Monday, September 28, 1998

Patients' rights haven't wasted Texas

By Molly Ivins

AUSTIN - Sorry, Congress can't be bothered to do anything about abuses by HMOs and other managed health-care plans - too busy reading the Starr report. The House did pass a bill concerning health maintenance organizations, but it's so bad it would actually erode patients' rights, and President Clinton has already said he'll veto it. In the Senate, they're still bickering about how to debate the issue.

Meanwhile, HMO lobbyists are stepping up their public relations campaign with television ads claiming a patient's bill of rights with real teeth in it would "swamp the system, drive up costs and deny health care to millions." The ad campaign, paid for by the Business Roundtable, is coordinated by the same guy who made the "Harry and Louise" ads that destroyed the Clinton health-care plan in 1994.

We happen to know the allegations made in these new ads are not true because Texas, of all places, is ahead of the curve on this one. We're the only state in the country that has already passed a strong patient's bill of rights - major credit to state Sen. David Sibley, R-Waco - that allows patients to sue HMOs and establishes a separate appeals process when insurers refuse to pay for needed treatment.

Gov. George W. Bush and other Republican candidates would have you believe Texas teems with shark-like trial lawyers, ever looking to sue big companies. According to The New York Times, after more than a year of having the right to sue insurers, exactly zero cases have been brought. There have, however, been a number of appeals, and half of them have gone against the insurers.

None of the horrors predicted by opponents of a national patient's patient's bill of rights have come to pass. The system has not been swamped (there have been fewer appeals than expected); costs have not soared or even gone up; businesses have not dropped their coverage; and health care has not been denied to millions.

It's true more than 4 million Texans don't have health insurance (that's 23.9 percent of non-elderly Texans - the second-highest rate in the nation, according to the Kaiser Commission), but they didn't before the bill was passed, either. Unlike Pennsylvania, Texas does not even provide health insurance for children; 17.8 percent of our kids have no health insurance, and our school-based health clinics were only recently saved from budget cuts by election-year politics.

If not one lawsuit has been filed, one could argue, perhaps such a provision is not needed. But Texas doctors say HMOs are showing more willingness to go along with their treatment plans since the law was passed, according to the Times article.

Another major medical mess that's being ignored in the furor over the president's sex life is the home health-care situation. This beleaguered industry chose the day the Starr report was delivered to Congress to stage a rally at the Capitol hoping to draw attention to this issue. It got no coverage.

The problem here is a misguided effort to cut down on Medicare fraud and waste in the Balanced Budget Act. Medicare administrators responded to the congressional directive by imposing an annual cap on per-person home health-care costs. No matter how much the home health care costs, Medicare will reimburse the agencies only for $3,400.

According to the Dallas Morning News, since the cap was imposed last October, 650 of Texas's 4,000-plus licensed home health-care agencies have closed, and more are going under almost daily. The consequence, of course, is that many frail, elderly people can no longer get home health care and must now go into nursing homes, which cost Medicare much more money. This is not a shrewd response to fraud and waste.

There was abuse of the system before. According to the Morning News, the average annual number of home visits jumped from 33 to 74 between 1990 and 1996, with Medicare getting billed for each visit. The trouble with capping per-patient costs is that even though one patient may require only a monthly visit to check on heart medication, another - say, a double amputee with advanced diabetes - may require daily visits.

In theory, this problem will be solved when Medicare goes to something called a prospective payment system (PPS), which is the same system they use to pay hospitals. Unfortunately, by the time the PPS is up and running, there will be no home health-care agencies left unless Congress acts now to remedy the problem.

Texas Rep. Bill Archer, chairman of the Ways and Means Committee, has been notably tepid. In July, he sent out a "Dear Republican Colleague" letter that consisted entirely of how to handle the political fallout from this mess rather than addressing a solution. Since Archer is so hell-bent on cutting Medicare costs, I point out again that forcing elderly people into nursing homes is the most expensive option possible. The $1 billion he claims the PPS will save Medicare is nothing compared to what forcing folks into nursing homes will cost.

Creators Syndicate, Inc.