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March 11, 2000, Saturday, Home Edition

SECTION: Metro; Part B; Page 7; Editorial Writers Desk

LENGTH: 542 words

HEADLINE: HEALTHY COMPROMISE;
LEGISLATORS SHOULD SHUN MANAGED CARE REFORM THAT HAS LITTLE CHANCE OF PASSAGE. A REGIMEN OF COOPERATION MIGHT BE THE RIGHT MEDICINE.

BODY:
Last year, Gov. Gray Davis signed into law a raft of bold reforms of managed health care. The legislation created the Department of Managed Care, gave patients the right to sue their health plan for harm and guaranteed an independent medical review when an HMO denies needed services.

This year, legislators have introduced similarly sweeping health reforms, but without any sign of the spirit of compromise that allowed last year's bills to pass. So far the proposed reforms are pitting one special interest against another and inspiring name-calling rather than consensus-building. For instance, Sen. Jackie Speier (D-Daly City) says her new bill to exempt doctors from antitrust laws so they can negotiate higher fees from "monster" HMOs is essential because of the HMOs' overwhelming power. But HMO lobbyist Bill Wehrle derides Speier's bill as a cartel for doctors, "California's answer to OPEC."

Legislators are in danger of repeating the sins of previous years, when committees would spend months crafting impractical and competing managed care reforms, which were then defeated in other committees or vetoed by the governor. The Legislature can avoid this by putting less divisive bills at the top of the agenda and seeking common ground on the more controversial ones.

The most viable and arguably most essential reforms would reduce the number of Californians without health insurance, which soared to 7.3 million in 1998. Legislators should prod the Davis administration to clear bureaucratic roadblocks that thwart families from enrolling in Medi-Cal and Healthy Families, the state's health insurance programs for the working poor. Underenrollment in these programs is preventing California from collecting more than a billion dollars in federal matching funds.

As Walter Zelman, the head of the state's managed care industry lobbying group, pointed out Friday in a speech to state physicians, compromise might be possible even on the two reforms his association most strongly opposes:

* Speier's SB 2007, which would exempt doctors from antitrust laws so they can band together to gain higher fees from HMOs. Zelman's group opposes the bill because it would prevent managed care plans from wrangling the best deal from individual physicians. But he said his group might support requiring health plans to pay physician groups far more promptly than they do now.

* AB 1751, by Assemblywoman Sheila Kuehl (D-Santa Monica). This legislation would ban mandatory binding arbitration clauses in health care contracts that prevent patients from taking grievances to the courts. There is no broad political support for Kuehl's sweeping measure, but legislators could make arbitration considerably fairer by passing a moderate reform bill by Sen. Richard Polanco (D-Los Angeles) that would compel health plans to apply to arbitration the procedural safeguards that patients would get in court. In addition, the Legislature should subject arbitrators to rules that help ensure objectivity.

Another argument for moderation is that most of the hefty reforms passed last year won't go into effect for several more months. Let's see how that legislation affects the current state of managed care before forging too far ahead.

LOAD-DATE: March 11, 2000