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Copyright 2000 The National Journal, Inc.  
The National Journal

April 15, 2000

SECTION: LOBBYING; Pg. 1225; Vol. 32, No.16

LENGTH: 990 words

HEADLINE: A Cure Worse Than the Disease?

BYLINE: Marilyn Werber Serafini


The trade group for health maintenance organizations insists that
its two-week, $ 200,000 advertising blitz was intended to unite
health care interests on liability issues. Instead, the
controversial television ad has inspired a huge rift between the
American Association of Health Plans and just about everyone else
in the health care industry.

     The first line in the ad has infuriated doctors, hospital
groups, and nurses. "Medical mistakes can kill," the 30-second ad
states, below footage of a surgeon in an operating room. The ad
continues: "Washington prefers more lawsuits. But lawsuits don't
save lives-doctors do. Get patients the care they need instead of
getting lawyers the clients they want." The ad ran on CNN and
several national TV shows in late March and early April.      "My members are ballistic," said Thomas A. Scully, the
president of the Federation of American Health Systems, a trade
association that represents for-profit hospitals. Repercussions
from the ad campaign are already being felt. For example, the
federation and the AAHP had started running joint ads that argued
against cuts in Medicare spending. After receiving angry
telephone calls from his members about the AAHP's TV blitz,
Scully said he pulled the ads. "The fact that they would aim the
gun at us when we were trying to be nice to them is outrageous,"
he said. "This is going to be remembered for many, many years.
Hospitals are going to take extremely aggressive shots at managed
care plans for a while."

     The federation had also planned to join the AAHP in
opposing a House bill that would change the antitrust laws by
allowing doctors to collectively negotiate with health insurers.
Instead, Scully's association may support exemptions to the
antitrust laws that would permit groups of doctors and hospitals
to negotiate contracts with HMOs and other managed care plans.

     The ad also outraged the American Hospital Association,
the American Medical Association, and the American Nurses
Association. "Differences of opinion have existed among our
organizations, but the health care community has always been
together on one fundamental tenet: Public confidence in the
health care delivery system should not be threatened or
sacrificed for political benefit," the groups said in a joint
letter to AAHP President Karen M. Ignagni. "The American
Association of Health Plans has crossed that sacred line." The
groups urged her to pull the ad, but the campaign continued.

     Instead, Ignagni immediately telephoned the angry leaders
of the other health associations and said they had misinterpreted
the ad's message. In an interview, Ignagni said that the ad's
critics should watch the ad before going on the attack. "What's
happened here is that there was a very quick reaction prior to
viewing the ad. Now individuals who've had the opportunity to see
the ad, and listened to the intent of the message are probably
realizing there was a jumping of the gun."

     The ad's message, says the AAHP, is that too many people
are looking to litigation to solve health care problems. On March
22, the day before the ad blitz began, Ignagni sent letters to
the leaders of several health care associations and urged them to
work with the AAHP on a joint position on liability.

     Medical providers want liability protections in
legislation that would require doctors and hospitals to report
medical errors. For years, they've also sought caps on
malpractice awards. But the hottest issue on Capitol Hill is the
right of patients to sue HMOs and other managed care plans for
denying them coverage for treatment.

     Neither the ad campaign nor Ignagni's effort has found a
receptive audience on K Street. "They know exactly what they're
doing," the hospital group's Scully said. "They're clearly trying
to say that medical errors is the problem, not managed care."

     Leaders of other health care groups say the AAHP wants to
divert attention from discussions of patients' rights. "Patients,
physicians, and lawmakers have worked for more than half a decade
on a patients' rights bill to hold HMOs and other insurers
accountable. HMOs have fought back every step of the way," said
Nancy W. Dickey, a past president of the American Medical
Association. "As the only entity in society immune from
accountability for the harm they do, HMOs will do anything to
preserve their special status."

     The ad also attracted scathing criticism on Capitol Hill,
where House-Senate conferees are struggling to put the finishing
touches on a patients' rights bill. At an April 5 press
conference, Democrats and Republicans asked Ignagni's group to
pull the ad. "The ad is deceitful," Rep. Frank E. Pallone, D-
N.J., said at the press briefing. "They're trying to muck up the
(patients' bill of rights) conference. The ad is trying to enter
into the debate the whole issue of medical mistakes."

     At this late date, injecting medical mistakes into the
discussion of patients' rights would kill or delay the
legislation, several lawmakers said, because Congress has not
debated the issue.

     Ignagni's critics say they don't understand how the
AAHP's goals mesh with its strategy. Why, they ask, did the AAHP
raise the inflammatory issue of health care liability in a TV ad
campaign before discussing the matter with fellow trade group

     Despite the firestorm of criticism, Ignagni defends the
AAHP's decision to take to the airwaves. "To the extent that our
current television advertising campaign has helped spark a
broader awareness that the true path to patient protection is not
built on more litigation, that's a step forward," she said. Or
one giant step backward, say her critics.

LOAD-DATE: April 18, 2000

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