The most contentious aspect of the managed care reform debate comes down to one question: When an insurance company denies care that could have saved a life, how does one explain to the family that the insurance company cannot be held accountable for its action?

That's what the Illinois Supreme Court addressed when it ruled recently that patients in Illinois have the right to sue their HMOs. And last month, the 3rd U.S. Circuit Court of Appeals in Philadelphia ruled that federal law does not exempt HMOs from medical malpractice suits.

In his Oct. 5 op-ed column, M. Anthony Burns cites speculation that the Norwood-Dingell patients' rights bill passed by the House would open the floodgates to litigation against employers. Recent analyses of the bill find the opposite.

The language of the bill, existing laws and past experience tell us that the sky isn't falling. In the two years since Texas enacted a law that allows HMOs to be sued for negligent decisions, only five cases have been filed.

Also, it has never been the intention of the American Medical Association and its members to hold liable employers who provide the health care benefit for decisions made by managed care plans. The bill exempts employers from such liability.

Further, Mr. Burns's comments about the effect that meaningful patients' rights legislation would have on employers run counter to the statements made by insurance industry representatives, who have said that holding managed care plans accountable for their actions would have no significant impact on health care premiums.

Some states, by legislation or court decisions, have given their residents the right to hold managed care entities accountable for their actions. It is time to extend that right to all Americans.



American Medical Association