Lawsuit Issue May Be Key To Managed Care Reform
Republicans, Democrats indicate room for compromise
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WASHINGTON (AllPolitics, July 19) -- To sue or not to sue -- that is the question upon which the fate of congressional attempts to regulate managed health care may hinge.
Democratic leaders in Congress and the White House support giving patients the right to sue their insurance companies if they are hurt by a decision not to pay for care they request. But some Republicans, including Senate Majority Leader Trent Lott (R-Miss.), oppose such a provision, saying it will drive up health care costs.
"Do they want results or do they want lawsuits?" Lott said during an interview on "Fox News Sunday." "I think the answer should be found in the operating room, not in the courtroom."
But Health and Human Services Secretary Donna Shalala, also speaking on "Fox News Sunday," defended giving patients the right to sue, saying that "without that enforceability, you simply don't have any rights that are worth anything."
However, with reform of managed care looking like the dominant issue in the closing months of this year's congressional session, both sides are indicating they think there is room for compromise.
Republicans have put forward a proposal that, in lieu of lawsuits, would allow patients to demand quick internal reviews of decisions to deny coverage and then give them the right to an additional appeal to independent medical experts.
Lott said that many Americans who think they would rather sue will discover that when given a workable appeals process, they are actually better off.
But the Senate majority leader indicated that Republicans won't draw a line in the sand on the lawsuit issue.
"I'm opposed to [the right to sue]. I think it is a mistake," Lott said. "But I'm not going to start now, like the administration would do, by saying, 'It's my way or no way.'"
A leading Democratic voice in the health care debate, Sen. Christopher Dodd (D-Conn.), indicated Sunday that Democrats might support an appeals process -- if patients are given the right to sue in some circumstances.
"Having no damages at all ... it's going to be very difficult to have the kind of incentive to see to it that patients are going to get the kind of protections they deserve," he said.
Democratic and Republican plans for managed care reform would both require health plans to pay for emergency room care and let women see an obstetrician-gynecologist without prior authorization. However, the Republican proposals would only apply to about 48 million Americans enrolled in federally regulated health plans.
The GOP also wants to give Americans the option of opening tax-free medical savings accounts, personal investments that would pay for health care. The White House strongly opposes the idea, insisting that those accounts will siphon healthier and wealthier Americans out of regular health plans, driving up costs for those who are left.
The Associated Press contributed to this report.
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