MANAGED CARE October 1997. ©1997 Stezzi Communications
MANAGING EDITOR'S MEMO
I don't want to sound naive, but a fundamental characteristic of democracy is that we work out solutions to problems in such a way as to benefit the entire society, meanwhile protecting the rights of minorities.
When you read Peter Wehrwein's cover story [1] on legislative intrusion into health care insurance, you'll get a broad picture of the forces at work on Congress and state legislatures. We often see these debates as "us vs. them," "doctor vs. HMO," "patient vs. plan," rather than look at what each category of legislation does for, or to, health care and society as a whole.
And often enough, things work out for the best. We're not just talking about whether Massachusetts or Virginia will lose a military base. We're talking about decisions that can raise or lower the standard of health care for all of us and our children, and just as easily raise or lower our standard of living through their effect on health care costs.
Until recently, there was no way a consumer or purchaser could compare plans except for price. Now NCQA, FACCT, JCAHO and others are attempting to measure quality. Under fee-for-service medicine, quality was seen to be referrals, tests and drugs on demand. Now we're looking at outcomes and at processes. Eventually employers won't support plans with too many readmissions of newborns; minimum-stay laws will be unnecessary. But those and other recent laws, while they may increase costs slightly in the short run, send a needed message to insurers: Americans want high-quality care and compassionate treatment by plan as well as physician.
A little legislative intrusion, then, has its uses. Where legislators are working against the general good, though, is in kowtowing to specific providers, be they chiropractors, acupuncturists or ob/gyns. This is a bad side of politics, one we see far too often. Special interests, not the public's fear of gag rules and premature hospital discharges, are the real enemy.