In the Oct. 5 editorial "The Right Managed Care Bill," The Post said patients deserve access to an independent external system of review of health plan decisions. In fact, 30 states have such systems, and Medicare and Medicaid operate similar systems for their members. But The Post was wrong to suggest that such systems supplant the right to sue.

External review systems can prevent unnecessary injuries and deaths by reversing a health plan's bad decision before it causes harm to the patient. But these systems can do nothing for a patient who has been injured or killed as a result of a wrongful decision to deny care. In these cases, the only question is who should be held accountable.

The insurance industry argues that a broader right to sue will result in a flood of lawsuits and a sharp increase in insurance premiums. Yet millions of Americans -- including state and local government employees and Medicare and Medicaid beneficiaries -- already can sue their health plans, and few have done so. Even in Texas, where all consumers are allowed to sue health plans, only six suits have been filed in the two years since the law was passed.

Health plan executives who know they could end up in court will be much less likely to deny worthy claims in the hope that the patient will not protest. It is not a perfect system, but it is one that is tried and tested.



The writer is a senior researcher at Georgetown Public Policy Institute.