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We were hardly surprised when a group of Republican and Democratic state legislators last month proposed a model bill to restrain what they described as "managed care excesses."
As we reported, the measure-intended for adoption by state legislatures around the country-would guarantee patients their choice of providers so long as they pay an additional fee; allow the patient to pick a specialist as a primary care physician; prohibit so-called gag clauses; and require plans to disclose limits on coverage for experimental treatment and to provide written justification of denials (BI, Jan. 20).
This proposal isn't the only example of what we would call managed care bashing. In New York, for example, Gov. George Pataki and leaders of the state legislature have agreed to jointly back legislation that would allow patients and their physicians-not insurers-to decide how long they need to remain in the hospital after mastectomies.
We fully expect these proposals to be only the first of a wave of anti-managed care measures.
Indeed, managed care bashing got its start last year when Congress passed legislation-effective next year-that will require health care plans to provide 48 hours of inpatient coverage after a normal delivery and 96 hours after a Caesarean section.
It would be overly simple to say that the managed care industry has no one to blame but itself for the beating it is taking now.
Many employees still resent the loss of the freedom they once had to pick any provider as their physician. And many providers, unquestionably, have had difficulty adjusting to a health care system where their leverage to charge the fees they want has been severely eroded by the power of managed care groups, especially health maintenance organizations.
Having said that, the managed care industry, through its own practices, has set itself up as a juicy target for attack.
Kicking mothers and their newborns out of the hospital one day after delivery, which HMOs took the lead in doing, has no defense. Nor can baring physicians from discussing with patients alternative treatments be defended.
Similarly, how can one defend any health care plan that would force-or even encourage, as some HMOs apparently were doing-women to leave the hospital immediately after a mastectomy.
When outrageous practices occur, there will indeed be a backlash against those practices. The trouble, though, with a backlash is that legislators-to cure what they see as a problem-often end up taking far more action than is necessary.
The shame of all this is that it is so unnecessary. Sometimes, we wonder if the managed care industry has lost sight of what it is all about.
We see managed care as providing the optimal level of care at reasonable prices. That means, for example, all necessary services should be provided and length of stays in hospitals geared to what is needed to best assure rapid recovery.
Practices like "drive-through" deliveries and gag rules seem to us not only an abuse of power, but also anti-managed care. Providers should, in fact, be encouraged to discuss treatment options with their patients, while too-rapid discharges from hospitals are likely to lead to medical complications and ultimately higher costs.
The managed care industry still has time to get its act in order. But if it fails to do that, legislators will be only too happy to do it for them. Given that legislative interference in the health care arena often does more harm than good, we hope the industry, through self-policing, doesn't let that happen.