Regarding the editorial “Sue your HMO? Bad idea,” your warning that current reform bills will bring about rampant litigation against insurers and employers is unfounded.
Let us look at the precedent of the Texas Senate Bill 386, the first managed-care liability reform measure of its kind that circumvents ERISA. In similar debate over Senate Bill 386, the insurance industry warned Texas employers that they would be sued by employees. The language in the bill, as with federal reform bills, states otherwise, as it instead exempts employers from liability. Industry representatives also echoed your threat of “a flood of lawsuits against insurers.” In fact, since the Texas legislation passed on Sept. 1, 1997, research has shown only one lawsuit has come under the statute, according to the author of the bill.
Do federal reform bills mean increased costs that have “the potential to undermine the nation’s voluntary, employer-based health insurance system, adding untold millions to the ranks of the uninsured” n actuarial analysis by the accounting firm Milliman and Robertson, completed for a Texas HMO after the law passed, showed the estimated cost to be “a mere 34 cents per member per month (about 0.3 percent).” Hardly the increase that would bring about the dismantling of the current system.
Lastly, in response to your claim that the majority of Americans insured under group health plans are happy with their coverage and the treatment they receive from their HMOs, I can only lay testament to the numerous calls our organization receives each day to the contrary. Unfortunately, it often takes an emergency or tragic illness before an insured American is enlightened to the dysfunctions of our current managed-care system, where “medically necessary” tends to be synonymous with “financially auspicious” for the insurance companies.
