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Commentary on the Patients' Rights Bills in Congress

Article by Art Myatt, webmaster for MichUHCAN, June, 1998

The rights that patients ought to have in the medical insurance and treatment system make for a complicated issue. Instead of commenting directly on the items in the three bills we are discussing, let's look for what is missing in all of them.

Although each of the bills do mention patient privacy, there is no actual effective or enforceable right to privacy. There is no compensation for the patient or other penalty for a violation of privacy, either accidental or deliberate.

The President's Commission thought consumers should have the right to review and copy their own medical records. None of these bills addresses this particular issue.

All of the bills set up a process for appealing a decision by the "plan" (insurance company, HMO, whatever) to deny coverage. At least one bill even insists that the plan must refer the patient to an out-of-network provider if a suitable one is not available in the network. None of the bills actually establish a right of the patient to get available treatment for the condition from which they are suffering. That is to say, none of these bills deal with the most common excuses that insurers use to deny treatment: pre-existing conditions; conditions such as AIDS or mental problems for which expenditures are specifically limited; so-called "experimental" or "investigational" treatments where there are no objective standards or authoritative bodies outside the insurer to classify these treatments; services such as in-home therapies or nursing visits which may be medically required but for which expenditures are specifically limited; and overall "lifetime" limits on expenditures for any one patient or family.

What a person needing medical treatment expects is that his health insurance will pay for whatever treatment is medically necessary and available. All too often, the insurer can find a legal excuse not to pay. All to often, people do not get the treatment they need, and die or are permanently damaged as a result. These bills do not close most of the loopholes the insurers have invented.

Only one bill insists that the premium charged for a Point-of-Service option be fair and reasonable. None of them dared to address the question of whether the overall premiums should be fair and reasonable. In the real world, insurance companies commonly force out expensive patients by charging exorbitant premiums for individual coverage or force out expensive "groups" by exactly the same methods.

While one bill does require that drugs not on the company's preferred list be covered, no bill requires that prescription drugs be covered at all by any plan, or that the amount of the deductible be at all reasonable, or that the premium for coverage of drugs be fair and reasonable, or that the drugs on or off the preferred list be justified by any objective or impartial standard.

Continuity of care is at least addressed in the case of a provider or an employer leaving the plan. None of the bills says anything about continuity of care when the employee leaves the employer voluntarily or involuntarily. This is the situation most commonly leading to discontinuity of coverage, but the bills in Congress are mute. An unrelated bill has addressed to some extent the issue of portability, without making portability affordable for the employee who needs it.

The best of these bills does absolutely nothing to provide any type of coverage for the more than 40 million people in this country who now have no health insurance. None of the bills mentions any requirement or incentive for employers to provide health coverage for their employees. One of the reactionary arguments that has been raised against all of these bills is that they will actually have the effect of reducing the number of people who are offered any kind of plan by the employer, and it will further reduce the quality of the insurance for many of those who are offered it by the employer, because even the least of these bills will make health insurance more expensive for the employer. This argument is not wrong just because it comes from conservatives. It is correct. It helps to explain the direction the society is moving.

The trend these days is that from one year to the next, there are more uninsured. The trend is that the quality of health care coverage deteriorates incrementally for those who still have it. That trend shows every sign of continuing. The insurance companies that came up with one-day deliveries and drive-by mastectomies are now putting the finishing touches on their new guidelines for pediatric treatment. Don't be surprised if your child is shoved out of the hospital within hours of his first temperature reading less than 101. The money saved by one less day in the hospital for a thousand or two children will do nicely for the yearly bonus for an HMO CEO.

The trend will continue unless we (the people) are a lot more effective in organizing to oppose it.

Meanwhile, the Patients' Bill of Rights (H.R.3605/S.1890) sponsored by Senators Daschel and Kennedy and Congressmen Dingell and Gephardt is not bad. At worst, it is the best of an uninspiring lot. At best, it provides some necessary regulation for HMOs without making any fundamental change in a fundamentally flawed system.

MichUHCAN supports it, particularly in preference to the other two bills, without especially being enthusiastic about it. It falls far short of solving the real-world problem upon which it touches. Health care ought to be a right. This society certainly has the resources to provide excellent health care to all its citizens, both now and in the foreseeable future. That is does not is a problem of finances and politics, solvable as soon as a vocal majority of the population is determined to solve it.

We enthusiastically support the principle of a universal single-payer health care system with strong legally enforcable rights for patients. We believe the whole idea that hospitals and clinics and health insurance must be businesses run for profit is wrong, just as it would be wrong to run the armed forces for profit, just as it is wrong for people to enter public service primarily for the purpose of enriching themselves and their friends. We are at this time a vocal minority, but we are raising our voices, not just silently putting up with what we believe to be wrong. We are a minority today. How long we remain a minority is in part up to you.

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