'Dying for Reform'
Sunday, August 16, 1998; Page C06

Robert Samuelson's op-ed column on managed care reform legislation reads like a compilation of press releases put out by the American Association  of Health Plans, the HMOs' mouthpiece ["Myth of the Managed Care Monster," July 29].

Mr. Samuelson seems to think that managed care is great because it has held down health costs, and evidence of HMO abuses is "anecdotal." This is a convenient way to brush under the rug the hundreds of people who have died or suffered serious injury because their health plans denied
needed medical care. The problem is exacerbated by a loophole in federal law that allows group health plans to skirt legal responsibility for their bad decisions.

Mr. Samuelson also seems to imply that the organizations that support managed care reform do so for financial gain. He ignores the fact that a key provision of the Patients' Bill of Rights is designed to prevent doctors from getting paid more to withhold care.

Moreover, the bill enjoys the support of more than 170 groups, including the American Cancer Society, the Center for Patient Advocacy, AARP, Consumers Union, the American Nurses Association and the AFL-CIO. These groups support the Patients' Bill of Rights because consumers need protection from a health care delivery system that results in companies making more money for providing less care.

Businesses pushed their employees into managed care because it promised lower premiums. At first, it may have produced savings through steep discounts. But reports from around the country show that HMOs are planning double-digit premium increases for next year. Prices have been kept artificially low to gain market share, but that does not translate into a long-term solution.

Finally, Mr. Samuelson suggests that the problem is not significant because 66 percent of those in managed care rate their health plan favorably. That misses the essential fact that most people are healthy. However, many people live in great fear that if they get sick, their plan won't live up to its promise. The Post recently ran a cartoon in which a health insurance executive tells a patient, "Of course we're concerned about you -- you're close to meeting your deductible." Patients are happy when they are healthy, but they are justly afraid that they will have trouble getting quality care if they become seriously ill.

Opponents of HMO reform legislation frequently say that the stories of HMO malpractice are just "anecdotes." This is a sanitary way to dehumanize the mothers and fathers, friends and neighbors, who have fought with their plans for needed medical care and been denied. Congress and the president must agree on managed care reform legislation this year, before the list of "anecdotes" grows any longer. Our constituents are literally dying for reform.

GREG GANSKE

U.S. Representative (R-Iowa)

Washington

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