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Restoring trust in health care

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Used to be, the health-care profession was among the most trusted institutions around. That was before managed-care health plans and HMOs, or health maintenance organizations, took charge. Now, the supply of horror stories about denied coverage and financial scandals seems never ending.

The message is becoming clear. People are skeptical of their health plan's interest in their personal well being, and they suspect many of these providers, particularly HMOs, care more about profits than people.Against this backdrop, Congress has begun debating health-care reform. While some good ideas are swirling around both sides of the political spectrum, the public shouldn't be satisfied with anything that doesn't provide real penalties for providers who deliberately do things wrong.

Republicans support a proposal that would strengthen a patient's right to appeal when a provider denies coverage. But they don't want to remove the legal restraints that keep many patients from suing their providers. That is unfortunate, because some providers aren't likely to take concerns seriously without the threat a lawsuit could provide.

In 1974, Congress passed a law that allows patients to sue only for the cost of a benefit that was denied. In other words, if an HMO denied a cancer treatment, the most the patient could sue for would be the actual cost of that treatment. The HMO cannot be held liable for lost wages, suffering or damages. It cannot even be made responsible for the cost of treating a cancer that spread because it wasn't treated. The law covers only those people who receive health care from their employers, but that is the majority of Americans.

The fear, of course, is that the cost of health care would rise if HMOs and other providers were liable for huge legal damage awards. Not surprisingly, the health care industry is eager to spread doom and gloom about how much premiums would rise.

But a study by Cooper & Lybrand, quoted recently in the Boston Globe, found that litigation costs comprise between only 3 and 13 cents of the monthly premiums paid by the people who currently have the right to sue. That's a minor cost compared with the benefit to consumers, who would have a meaningful recourse.

The bills under consideration would greatly improve the type of health care most Americans would be entitled to receive. Considering 75 percent of Americans now rely on HMOs and other managed-care providers, that type of reform is important. But it won't mean much if the providers don't stand to lose substantially when they misuse their trust.