Clinton Calls for Legislation to Grant HMO Patients Appeals

WASHINGTON —  President Clinton called Friday for legislation giving members of managed health care plans the right to appeal decisions and ordered the government to distribute information on the quality of health plans that serve federal enrollees.

That means that about a third of Americans, including federal employees and Medicare and Medicaid recipients, will have access to such information

Clinton, who has been pressing for a patients’ bill of rights to offset the growing power of health maintenance organizations and other managed care plans, urged that those rights also include opportunities to see medical specialists and to receive information about the quality of health plans.

“Congress must take the next step and make the patient’s bill of rights the law of the land,” he said.

Clinton made his comments as he received the final report of his commission on health care quality. The commission, whose 34 members included representatives both from managed care providers and from employer groups that are worried about escalating health care costs, did not endorse legislation.

In another executive order last month, Clinton gave members of federal health plans the right to appeal decisions and to gain access to specialists. These moves put the federal government’s plans “in the lead in assuring patients’ protections,” according to the executive order.

“For all its strengths, our health care system still is plagued by avoidable errors, overused and underused procedures and gaps in the quality of care,” Clinton said in Friday’s Rose Garden ceremony.

He highlighted his commission’s account of the American health system’s frequent failure to provide quality care.

“When hundreds of thousands of Americans are needlessly injured while in the hospital, when 18,000 Americans die of heart attacks that did not have to be fatal, when 80,000 women undergo unnecessary hysterectomies every year, surely we can do better,” Clinton said.

He endorsed the commission’s latest recommendation that he create a government council to set national goals for quality and monitor progress in meeting them, and a private forum that would identify ways to measure quality that could be adopted by health plans nationwide.

However, the outlook for congressional action is cloudy, reflecting public uncertainty.

“Public opinion is formed on what’s wrong with managed care, but they haven’t given a lot of thought to what government ought to do about this problem,” said Robert Blendon, a professor of health policy at Harvard University.

Blendon said that discontent with managed care will grow, particularly in California, where almost all consumers are enrolled in managed care plans.

“Californians are unhappier campers than the rest of the country, which suggests that employers’ argument that this is just a transitional problem as people adjust to managed care is off the mark,” he said.