Health maintenance organizations are proceeding with their massive behavior modification program with generous help from Republicans in the Senate. The HMOs have been trying to persuade Americans not to get sick, or, if they insist on doing so, to have the decency to drop dead and spare their insurers a great deal of expense.
The Republicans understand. People can be so unreasonable. For instance, they experience chest pains in a location far from the emergency room of the hospital the HMO has chosen for them. They go to the nearest hospital, and the next thing you know a doctor has detected something else wrong with them. Under the HMO's rules, the offending patient must be transferred to a hospital on the approved list. Or, he must expect to be asked to pay more. It's a penalty for showing the bad judgment of getting sick in the first place.
HMOs treat old ladies like suspected drug dealers. If they come in with a request for a refill a day or two ahead of schedule, they must be punished. Maybe the doctor told them--and not the insurance company--that if they felt woozy they should take an extra dose. Or maybe, shuffling about in the morning, when everything is so marginal, they dropped the medicine bottle down the gap between the sink and the stove and can't get it out.
Don't try any of these hard-luck stories on the HMO wardens, who are on to their rapacious ways. The old girl can get her medicine, but she must pay for her recklessness--full price instead of the reduced price that she thought she had paid the insurance company to give her. As for going on vacation and getting advance rations, HMOs don't like it. There's a way to do it, they say, but they never tell you how.
But women are tiresome anyway. They do all sorts of things to irritate their HMOs. An example: They get breast cancer. They require surgery, which they unaccountably find traumatic. HMOs have told them, time and time again, to pull up their socks and keep moving. They expect to stay in the hospital, in total disregard of the HMOs' profit sheets. They object to what Democrats call "drive-by mastectomies," which can be done in a day and have them home in time to get their husbands' supper. They whine that they are still bleeding, a spurious argument that does not move the bookkeepers, who rank higher than doctors in the HMO hierarchy.
Sen. Charles S. Robb (D-Va.) introduced a women's health amendment that would have let the doctor decide how long the woman would stay in the hospital after her operation. The Republicans turned him down 52-48 but accepted a similar amendment from Sen. Olympia J. Snowe (R-Maine). But they rejected the right of a woman to have a gynecologist as her primary care doctor.
HMOs drive many Americans crazy, and they have driven doctors to form a union. But Republicans don't mind. They have found the perfect front man to present their case. He is the Senate's only doctor, Bill Frist (R-Tenn.). He is not just a distinguished heart surgeon, but also is tall, handsome, courtly and endlessly earnest. He was a Capitol Hill hero last year when a crazed gunman started shooting under the dome.
Edward M. Kennedy, the Democrats' lead man, obviously is not comfortable bellowing at him. The Massachusetts senator, a grizzled veteran of the health care wars, shouts a lot at his other Republican colleagues. On the second day of the debate, smug Don Nickles of Oklahoma, the GOP whip, told him, with a sneer, that his "bill of rights" would cost many Americans their coverage.
Kennedy, who seems to burlesque his florid oratorical style, shouted back, "That's a red herring." He spoke with such force the papers on his desk bounced. Then Kennedy joined in the bipartisan wagering about when he would have a heart attack from so much roaring and arm-waving. Democrats jocularly speculated that, under Republican restrictions, if Kennedy were stricken, he couldn't get Frist to help him.
Frist made matters worse by appearing chagrined when Kennedy pointed out to him the consequences of certain callous Republican provisions. He kept promising revisions, but they never occurred.
Republicans have bought into the HMO view of ailing Americans as rapacious malingerers who are full of tricks. The sub-theme in the debate was that they are not to be trusted. Some of them deliberately contract cancer and are told by their doctors they have six months to live. Their insurance runs out after 90 days of treatment, but do they take the hint? Do they turn their faces to the wall out of decent respect for the balance sheets of their HMO, whose chief executive officer may get only $20 million a year? They do not.
The Democrats say the Republicans will pay for their obtuseness. The bill, they believe, may be presented by the voters in November 2000.