A political circus

By Vin Suprynowicz
web posted July 19, 1999

Reflecting their standard dedication to thoughtful and informed debate, both Democrats and Republicans staged news conferences and pep rallies on Capitol Hill last week, dragging lab-coated professionals and the grieving parents of dead children onstage to help promote their own (while demonizing their opponents') versions of a national "Patients' Bill of Rights."

President Clinton reinforced the circumspect atmosphere by promising to veto the GOP version once it reaches his desk (Republicans passed their version Thursday), thundering that the stingy GOP plan "covers too few people, provides insufficient patient protections, and contains inadequate enforcement provisions."

At issue were the Democrats' demands that these new "consumer protections" -- including a guarantee of emergency room services and increased access to specialists -- be extended to 160 million Americans, rather than the Republicans' paltry 48 million, and that decisions as to what medical care is necessary be returned entirely to attending physicians (providing they follow "generally accepted medical practice.")

Republicans warned that would destroy the efforts of health care plans to put a lid on medical costs, bringing back uncontrolled medical inflation and ultimately causing 1.8 million Americans to lose insurance coverage, entirely.

(Actually, the Congressional Budget Office estimates the Democratic plan would have added 4.8 percent to the cost of insurance over five years, while the GOP version would add 0.8 percent.)

"The Democrat plan means more government, more lawyers, more rules, more uninsured and more government control," declared Sen. Phil Gramm, R-Texas. Meantime, across the aisle, millionaire whisky heir Sen. Edward M. Kennedy, D-Mass. and co-sponsor of the Democratic proposal, called the GOP version a "profit-protection plan for the insurance industry."

Needless to say, the dog that never barked in this particular circus is the one that might have pointed out the U.S. Constitution grants no authority for the federal government to meddle in the medical market at all -- that Americans are supposed to be free to contract for the medical insurance of their choice (if at all), and that national edicts requiring a gray sameness of "consumer protections" were never part of the founder's vision of a "small central government, with limited powers, sharply delineated."

Such quaint notions no longer receive even token attention in Washington, of course.

So, unfortunately, even the GOP plan will now make it harder for patients to sue their HMOs -- a further restriction on patient rights, peddled as part of a "Patient Bill of Rights." How charming.

What "rights" are guaranteed? Both the Republican and Democratic plans would require that insurers pay for emergency room visits outside the plan's network when a "prudent lay person" would believe symptoms indicate a medical emergency. (An insurer would have to pay for an emergency room visit for chest pains, for example, even if the pains turned out not to indicate a heart attack.)

That seems reasonable at first glance. But look again. No one has proposed barring access to emergency rooms, which nearly always treat life-or-death emergencies without advance payment guarantees. Furthermore, patients always retain the option of paying such bills themselves. (Would you allow your favorite politician to condemn your grocer or health insurer for "conspiring to starve the children" because the grocer expects to be paid for his produce and the insurance company won't buy it for you - despite the obvious importance of fruit and vegetables to your health?)

And why should consumers be banned from buying less expensive policies that announce up front they will not pay for ER visits that fail to result in hospital admissions -- a mighty expensive alternative to the local health clinic?

While patients should certainly have an accessible grievance process, and retain the right to sue their insurance companies, grisly photographs and worst-case anecdotes about HMOs denying "life-saving treatment" -- often referring to expensive experimental treatments for patients already terminally ill -- ignore the fact that managed care is working well at holding back costs, which is all that makes medical insurance affordable for millions, in the first place.

Our medical system, while the best in the world, could stand some reform. Getting government quickly out of the picture-- except for courts to prosecute fraud -- would be the best and fastest fix. (Even the "linkage" of health insurance to the workplace -- the root of the current problem -- was the direct result of a government intervention, since the 1940s federal wage freeze allowed employers to compete for employees only by offering better tax-deductible health insurance -- a tax advantage never offered the self-employed.)

But failing that, what's required -- if anything -- is minor surgery under the old guideline: "First, do no harm."

Does anyone really believe that's what we're likely to get, in an atmosphere of hucksters and carnival barkers maneuvering to savage their Year 2000 opponents with charges they "don't care about dying children"?

Vin Suprynowicz, assistant editorial page editor of the Las Vegas Review-Journal, is author of the new book, "Send in the Waco Killers."




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