By Mary Mostert, Analyst
July 7, 1998
The Washington Post lead story today is all about trying to find a "cure" for the HMO disaster, which came about entirely during the Clinton Administration. We should be thankful, I suppose, for the fact that we may be able to undo part of the mess foisted on the American people by Bill and Hillary. At least they did not succeed in getting their ENTIRE "Health Care" program passed by the Democrat Congress in 1994. If it had passed, the problem would be one hundred times worse than it is now.
Remember the Clinton Health Care Plan? It would have required 59 new federal programs or bureaus, expanded 20 others, and imposed almost 80 new federal mandates, besides changing the tax code. It would have included an agency for health care policy, a drug pricing committee, a group of health alliances, a bureau to regulate the corporate alliances, another to monitor the performance of regional alliances, yet another monitor health care implementation at the county level, etc.
The proposed government bureaucracy would "control costs." Controlling costs would have entailed the government dictating how much money overall would be spent on health care . The White House, of course, at the time denied that this is so, saying that "only insurance premiums would be controlled." Of course, if insurance premiums are arbitrarily fixed, it necessarily follows that the amount of money available for health care is also fixed. At the time Rep. Solomon (R-NY) observed, "The plan entails dictating, albeit indirectly, how much money doctors can receive for what treatment."
That was five years ago and the Clinton plan did not pass. What we have cooking in Washington at the present time is round two of the Clinton Health Care Plan. The same cast of characters who planned to socialize 17% of the Nation's GDP by socializing medicine are planning to "fix" problems that are now obvious to all in the HMO system by - guess what? Resurrecting key portions of the Clinton Health Care Plan of 1993-94.
Of course, the name has been changed. Now it is going to be called "patients' rights legislation." At the heart of the fight, according to the Washington Post, "are consumer fears and complaints that managed care health plans, particularly HMOs, are denying or limiting needed benefits and services in order to save money. In hearings on Capitol Hill and accounts in the press, patients have told heart-rending stories of being trapped in life-threatening situations with no recourse or help from their health plans."
Surprise, surprise! That's exactly what the doctors said would happen, but no one seemed to think that the doctors knew anything about curing sick people. About 60 percent of Americans were enrolled in some form of managed health care plan in 1996, according to the American Association of Health Plans, up from 36 percent in 1992. Had the Clinton socialized medicine plan been passed, it would be 100% of the people who would be in government managed health care plan.
The problem with Clinton's Health Care plans and the HMOs is that they are just that...they are only for the people who are healthy. If you get sick, you mess up the profit for the folks managing the organization - who are almost never doctors. They are business executives, many of them new millionaires, in this new field called "health maintenance."
Now, what Washington is talking about is not to turn back the clock and giving doctors the freedom to actually heal the sick. That's too expensive. What the politicians are talking about as "the way out of this dilemma" is to give people the right to appeal an unfavorable decision by their HMO to an impartial outside body, to let patients use doctors outside their health plan's limited list of care providers if they urgently feel they must, and to permit lawsuits against the health plan itself, not just a doctor, as a backup threat if skimping on care by the plan causes serious damage to the patient.
Caught in the middle of all this is are the doctors - especially the specialists who, the HMO and Managed Health Care nuts in the Clinton Administration believe, are too expensive and should not be easily accessible to ordinary folks. For themselves, perhaps. Not for the rank and file taxpayer.
A great many people have adopted the Clintons' notion that the doctors are the enemy and, by making sure they are not allowed to provide for patients, or perhaps not allowed to charge for their services, that the rapidly rising cost of medical care will miraculously go down.
Every Clinton scheme somehow reduces the payment to doctors. Between the Clintons, the Kennedys, and the media, most Americans are convinced that it is the doctors who are causing their medical care to be so costly. Yet, if the "let's cut the doctors out" syndrome is taken to its ultimate conclusion, and ALL doctors were eliminated from the health care system, it would only reduce costs by 8%. I rather suspect that is the direction the Clintons are headed and the American people need to know that when all doctors ARE eliminated from the system, their costs will only go down about 8%.
