Letters on Regulating Health Care

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Sacramento Bee

Those who pay skyrocketing HMO premiums cannot afford to be as incurious as Weintraub was in his column, in which he condemned legislators and consumer groups for sponsoring legislation that would require the HMOs to make their case to someone in addition to Weintraub before they raised their rates.

Small businesses’ rates have soared about 20 percent for three straight years; profits are at record levels; HMOs are amassing unheard-of surpluses. Yet, as Bear-Stearns, an industry analyst firm, observed recently: “We continue to see evidence that medical cost trends have peaked … a factor we expect will be more evident in 2003, resulting in continued margin expansion.”

I agree with Weintraub that just looking at HMO profits is not sufficient to do a thorough review. This is why SB 26 doesn’t just look at HMO profits, a fact strangely ignored by Weintraub.

What are the HMOs hiding? The HMOs and Weintraub should welcome the opportunity to prove their case to those of us more skeptical about HMOs and their unverified data than Weintraub appears to be.

-Jerry Flanagan, San Francisco Health Care Advocate, Foundation for Taxpayer & Consumer Rights


Re: “Ruling backs states’ power over HMOs,” April 3:

U.S. Supreme Court ruling upholding a state’s right to regulate HMOs is a landmark decision.

It defines HMOs as health care insurers, a responsibility HMOs have been dodging for decades, and it upholds the right of a state to regulate its insurance industry even if the HMOs try to hide behind the federal ERISA loophole.

The ruling also legitimizes the “any willing provider” (AWP) laws by which states can mandate that HMOs do business with any provider (hospital, doctor, pharmacy, etc.) willing to care for a patient. Most important, it upholds the concept that we have the right to access essential health care; and providers and insurers alike must respect that right.

Unfortunately, California does not have an AWP statute. Our HMO industry is strong and most providers and patients have long since been herded into managed care groups. Indeed, we have been bound to this treadmill of capitated care for so long that even the California Medical Association is afraid of change.

The arguments are complex and confusing, but one simple truth remains: We benefit from freedom of choice, and AWP laws uphold this right.

-Lawrence A. Danto, M.D., Truckee

Consumer Watchdog
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