California voters to have their say on HMOs
May 18, 1996
Web posted at: 6:20 a.m. EDTLOS ANGELES (CNN) -- Not a day goes by that Linda Ross doesn't mourn the death of her mother who died almost five years ago at the age of 61 due to complications resulting from blood clots.
"She was my best friend and we had a very close relationship and when she was gone it was like this void that's still there. She was really special."
What makes it so unbearable for Ross is that her mother's life might have been saved had doctors promptly examined her. It is a mistake the hospital, run by a health maintenance organization (HMO), admits it made. Ross was awarded a $150,000 judgment from the hospital.
"Ms. Ross's mother came into the emergency room and our protocol showed that she should have been seen within 30 minutes to an hour and that did not occur. It was human error," Trischa O'Hanlon of Kaiser Permanente Hospital.
Ross thinks it was an error that could have been avoided had the hospital been adequately staffed. She thinks her mother became a victim of an HMO-run hospital motivated more by cost-cutting than the care of its patients.
She is not alone. "What we're seeing is a tremendous increase in the number of complaints and horror stories, including fatalities, associated with the rush to corporate, profit driven health care in our country," said consumer advocate Harvey Rosenfield.
Now, nursing and consumer groups say they have the signatures to let voters take on California's powerful HMO industry this fall.
"The HMO's and insurance companies are making huge profits by denying people health care that they've already paid for and that they need," said Dr. Jennifer Reifel, Consumers United Against HMO Abuses.
The groups are sponsoring two separate but competing initiatives aimed at curtailing alleged HMO abuses.
Both the initiatives would, among other things: ban HMO financial incentives to doctors or nurses who deny or delay health care; require second opinions before insurers could deny payment for care recommended by a doctor; and set up a watchdog agency for consumers and patients.
The HMO industry opposes the inititatives on grounds that they would create a large bureacracy funded by higher taxes. łThe impact ... will be to drive up the cost of health care and make it unaffordable for more and more Californians," said Arthur Southam, a representative of the California Association of HMOs.
Opponents also suggest the initiatives are nothing more than thinly disguised attempts to preserve union jobs while offering no new consumer protections.
Deciding which side is right apparently will be made by California voters in a high-stakes local battle that will surely fuel the national health care reform debate.
The two initiatives willbe on the November ballot.
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