Setting Health Care Priorities

Last year, state Auditor Kurt Sjoberg accused the Department of Corporations, which regulates HMOs, of lacking “the insight necessary” to oversee health plans. Now the department is trying to prove Sjoberg wrong. Awakening from its regulatory slumber to require Kaiser Foundation Health Plan to cover Viagra and all other sexual dysfunction treatments, the agency proclaimed itself a protector of Californians’ right to obtain any “medically necessary” treatments.

But the department’s claim only highlights its inability to distinguish between which treatments are medically necessary and which are “lifestyle enhancing” remedies.

It is far from clear that Viagra, a drug that treats male sexual dysfunction, is more “medically necessary” than the drugs that the department has allowed HMOs to deem “medically unnecessary”--drugs like Risperdal, which controls schizophrenia without the lifelong debilitating side effects of Haldol, another drug prescribed for the condition.

Ineptitude by the Corporations Department underscores the need for Gov. Gray Davis’ administration to back a bill by Sen. Herschel Rosenthal (D-Los Angeles) that would transfer HMO oversight from the department, which specializes in financial investments, to a new Board of Managed Health Care, specializing in consumer protection.

To tackle the underlying problem, Grantland Johnson, the new secretary of Health and Human Services, should convene a panel of physicians, HMO executives and consumer advocates to examine how to better distinguish between lifestyle-enhancing treatments like Viagra and lifesaving care.

Given the expected rise of 5% to 25% in health insurance premiums this year, Sacramento should resist legislating expensive new coverage mandates and instead engage all Californians in a debate about which treatments should and should not be covered. At stake is the health of California workers and their economy.