The Democrats who pushed hard for the Clinton Health Care Socialized Medicine plan in 1993-94, Rep. John Dingell, D-Mich., Senator Tom Daschle, D-S.D., and Sen. Edward M. Kennedy, D-Mass. are sponsoring legislation [Senate Bill S. 1890] and [House Bill H.R. 3605], which has provisions that includes the right to sue health plans and binding outside review of patient appeals on medical coverage decisions. Rep. Norwood sponsored another bill [H.R. 1415] that was the original proposal to allow patients to sue health plans. Major insurer groups such as the American Association of Health Plans (AAHP) want no new legislation, fearing that government requirements for specific services would paralyze the HMOs' ability to tailor efficient low-cost health plans, and would be a foot in the door to further government micro-management of health care.
However, two major HMOs - HIP Health Plans and the huge Kaiser Permanente group - together with the American Association of Retired Persons, the giant seniors' organization which pushed for the original Clinton plan, and a group called Families USA, said in a joint statement that they will back "legally enforceable national standards" for a number of provisions, although the group did not endorse inclusion of the lawsuit provisions. AAHP and other health plan spokesmen fear that the proposed bills would also greatly increase costs because of the additional services that would have to be provided.
Bill Gradison, president of the Health Insurance Association of America said, "Our basic concern has been about cost It's a duel of numbers. Supporters [of various provisions] say the cost is trivial and others - us - say the cost is large and would reduce coverage." Of course, backers of the Dingell-Kennedy bill deny the costs of their provisions would increase the 8.6% that the Insurance Association study claim it would.
The Association of Private Pension and Welfare Plans-The Benefits Association, which represents employers who sponsor health plans, opposes federal legislation. The group's Paul Dennett said that the market is already moving to provide some of the protections sought by consumers and that "we oppose all of this being done by legislation." Once you get started writing mandates, "pretty soon you end up with everything mandated," said Dennett, raising costs and paralyzing the ability of plans to innovate and keep premiums low.
The GOP task force plan was denounced by the Democrats as far too weak and a sellout to the insurers and they claimed it was designed to undermine the Democratic bill. But the HMOs and health insurers didn't like the GOP plan, either. The AAHP said that while it was "less onerous than the Kennedy-Dingell and Norwood bills, we oppose its reliance on government mandates that could have the unintended consequences of micromananging the market."
On November 22, 1993, Rep. Dingall observed on the floor of Congress: "Ms. (Hillary) Clinton accused the industry of greed and dishonesty in asserting in its ads that the administration's reform initiative would cost too much, create too much regulatory bureaucracy, and impermissibly limit patients' choice of doctors and hospitals. To the contrary, she argued, health insurers' profit-motivated restrictions on medical coverage have diminished choice, denied affordable insurance to millions of Americans, and brought the U.S. health care system `to the brink of bankruptcy.'
"By contrast, the president's (and her) managed `competition' proposal, she said, would enhance choice and security by allowing Americans to select from an array of health care plans, including the traditional fee-for-service model. But what happens, critics ask, if one's preferred plan is oversubscribed or runs out of money?"
It's only taken five years and the participants in HMOs are finding out what happens. What happens is you just don't get the operation you need or the other medical procedures that might save your life.
Senator Tom Daschle was an even more enthusiastic supporter of the Clinton Socialized medicine plan. He said, two days before Dingall's speech, "Fortunately, we have a President and a First Lady who share this belief ( in government controlled health care.) They understand that, as in 1933, we have fallen behind the other industrialized nations at a great cost. They recognize that something is terribly wrong when we stand alone with South Africa as the only two advanced nations in the world that fail to secure its citizens against disease, and condemn families to a lifetime of poverty when their children fall ill."
Daschle failed to also point out that it was South Africa which performed the first heart transplant and the United States which developed successful life-saving heart transplant and heart by-pass surgeries. That's one reason why medical costs have gone up - new procedures that save a lot more lives were developed by America's and South Africa's once free medical institutions. Of course, when left to market forces, those heart by-pass surgeries fell in price much like computer prices fell in price, when left to market forces. But, who wants improved and new medical discoveries when we can have socialized medicine like China and Russia?
But, folks, it could be worse. We could have 100% of the people in HMOs instead of merely 60%. If Americans continue to believe the anti-doctor propaganda of the Clintons and the socialized medicine lobby, they will deserve the cheaper and less effective methods of those countries Daschle admires.
To Comment: mmostert@waveshift.com