ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Monday, September 30, 1996 TAG: 9609300119
SECTION: EDITORIAL PAGE: A-6 EDITION: METRO
MANAGED CARE, when President Clinton proposed it as the foundation of health-care reform early in his presidency, was supposed to help bring costs under control. In the marketplace, as it has happened - absent government intervention to assure comprehensive coverage - managed care has gone a long way toward doing just that.
Lawmakers should keep that observation in the forefront when they are wrestling with the temptations of writing a law to settle every dispute between health-care provider and customer.
Managed care has not been a panacea for the health-care crisis that Republicans insisted did not exist. It does not provide insurance coverage for the working poor, for example - a continuing outrage in a nation as affluent as ours. But it has slowed the steep climb in insurance costs that had many in the middle class worried they'd soon be joining their less prosperous brethren among the great mass of uninsured.
That success has had a cost: in many cases, less care. This should not be a surprise. Nor is it in all cases a bad thing. Among the "waste" that had to be reduced to get costs under control was overtreatment in a fee-for-service system.
HMOs and other types of managed-care plans slowed the precipitous rise in employers' insurance costs by making cost-cutting a primary goal - in part, by encouraging doctors and hospitals to limit care to the minimum needed to treat a patient effectively.
"Effectively" is the key word, of course. HMOs, critics say, sometimes are willing to compromise patients' health because they are paid a fixed premium for each member each year. The less care provided, the more money they make. Ideally, this reduces unnecessary care.
But when disputes arise between numbers-crunchers and health-care professionals about what care is unnecessary, where does the public go? To lawmakers, of course, armed with horror stories and demands that there oughta be a law. And lawmakers are listening.
Virginia's General Assembly passed a law last year requiring insurers to follow medical guidelines on the length of hospital stays covered for mothers giving birth. Congress has enacted similar legislation, and various other restrictions on managed-care plans are being considered there and in statehouses across the nation.
Some of these limits may be helpful. Business practices that seek to limit the information patients may receive, or that impose financial penalties for needed treatment, ought to be banned, for example. But anecdotal evidence of poor medical care is not a sound basis for a slew of regulations that would undermine managed care and the savings it is achieving. Some medical misjudgments would occur in any system of care, including old-fashioned fee-for-service. And an increasing emphasis on preventive medicine under HMOs could well improve outcomes over time.
To date, there is no data to suggest that managed care results in worse outcomes overall. Until such day as that evidence exists, lawmakers who did not want government running health care should keep it out of the business.
LENGTH: Medium: 58 linesby CNB