George S.Cole:Inflation on the way!!!Hear all about it!!!
right here George:
msnbc.com
This is big:
This will blow the lead off health care price control.
( They will accept gold in payment however, <VBG>
TA
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California overhauls HMO oversight
New law will allow consumers to sue their health plans
By Barry Kliff
MSNBC
Sept. 27 ? California Gov. Gray Davis signed a
sweeping package of health care bills Monday
that, among other reforms, will allow consumers
to sue HMOs for damages. The ambitious plan, in
a state which has given birth to many nationwide
trends in the past, could determine how far federal
and state governments are willing to go in the
battle over patient rights.
?CALIFORNIA, WHICH WAS a pioneer in the field
of managed care, is now leading the way in reforming the
system,? said Jamie Court of the Foundation for Taxpayer
and Consumer Rights. ?I think what California is doing will
become a rallying point for other states across the country.?
Starting on Jan. 1, 2001, Californians will witness some
dramatic changes to their health care system:
Patients who are substantially harmed by a health
insurer?s decision to delay, deny or alter necessary
treatment will be allowed to either sue their health care
providers or use arbitration to collect damages from health
care organizations. Only three other states, Texas, Georgia
and Missouri, currently allow people to sue their health
maintenance organizations.
Health care providers will be required to pay for a second
opinion if either a patient or primary physician requests one.
Doctors will be required to provide patients with a written
explanation when health care services are denied.
The state will create an independent system that will
review ? and possibly reverse ? health plan decisions that
block or delay patients? care.
Employers who already offer plans to cover physical
ailments will also be required to provide treatment for
severe mental illness.
?These bills taken together will ultimately put medical
decision-making back where it belongs: in the hands of
doctors and patients,? Davis said at a signing ceremony
before more than 100 doctors, consumer advocates, health
insurers, lawmakers and others at a medical clinic.
?Across the country, pressures to keep health care
costs down have resulted in managed care organizations
taking some very aggressive measures to limit care and
people have complained about these changes,? said Walter
Zelman, president of the California Association of Health
Plans. ?In California, both the legislature and our industry is
responding to their concerns.?
But Zelman, whose organization represents 38 health
care organizations with more than 20 million members, said
these changes will not come cheap.
TREATMENT FOR MENTAL ILLNESS
In addition to giving patients the right to sue, one of the
most controversial parts of the reform package is the
mandate to cover the cost of treating mental illness. Under
the current proposal, treatment for nine mental illnesses,
including schizophrenia, depression, panic disorder and
obsessive-compulsive disorder, would be covered. The
proposal also covers mental health care for children.
?The IBMs and Intels of the world can easily absorb
the cost of providing mental health care, but I?m not so sure
smaller companies can,? Zelman said. ?Some of these new
benefits will wind up being pretty expensive.?
ASKING FOR TROUBLE?
John Murray is also concerned about the cost of
California?s newly-enacted reforms. As Director of Public
Affairs for the American Association of Health Plans, his
job is to represent the interests of 1,000 HMOs across the
country that provide health care for 140 million people.
By allowing patients to sue their HMOs, Murray said
that California is asking for trouble.
But in Washington, Republican House Speaker Dennis
Hastert recently promised to bring patient-protection
legislation to the House floor in early October. One of the
proposals gives patients a host of new rights in dealing with
their health insurance companies and removes a provision in
federal law that has prevented many patients from suing
their HMOs when they are harmed.
CONGRESSIONAL DEBATE
Even though Hastert has so far declined to endorse any
particular bill, Murray said his organization adamantly
opposes giving patients the right to sue their HMOs.
?You can not,
either as a member of
Congress or a state
legislator in California
improve the quality of
health in the United
States by making
lawsuits part of the
system,? he said. ?The
only thing that will
happen is that people
will pay higher
premiums and more
people will become
uninsured. ?
But Court, of the Foundation for Taxpayer and
Consumer Rights, said HMOs must be held legally
accountable for their work. He noted that his group is now
working with consumer organizations in 23 other states to
insure passage of laws giving patients the right to sue.
It?s only a matter of time, Court said, before consumers
in other states have the same health care rights as people
living in California.
?If there weren?t any problems, then people wouldn?t
be asking for the right to sue,? he said. ?The industry is
really afraid that legislators will say they passed this kind of
legislation in California, so we can pass it in our state.?
TOUGH BATTLE AHEAD
Both sides, however, agree that the battle over
reforming HMOs will depend more on politics than health
care itself.
President Bill Clinton and House Democrats have said
they will oppose any federal legislation that does not give
patients the right to sue their HMOs. Many House
Republicans are just as adamantly opposed to including
such a provision. Even if a sweeping bill does pass the
House, it must be reconciled with the Senate version of
patient protection, which allows for no new lawsuits and is
more limited in other respects as well.
?No matter how you feel about it, health care reform is
something that no politician can ignore,? Court said. ?Now
that California has jumped into the fray, no politician can
afford to ignore what that state has done. ?
The Associated Press contributed to this report.
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