President Bush, Managed Health Care and the Magic Number...

Great Debates
1

President Bush has stated that he will not support the Patients’ Bill or Rights in its current form. The way it stands now, patients will be able sue HMOs for no more than five million dollars.

Bush says five million is too high but has yet to name a number. With no or a high liability cap, managed health care providers will have to increase their costs. This means that many employers will no longer be able to offer inexpensive health care coverage to employees who desperately need it.

Several questions come to mind. They are:

**What’s the magic number? **
What should the cap be? If it’s too low, will managed care providers still continue to deny patients expensive but necessary treatments? If it’s too high will the managed health care industry eventually fold?

**Why does a bill have to be passed for patients to be able to hold HMOs liable for not providing necessary care? **
Are patients unable to sue managed care providers now? How did that come to be?

**What does the lack of a Patients’ Bill of Rights mean? **
Assuming the Bill will eventually be passed, how will it affect patients of HMOs? Will the cost of managed health care go up anyway? Will this lead to uninsured masses of people?

I look forward to your input. I especially interested in hearing from Dopers in the managed health care industries.

2

Couldn’t give a number, but the jury is still out on the managed care industry in any event. The pendulum has swung towards wanting less management and more care. I read an article in the NY Times a while back which said that experts feel that managed care companies are denying treatment too rarely, not too much. And this without a Patient’s Bill of Rights. With too much potential liability HMOs will be even more tentative about managing care, eliminating cost savings and putting the HMO model at risk.

Don’t know for sure. But I would think any person could sue an HMO to force them to give treatment believed to be covered. The issue is if they are liable for damages that resulted from your decision not to seek treatment, as a result of their decision not to pay. This is a very indirect damage. Suppose your homeowner’s insurance does not reimburse you for a broken window. You therefore do not fix it. Robbers then come in. Is the insurance company liable for the theft?

Managed care costs will go up anyway. They will go up more as a result of a Patient’s Bill of Rights. How much they will go up is the $64,000 question.

3

Thanks for the reply, IzzyR. I really hope someone else will come along and expand on question number 2, though.