Patients' rights vs. politicians' wrongs

With the recent change in the Senate leadership, patients' rights have once again become the hot topic on Capitol Hill. Leading the charge is Massachusetts Senator Ted Kennedy, who recently stated, "It is time to end the abuses of managed care that victimize thousands of patients each day." As a proposed solution to the problem, Senator Kennedy is aggressively pushing for a so-called "patients' bill of rights" that would allow patients to sue their health maintenance organizations (HMOs) for denying them necessary medical care.

What's ironic is that Senator Kennedy sponsored the legislation that spawned our nation's managed-care system. This law, known as the HMO Act of 1973, federally funded the creation of HMOs and required employers with 25 or more employees to offer HMOs to workers. (That requirement was halted in 1995 after more than 46 million Americans were already shepherded into HMOs.)

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Five years after the HMO Act of 1973 became law, at a hearing of the Senate Subcommittee on Health and Scientific Research, Senator Kennedy even praised himself for his role in the system's creation, saying, "As the author of the first HMO bill ever to pass the Senate, I find this spreading support for HMOs truly gratifying. HMOs have proven themselves again and again to be effective and efficient mechanisms for delivering health care of the highest quality."

Today, Senator Kennedy is not wrong in wishing to end the abuses of managed care and restore patients' rights. But, as he was in 1973, he is seriously misguided in his current policy prescription.

Rather than focusing on passing a law encouraging patients to sue HMOs, Congress would be much better off concentrating on fixing today's federal tax policy to prevent patients from being shepherded into HMOs in the first place. Although employers are no longer mandated to offer HMOs, many still do and employees are often coerced into joining them because of federal tax law. Here is how:

Currently, federal tax law says that if employers purchase health insurance for their workers, that money is not taxed. But workers must pay income taxes on money they use to purchase health insurance on their own. This means that workers must either accept their employer-sponsored health plans (often HMOs) or pay higher taxes.

Congress should change the federal tax law so that income spent on both
employer-sponsored and employee-purchased health insurance is excluded from taxation. That way, rather than being forced into an HMO in the first place, Americans can instead choose another type of health insurance without paying higher taxes.

In addition, Congress should focus its attention on reducing the overall tax burden of every American. Although President Bush's tax cut is a move in the right direction, even lower taxes would free up more money that would allow people to pay privately for the health services and insurance of their choice. It is well known that, "he who pays the piper calls the tune." Until individuals are the ones paying the bills and choosing their insurance, they won't truly have control over their own health-care decisions.

Congress also should deliberate on other policies that would restore citizens' freedom of choice in health care, including making it possible for patients to contract privately with doctors and other health-care practitioners of their choice, permitting Americans to maintain private patient-doctor (or other provider) relationships, and – most important – allowing patients to choose experimental treatments without government (namely Food & Drug administration) interference.

Today, strong consensus exists regarding the serious shortcomings of HMOs and managed care. As Senator Kennedy correctly points out, "The list [of problems with HMOs] goes on and on." But, without repealing or amending existing perverse laws, reducing taxes and restoring freedom of choice in health care, no legislation can truly be deemed a patients' bill of rights.

Senator Kennedy, let's do it the right way this time. Let's make sure any and all future health-care proposals do not continue to erode Americans' health care choices and access to services they so desperately seek.

Sue A. Blevins is president of the Institute for Health Freedom in Washington, D.C.