Congress is considering several versions of the Patients' Bill of Rights. The White House has promised to veto any legislation that goes too far. But according to the NCPA's Greg Scandlen, members of Congress, like old generals, keep fighting the last war. Most of the problems associated with Health Maintenance Organizations (HMOs) and other managed care providers are being fixed -- not by legislation, but because of the demands of the market, evolving case law and changing public perceptions.

• A Kaiser Family Foundation survey found Americans report far fewer problems with their health plans than they enumerated in a similar survey three years ago -- in some cases a drop-off of 40 percent (see table).

• When asked if they favored the Bill, 85 percent said they did and 10 percent opposed it.

• But when asked if they still favored it if it raised premiums $20 a month, the numbers went to 60 percent and 30 percent respectively.

• And if it meant some companies might stop offering health plans to their workers, only 41 percent continued to support it while 47 percent opposed it.

As for the provision allowing people to sue HMOs for malpractice if they make "life-or-death decisions," the Supreme Court has already ruled (in Pegram v. Herdrich) that they can. In fact, HMOs are being sued left and right.

The lawsuits and the changing face of the marketplace have caused HMOs to reduce their use of "gatekeepers" and "capitated" payments to physicians and drop utilization review and preadmission certification requirements.

In fact, says Scandlen, in many cases they have stopped being HMOs at all, moving instead to become "point of service" plans or "preferred provider organizations" -- and making the Patients' Bill of Rights unnecessary.

Source: Greg Scandlen (NCPA), "Fighting The Last War," NCPA Brief Analysis No. 363, June 28, 2001.

For text http://www.ncpa.org/pub/ba/ba363/index.html