NAELA News August, 1999 - National Academy of Elder Law ...

NAELA News ● August 1999
Exclusive to the NAELA
News: An Interview with
Jane Bryant Quinn
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RCM
In terms of managed care and
HMOs, last year in Congress
both parties had a proposal on
patients’ rights. One of the
differences that was often made
between the Republican
proposal and the Democrat
proposal was that the Democrats’
proposal gave the patients the right
to sue. The managed care HMO
issue is back before Congress this
year and they’re hoping this year to
do something regarding patient
rights. Would you like to see
Congress give patients the right to
sue the managed care plans or the
HMOs?
Quinn I think that the right to sue is not
the ideal solution. However, what
we have now is worse. Today,
managed care can deny you, in
most states, with no accountability.
If they’re wrong, it’s your
problem, not theirs. So there’s an
incentive for plans to say no
more than they otherwise would.
There’s no question about it.
That’s how incentives work.
Lawsuits are not the best solution
because they’re a lottery. Some
people win big tickets, some
Mark Your
Calendar!
NAELA’s Washington State
Chapter will hold its annual
meeting in Seattle, WA on
September 24, 1999.
NAELA President A. Frank
Johns, CELA, will be the
featured keynote speaker.
For more information,
contact meeting chairperson
Janine Lawless at
(206) 782-9535.
people win nothing, some don’t
sue at all. Lawsuits also put
insurers and doctors into a
defensive posture. They hide
records. Nobody can find out
what really happened, because
they’re all looking for the
scapegoat. My preference is
something no one is suggesting:
that’s some form of nofault.
If you are injured in a
hospital, you’d get paid by
your own insurer. There’s a
designed program, defining
what’s covered—rather like
worker’s comp. No-fault would
also encourage hospitals to be
more forthcoming, when
something goes wrong. It’s
usually not one bad doctor or
nurse. It’s a whole system. A
lot of little things go wrong,
with catastrophic results. If
you had no-fault, there would
be more incentive to look at
how these systems work, to
correct these little failures. But
no-fault won’t happen. You
can’t even get it through for
auto insurance, in most states.
That leaves third-party review,
using systems not connected
with or indirectly controlled by,
managed care plans. You need
a lottery or revolving system for
choosing arbitrators. Review has
to be very timely. It has to happen
in 24 hours, when there’s a lifethreatening
case. But I don’t think
you’re going to get a timely review
system, either. So then we come
back to lawsuits, as the only option
even halfway on the table.
RCM Do you think it’s likely we’re going
to get anything this year from this
Congress?
Quinn The normal rule is that nothing
passes in an election year. However,
there was one election year,
maybe it was ’94, when all of a
sudden, lots of things passed,
because the public wanted them.
That could happen again. But it’s
most unlikely that something as
big as Social Security reform
could pass.
RCM So you don’t think we’ll get
Social Security or Medicare
reform this year?
Quinn Well, we’ve had a lot of Medicare
reform already, you know. We’re
in the process of cutting the
growing payments to providers.
The Balanced Budget Act ’97 cut
Medicare by $112 billion
between 1997 and 2002. We’ve
got this experiment with Medicare
called the Part C program.
It started in a few states and will
expand to the rest of them this
year. I don’t think much more is
going to happen now.
RCM: What about the Medicare
Commission?
Quinn They’ve proposed a radical
reform that privatizes Medicare.
It’s similar to something they did
for state retirees in Kentucky.
Retirees were given a lot of
options, for private plans. They
kept their equivalent of Medicare—their
fee-for-service plan.
What happened is just what you’d
expect. The people in good health
went off into the private plans,
the sick people stayed with the
indemnity plan, and the indemnity
plan went broke. The same
thing would happen with
Medicare. People would turn to the
private sector when they were
healthy. When they got sick or
started quarreling with their HMO,
they would go back to the plan.
You would have an even more
screwed up system. There’s a
strong push to privatize everything,
but I think it would be a
bad choice for Medicare. It
would also run up the cost. The
overhead for Medicare is much
lower than the overhead for
private systems. Also, the
government has done a better job
of controlling costs than the
private health system has.
Everyone seems to think that the
government doesn’t know how to
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