You think we've made great progress, do you? Think again.
Headlines this week seemed designed for people who are inclined to crow at the dawn of the millennium. An example: "HMO to leave care decisions up to doctors." Big deal. Soon we'll be told that plumbers, instead of poets, will be called to fix pipes.
The story that prompted this remarkable return to the obvious was about UnitedHealthcare, one of the largest health maintenance organizations, and its decision to drop its practice of requiring doctors to seek approval before prescribing hospital stays or further procedures.
Ever since managed care came into being--and turned out to be often more managed than care--sensible people have been pointing out that it was reducing doctors from demi-gods to lackeys and elevating bookkeepers to the status of medical potentates. Now United has come out and seconded the motion. It'll let doctors make those life-or-death choices.
It is true that United did not say it was sorry or, for that matter, wrong. But it gave a reason that Republicans usually respect--the bottom line. It was losing money hiring clerks for the express purpose of harassing doctors and making people feel guilty for getting sick.
United's motives are not important. Its timing should have been. United made its announcement just as the Republicans were sending the Managed Care Improvement Act of 1999 off to the Capitol Hill equivalent of hospice care--a hostile conference committee. The bill passed the House on Oct. 7 by a vote of 275 to 151. Sixty-eight Republicans defied their leadership, which has conditioned them not to feel sorry for anybody but tycoons who have to pay taxes, to vote the popular will on the matter. Eighty-two percent of the voters want HMO reform.
This triumph was brutally reversed a month later. House Speaker J. Dennis Hastert, who earlier had made encouraging sounds about the necessity of health care changes, announced the roster of House conferees who would be sent to the other body to iron out the considerable differences between the House and Senate bills. The lineup was astonishing. Of the 13 House members Hastert chose, 12 had voted against the Dingell-Norwood-Ganske bill. He had snubbed the two Republicans who had collaborated with redoubtable veteran Democrat John Dingell of Michigan to write the bill, and ceaselessly lobbied their Republican brethren to vote for it. The Senate in July passed its version of reform, which could have been written in an HMO boardroom.
Charlie Norwood, a big, genial Georgian, is a dentist, and keeps an outsized plastic molar on his desk "to remind me where I came from and why I am here." Greg Ganske, from Iowa, is more of an introvert, a plastic and reconstructive surgeon with strong views about what medicine should do for patients. Both had done battle with insurance companies while they were practicing.
Norwood "just wouldn't quit when the bureaucrats said no. I'd fight until I got someone with a medical background and hammered some medical information into him." Ganske fought for his disfigured patients and their right to better looks.
The Senate bill, steered to passage by Bill Frist (R-Tenn.), the Senate's only doctor, prohibits patients from suing HMOs if denial of treatment has led to death or catastrophe. That is its greatest difference from Dingell-Norwood- Ganske.
"The Senate bill is a joke," says Norwood.
He and Ganske are much heartened by the fact that United has seen the light. But they want it codified and they hope it may be contagious. The development, which was such big news elsewhere, caused not a ripple among reform's intransigent enemies in the Senate. Very commendable and all that, said Majority Leader Trent Lott and Assistant Majority Leader Don Nichols, but the conferees will not meet this year.
Ganske and Norwood are cheerful for a pair suffocated by their own side. They say 2000 will bring back the roses to the cheeks of their bill. Despite the expected flood of "soft money" from the HMOs, Norwood says, "It's a campaign year and people may be somewhat more willing to do what their constituents want."
"Around July," says Ganske, "you'll start to see a big change."