HMO’s Principles Are Merely a PR Ploy

Kaiser’s subscription to general HMO consumer protection principles has been hailed as courageous, but it is mostly correctly described as clever [“Kaiser, 2 Other HMOs Join to Back Laws to Protect Patients,” Sept. 25].

HMOs like Kaiser have been on the run from reformers for their odious denials of doctor-recommended treatment, profiteering and lack of accountability. Most glaringly, an unintended glitch in federal law has prevented injured patients from receiving damages against HMOs that deny them medically necessary care. Federal and state legislators have been trying to rectify this inequity by ending the preemption of patients’ state remedies by the Employee Retirement Income Security Act, or ERISA. For the 80% of patients who receive their health care through their employer, HMOs can only be sued for the benefits they were supposed to provide in the first place, not for damages or the consumer’s attorney’s fees--hardly an incentive for HMOs to provide expensive medically appropriate care on the front end since there is no consequence for when they are sued on the back end.

Noticeably missing from Kaiser’s top 10 reform principles was any mention of ERISA or greater HMO accountability in the courts. Greater liability is the easiest way to reform a lawless industry that has evaded accountability for decades. . . . Kaiser knows this, fears this, and will do anything to avoid the bipartisan push for greater HMO accountability in the courts. . . . Genuine bipartisan reform efforts--fueled by constituent stories and outrage--must not be derailed by Kaiser’s clever public relations stunt.

JAMIE COURT

Santa Monica