annual costs for this care, saying the couple should do so on their own. The company chose to ignore the advice of Ian's pediatrician, who says the child needs professional care. As if that weren't callous enough, Ian's father says an Aetna representative outrageously suggested that the couple place their child for adoption so that Medicaid would pay for the treatment.

Vice President Al Gore mentioned the plight of the McDonalds during a campaign stop in Washington state last Sunday, calling on Aetna to provide Ian with professional care. Gore correctly pointed out that if there was a patient's bill of rights, which includes stronger appeal rights for the insured, six-month-old Ian likely would have gotten the care he deserves. Within 24 hours Aetna executives capitulated and agreed to cover Ian as long as he needs care.

It is deplorable that it took the vice president of the United States to get an insurance company to do the right thing. How many more thousands of patients are out there who don't have the good fortune to have the vice president fighting for them? Aetna is not the only one who should be ashamed. The Republican-led Congress deserves just as much blame for bottling up a patient's bill of rights advocated by President Clinton. It is unconscionable that basic protections for patients have been denied for so long.