BY PATRICK CROWLEY
The Cincinnati Enquirer
FORT MITCHELL -- America is sick of managed health care -- and politicians know it. With polls indicating that the public wants Congress to address health care and the role managed care companies such as health maintenance organizations play in their lives, the issue has become one of the key ones in political races here and across the country.
"It's time to rein in the HMOs and put patients over the profits," U.S. Rep. Scotty Baesler, a Lexington Democrat and candidate for U.S Senate, said in a recent debate.
"As Kentucky senator, I'll propose managed-care plans be guaranteed so that doctors and other health care professionals make decisions, not the insurance company."
Mr. Baesler's rhetoric is typical of election-year assaults on the managed-care system. It is heard in his race against Southgate Republican U.S. Rep. Jim Bunning.
And it is being heard in the Fourth District congressional race for Mr. Bunning's U.S. seat between Republican Gex "Jay" Williams and Democrat Ken Lucas.
"HMOs have been given a special level status," said Mr. Williams, a state senator from Verona.
"I don't know if the problem is reining them in as much as it is putting them on a level playing field with everybody else. Right now they have anti-trust protections, tax breaks and protection against litigation that puts them in kind of a class by themselves."
Congress is expected to spend much of its last month in session before the fall election break debating the many incarnations of so-called Patient's Rights legislation.
Lawmakers are eager to act because polling is showing that's what the American people want congress to do.
A Time/CNN poll of 1,024 people taken June 30 and July 1 showed that "health care reform" ranked third, at 76 percent, when people were asked what issues should have a high priority for Congress. The only issues finishing stronger were improving education at 85 percent and passing legislation to strengthen Social Security at 81 percent.
Health care finished higher in the poll, which carried a margin of error of plus or minus 3.4 percentage points, than getting tough on crime (73 percent), cutting taxes (66 percent), reducing teen smoking (54 percent) and campaign finance reform (38 percent.)
"We're doing everything we can to get a bill passed, and I think it will happen, and it could get to the (House) floor by late next week," Mr. Bunning said late last week.
Mr. Bunning and Mr. Baesler, by virtue of serving in the U.S. House, are picking sides on bills being circulated in Washington.
The options
Mr. Williams and Mr. Lucas, meanwhile, are talking in broader terms since neither will vote on a bill and with the various proposals sure to change as they weave through the legislation process in Washington.
Mr. Lucas campaign released a brief statement when asked the candidates' views on health care reform. In the statement, Mr. Lucas said he favors reform that preserves "doctor choice, with an emphasis on preventive care, especially for children."
"I want doctors, not bureaucrats, to make the medical decisions that affect our families," he said.
Mr. Williams also wants a system in which doctors are making medical decisions and patients can choose their doctors.
"But you're not going to cut the cost of health care by having a business manager or bureaucrat making decisions a physician should be making," he said.
"You can, however, build some efficiencies into a system. People who don't use emergency rooms for every little headache or scrape might be willing to pay a higher overall deductible if their overall costs are lower when they do go in for care or treatment," Mr. Williams said.
In Congress, there are three basic plans.
Mr. Bunning is on board with the bill being pushed by House Republicans, while Mr. Baesler is behind legislation backed by President Clinton and most House Democrats.
A third plan has been offered by Senate Republicans.
All the proposals would provide basic protections for millions of Americans, although there are differences embedded in the fine print. The protections include coverage for emergency-room care, a ban on "gag rules" that bar doctors from telling patients about costly treatment options and easier access for women to gynecological care.
And all three proposals also offer every American the right to external appeal if they are denied care by their insurance plan.
But in a key difference with Republicans, the Democratic - White House bill gives patients a right to sue the HMO.
"I want to work to guarantee that if the HMOs make a mistake, they can be held accountable," said Mr. Baesler, who plans to discuss his stance on the bill during a Mondaymorning press conference in Frankfort.
The House Republican approach allows an independent panel of medical specialists to settle disputes and even award damages of up to $250 a day, to a maximum of $100,000, if they are denied care improperly.
"We've addressed the litigation situation . . . by giving people direct access to solving their problems," Mr. Bunning said. "And if they feel they still have a problem that can go directly to the federal courts."
Mr. Williams also favors the peer-review panel, which he said is being used successfully in Texas.
"It's cut down on litigation . . . and I don't think more litigation is the solution of any (federal) legislation," he said. "A goal should be finding a way to reduce litigation, not encourage it."
GOP's version
The bill backed by Senate Republicans offers patients no right to sue beyond their current ability to recover the cost of denied medical care.
For their part, Republicans have also crafted other provisions designed to expand access to health care. These include making health-care costs 100 percent deductible for the self-employed and making medical savings accounts more widely available.
Mr. Lucas agrees that tax deductibility should be a part of any bill.
"Deductions should be increased for employers who offer health care to their employees," he said. "Reform should also provide working families with the ability to deduct health-care premiums from their income tax."
The Associated Press contributed to this report.
