Protect Patients, Not HMO Profits

By Senator Paul D. Wellstone

July 16, 1999

For the St. Paul Pioneer Press

It is heartbreaking to talk to a father whose son was denied experimental treatment for cancer by an HMO when that father wonders if his son might have lived had the treatment been made available. It is disheartening to meet with a railroad worker whose wife talks to you about how courageously he is fighting a terminal illness, but how every day she is on the phone battling health insurance companies to see whether or not they will provide needed coverage.

Such real life stories are why I have been an advocate for a "Patients' Bill of Rights" ever since becoming a senator. This week the Senate debated competing Democratic and Republican plans to provide patient protections. There are important differences between them.

The Democratic Patients' Bill of Rights covers all 163 million people in America who are privately insured. The Republican plan extends only to certain kinds of plans, reaching just 48 million people.

The Democratic plan guarantees access to specialists. That way parents may take their child to see a pediatric oncologist when they need to, or take an a older parent with Parkinson's Disease to see a neurologist. The Republican plan provides no guarantee of access to needed specialty care.

The Democratic plan allows you the right to keep your family doctor if your employer switches managed care plans, and gives you the right to go outside of the HMO's provider network to see specialists. The Republican plan denies you the choice of a doctor, fails to guarantee the continuity of your care, and will not permit you to go outside the HMO's network to see the best specialist, even if you are willing to pay a little bit more.

The Democratic plan allows women the right to have their OB/GYN as their primary care physician. The Republican plan denies women that right.

The Democratic plan gives you the option, if you believe you have been wrongfully denied needed care, to appeal the HMO's decision to an outside, independent organization. The Republican plan would leave the very insurance company that you have a grievance against in charge of the appeals process.

Unfortunately, as I am writing this, the handwriting is on the wall in the U.S. Senate. Republicans and their allies in the insurance industry have defeated or weakened nearly all of the Democratic proposals that I have just mentioned. They have assured that in 1999, we will end the year without meaningful health care reform or with only a few, weak changes to the system that puts insurance companies' profits ahead of patients' health.

It is a familiar story. The insurance companies, no strangers to the halls of Congress, have spent millions on an advertisement and lobbying campaign to defeat real patient protections. These ads, some of which have run in Minnesota, employ scare tactics to say that the Democratic Patients' Bill of Rights would drive up costs and people would lose health insurance because the HMOs can't afford to provide basic patient protections.

Don't believe it. The ten leading managed care companies hauled in record profits of $1.5 billion last year. Their CEOs' salaries are in the tens of millions of dollars. And they spent $5 million to lobby Congress, not to mention millions more in campaign contributions.

The minimal cost of the Democratic plan-- about $2.00 per month per person -- is not a lot to pay for the right to choose your own doctor, the right to have access to needed specialists, the right to an outside appeal when you have been denied care, and the right for women to have an OB/GYN as their primary care physician. What insurers are trying to hide is that they are raising HMO costs, with or without patient protections.

What we cannot afford is when women and families and children do not get the care they need and deserve and as a result, become more sick and maybe even lose their lives because of this neglect.

As for the insurance companies' newfound interest in America's 43 million uninsured, Where have they been?

More than one million people every year are added to the ranks of the uninsured in this country. And it was the insurance companies that took the issue of universal health care coverage off the policy agenda in Washington. Patient protections are important by themselves, but they should go hand in hand with comprehensive, universal health care coverage. That should be our highest priority.

Whether universal health care coverage or the much more modest Patients' Bill of Rights, enacting meaningful health care reform is increasingly about whether Congress works for the big insurance companies or whether Congress works for the people. This week, Republican senators favored the interests of the insurance industry over their constituents.

Despite what happened this week, the insurance companies will not have the last word. The fight over meaningful health care reform is far from over. Like the battles which led to the passage of Social Security, Medicare and the minimum wage in past eras, if enough Americans continue to insist on a basic guarantee of quality, affordable health care for all, sooner or later Congress will have to respond.