It’s about time

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His name is Jimmy Adams. He’s 7 years old, and he has no hands or feet. That’s because when he was an infant suffering from a high fever that sent him into cardiac arrest, his parents’ health maintenance organization denied him access to the nearest emergency room. By the time they reached the HMO-approved hospital 70 miles away, his hands and feet became gangrenous and had to be amputated.

This didn’t happen long ago in some developing nation. It happened in suburban Atlanta in the mid-'90s and, under current federal law, the HMO was responsible for nothing more than the cost of his amputations.

Horror stories like this are not hard to come by in the era of managed care, and for five years the right of people like the Adams’ to sue HMOs for medically negligent decisions has been at the center of a fierce debate in Washington. Now, reform-minded lawmakers of both parties are squared off against President Bush, who has promised to veto any bill that does not strictly limit such rights. That’s not the sort of “compassionate conservatism” Bush promised when he was running for office, and it’s not what’s best for the country.

In contrast to the bipartisan congressional proposals, the Bush-supported Republican alternative would void state laws allowing patients to sue in civil court and limit judgments to $500,000. Naturally, this watered-down “reform” has support from the HMOs, which recognize that the limits could save them millions. In fact, recent weeks have seen the HMOs spending their millions on television ads to convince you that the bipartisan reforms will result in a slew of frivolous suits, a windfall for trial lawyers and an economic meltdown.

Nothing could be more misleading. The truth is that costs would be marginal—unless an HMO is proved negligent. Patients could sue only after HMOs had been deemed medically irresponsible by an external review board, thus shielding the companies from frivolous suits. In California, where a similar state law has been in effect since January 1, the panel has ruled in favor of the HMOs 65 percent of the time, and not a single suit is known to have been filed following more than 160 hearings, leading analysts to conclude that, knowing their potential liability, HMOs are changing policy.

The bottom line is that HMOs will only change if being negligent becomes more costly than doing the right thing. By guaranteeing Americans the right to sue for judgments of up to $5 million, the bipartisan reforms will force HMOs to realize that every decision they make must be justifiable to a panel of doctors, and not merely to their own accountants.

It’s long past time to hold the HMOs accountable for the decisions they make. We urge Congress and the president to pass patients’ rights legislation now.