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In many ways, Montana seems light years away from the Beltway in Washington DC. While we watch the nightly newscasts of the happenings in the nation's capitol every day, those Congressmen seem far removed from the Treasure State. So it was truly fascinating to watch the Montana Legislature grapple with one of the issues that consumes much of Congress' time these days - managed health care. The Legislature was a study in microcosm of that same debate. The key difference here at home was the non-partisan nature of the conversation.

Along the Potomac, the debate crystallized along partisan lines: Democrats striving for the Patient Protection Act, that would allow patients covered by managed care companies, known loosely as HMO's, to be able to sue their insurer if care that they and their physician felt necessary, was denied. Republicans oppose the measure, saying that the cost of insurance premiums would sky rocket if such a provision were in place.
Interestingly enough, there is more than theory to back of the claims of those who wish to protect the rights of patients. The state of Texas passed a similar measure a few years back, so there is a track record, albeit short to measure the results of holding a managed care company liable for its decisions.

The Texas results featured prominently in the testimony regarding HB 607 here at the Montana Legislature last month. HB 607 would have allowed for patients to sue their managed care company if an independent peer reviewer to be negligent found them. The bill provided for the peer review, which assured a patient facing a neurological problem to have the appeal of his case performed by a physician trained as neurologist or neurosurgeon. While that seems to be just garden-variety common sense, it has not always been the case, by a long shot. There has never been a rule that specified such credentials for such important decisions.

If the independent peer reviewer agreed with the patient's physician about the best source of treatment, and the HMO still refused to cover the procedure, the patient would be able to sue them in court. The action could only take place once the independent reviewer had issued his opinion.

If there are only two statements that strike fear into the hearts of the members of the Montana State Legislature, they are these: "It will increase health insurance premiums" or its sidekick, often quoted in the same breath "It's a relief bill for the trial lawyers". Nice combo- a magic mix of what almost love citizens love to hate - insurance premiums and lawyers, all in one fell swoop.

To tell the truth, I'm certainly no fan of the Trial Lawyer Lobby myself, but I'm here to tell you, they've got this one dead to rights. And as far as health insurance premiums go, because I am self-employed I have individual insurance and it's plenty high. So I watch this stuff pretty closely.

The HMOs in this state have caught on to the fact that their most potent defense against any reform that protects patients is that it will raise premiums. Like the child who is afraid of the bogeyman, the legislature quails when the incantation is invoked. No one wants to visit higher insurance premiums on their constituents; it's political suicide. And so lobbyists circulate saying BOO to the elected officials and they, like the terrified 4-year-old cower in their beds, afraid to move.

And like those little kids, if they could just get up and turn on the light they would see that the boogieman under the bed is just the result of sloppy housekeeping…dustballs moving and shifting that look scary, but can be eliminated with a good sweep. But the first step has got to be turning on the light.

The Montana House of Representatives backed the patients all the way. HB 607 passed from the House with 67 YES votes. It fared less well in the Senate. The HMOs, stunned by their defeat in the House took the fight to the Senate Business Committee. The President of the Senate, Bruce Crippen, You remember him, "the will of the people pales in comparison to the judgment of the senate" Bruce Crippen, assigned the bill to Senate Business because he knew that many of its most influential members were sympathetic to the HMOs. To his lasting credit, the chairman of the Committee, Sen. John Hertel of Lewistown, made sure the hearing was fair, and that both sides had ample time to air their views. Later, during executive action, when the vote was taken, Senator Hertel once again was the ultimate in fair play.

Predictably, the HMOs chanted their dual mantra about raising premiums and the hey day for trial lawyers. It had the desired effect. By a 4-3 vote the committee stripped the liability portion of the bill, leaving intact the provision of the peer review process.
What was disappointing was this: when the HMOs threatened to raise premiums if the bill were passed, no senator asked questions that seemed painfully obvious: If they were doing a good job and providing quality care, why should they be afraid to be held accountable? Raising premiums is a business decision, just like the business decision Blue Cross Blue Shield made when it increased its payment to its CEO to $417,000 a year a few months back. Its chief lobbyist also enjoyed a pay hike that cruised around the 30% mark. At the same time they were increasing their premiums on you and me. It was too bad that no Senator asked that lobbyist why the increases were necessary in light of his salary boost. All the bill did was to require that HMOs have accountability equal to what doctors and other professionals have had for years. What's so wrong with that?
And as far as the Trial Lawyers getting rich off other peoples' misery, why didn't the Senators take a look at what has actually happened in Texas? In a state of 20 million people, some three hundred patients went to the peer review process, and ONE case made it to court. Only ONE because HMOs knew at the outset that we were going to be held accountable. Trial lawyers getting rich, nope, not under this plan.
Nobody's too hot on trial lawyers, at least not until they have been "had", but if my children are ever unfairly denied necessary health care, you can bet that I'm going to hire the biggest, baddest one I can find.

For many Montanans, you have as much choice about who your health insurance carrier is as you had your choice of parents. Someone above you is making that call. So, if you are one of the majority of Montanans whose has health insurance through your employer, you might want to ask your boss about the health insurer he puts you with. Ask your boss to demand from the company its annual report, listing its main budget items. Blue Cross Blue Shield has a $1.2 million dollar travel budget… seems a little high to me for a non-profit organization. I wonder what your benefits manager would think if they knew that.
Like the bogeyman under the bed, things get better once a little light is shed on them. That's what I will be doing from time to time during my commentary. There's more. Stay tuned.

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