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  •   Panel Outlines Protections For Health Care Consumers

    By Amy Goldstein
    Washington Post Staff Writer
    Thursday, October 23, 1997; Page A01

    A presidential commission yesterday outlined a broad set of protections for consumers frustrated by a changing health care system, proposing that patients be guaranteed a choice of medical plans, more information to make smart decisions and new ways to protest when they become dissatisfied with their care.

    Under the proposal, intended to protect all Americans with insurance, health plans would be forbidden from imposing "gag rules" that restrict the kind of treatment options physicians can mention to their patients. The confidentiality of medical records would be guarded more closely. And patients who are pregnant or chronically ill would be able to keep their own doctor for a guaranteed period of time, even if forced to switch health plans.

    The proposed "bill of rights" is the first concrete plan to emerge from a diverse panel – including representatives of insurance companies, consumers, physicians and employers – that for months has been debating what safeguards Americans need to ensure good medical care. As a result of a quiet, ongoing revolution in health care, most patients now are covered through health maintenance organizations and other forms of "managed care," which try to constrain costs by limiting how much and what kind of care people may receive.

    Even as its members found broad areas of consensus yesterday, the commission remained splintered over several important questions – whether health plans should be able to exclude people who are sick, for example, and whether the government should create a nationwide "ombudsman" system to help patients navigate the often-bewildering ways that their health care has changed. However, only those initiatives that won unanimous approval were included in the proposals agreed to yesterday.

    Health and Human Services Secretary Donna E. Shalala, one of two Cabinet members leading the commission, said the group had taken "remarkable steps" to expand patients' rights. But some commissioners disagreed. "It falls short of what the president asked us for. It excludes too much," said Ron Pollack, executive director of Families USA, a consumer-advocacy group.

    The panel plans to adopt its "bill of rights" in final form next month and to submit it to President Clinton, who will have to decide whether it should become the basis for legislation, regulation or exhortations for the insurance industry to police itself. The administration has given no indication which path it prefers.

    The Advisory Commission on Consumer Protection and Quality in the Health Care System is an attempt to look comprehensively at how to help protect patients in dealing with health insurers. Its work coincides with a flurry of largely piecemeal attempts to rein in managed care that have emerged in Congress, state legislatures, and various factions of the insurance industry.

    The panel also is the latest in a series of administration strategies, since the demise of its massive health reform plan three years ago, to tackle the issue in more finite ways. Last year, it backed the Kennedy-Kassebaum law that was designed to make it easier for people to get insurance after they become sick or change jobs. As part of the balanced-budget agreement, the White House gave its support to a $24 billion program to expand health insurance for children.

    "We aren't redoing the Clinton health plan," Shalala said yesterday, noting that the panel is not addressing the kinds of benefits insurance companies should provide or how to help the 41 million Americans who have no insurance.

    Even in its more targeted debate on the rights of insured patients, the diverse, 37-member commission has become a miniature version of the deep cleavages in opinion over what changes are needed in health care, and what role government should play.

    On issue after issue, representatives of consumers and health professionals argued for greater patient protections, while employers and insurance executives opposed them for fear they would cost too much.

    As a result, the draft excludes a proposal to guarantee patients the right to take part in medical research to test the effectiveness of new treatments. The panel deferred until next month its decisions over ombudsmen and whether to prohibit health plans from discriminating against certain high-cost or low-income patients in their marketing and enrollment practices.

    At the end of the two-day debate that ended yesterday, several commission members said they remained uncertain whether the final version will go far enough in protecting patients for them to support it. Some have talked of turning in a minority report.

    Nevertheless, the panel agreed on several important protections that would exceed those currently available to most patients.

    It recommended new restrictions to ensure the confidentiality of medical records, largely echoing a proposal that Shalala made to Congress last month – with one significant difference. Shalala urged that law enforcement investigators be granted broad access to patient records, without their knowledge and with their names' attached. The commission recommended such access only for investigations of health care fraud.

    The commission also proposed a major expansion of the information that doctors and health plans must give patients. If patients need surgery, for example, their doctors would have to disclose how many times they had performed that type of operation.

    For the first time, employers also would have to offer their workers a choice of health plans. And if consumers believed that their health plan had failed to provide or pay for the treatment they deserved, they would be able to appeal to an impartial, outside review panel – a protection available now only in seven states.

    © Copyright 1997 The Washington Post Company

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