State Legislation to Ban HMO ‘Gag Rules’

Your July 2 editorial supporting state legislation to ban HMO “gag” rules neglects to mention an issue of overriding importance. Even if state laws pass, they will be totally useless for protecting 70% of the HMO members in California, i.e., those whose HMO is provided in connection with their employment.

The problem is with a federal law called ERISA (the Employee Retirement Income Security Act of 1974). This well-intentioned law was designed to assure that workers would get the pension benefits promised them by their employers. Where it went astray was in a clause that “preempted” any state laws “relating to” employee benefit plans; this includes any medical benefits offered as part of such a plan.

No action at the state level can fix this problem. ERISA must be amended by Congress to remove preemption as applied to employee medical benefits. Control of quality of medical care has always been a concern of individual states, and should remain so.

So why hasn’t Congress addressed this egregious error? There are powerful forces that are perfectly happy with the status quo: the insurance industry; the nouveau riche HMO entrepreneurs; and most importantly, the employers, whose main criterion for employee medical benefits is that they be cheap. If our congressional representatives receive as many letters from us as they do dollars from the special interests, perhaps this unnecessary discrimination against employees will be corrected.

HARVEY S. FREY MD

Santa Monica

* Your editorial was right on target. Patients need protection against arbitrary, money-saving, profit-boosting decisions made by their HMOs. In the past patients have relied on their physicians to provide them with complete information and treatment alternatives. Now the physicians have to check with the HMO managers first as to what is most “cost effective” (for the patient or the HMO?).

There are two initiatives on the November ballot to protect the patients. These patient protection acts will provide for removal of gag clauses, enforcement of “just cause” for physician termination and public accounting of HMOs’ expenditures.

STEVE GUPTA MD

Glendale

* It is a sad moment in the history of medicine when an experienced and well-trained physician cannot prescribe the best medication and treatment for his/her patients. Ultimately, it is the patients who will suffer. Doctors will be forced to prescribe a treatment that is sanctioned for some financial reason, rather than ordering the right treatment to save a life.

I stopped practicing obstetrics/gynecology on June 1. I just could not accept to be forced by HMOs to practice second-class medicine.

CHARLES P. LEDERGERBER MD

Beverly Hills