Okay, this is caviling. But — they’re not denying care. They’re denying payment.

I agree with DB’s sentiments about this issue, but it is apparent the SC justices sided with the arguments of the lawyers representing the HMOs.

One, allowing patients to sue HMOs in state courts would drive up the costs for employers; second, the majesty of the federal law should be upheld over those of state rights, which essentially would reinforce the same language when ERISA was crafted 30 years ago.

I have read the background of the two cases filed in Texas, and the actions contested by the plaintiffs are practices not confined to HMOs, but allowed by companies outside of managed care as well.

Disputes can now be resolved by panels of physicians. If this mechanism does not work to the satisfaction of patients, Congress may have a chance to finally craft a Patients’ Bill of Rights.

You’re forgetting what an HMO is.

If you want an insurance plan that will pay for EVERYTHING your doctor thinks you need, buy an indemnity plan that has no pre-certification requirement. What, you can’t find one that you can afford? They have been pretty much priced out of the market for all but the very wealthy. What you get for substantially lower premiums in an HMO is less in return. There are limitations on which providers you can access, and on what they can do. Sometimes, inevitably, the HMO bureaucracy will do something that in retrospect was really boneheaded. In our system, the trial lawyers would put them out of business in a New York minute, and then you’re back to no affordable health care for a lot of non-wealthy people. When HMOs were designed, their marketers knew that they needed statutory protection from lawsuits for them to be viable. That is why the law reads the way it does. It’s analogous to the statutory protection the vaccine makers demanded to continue production. If you want the undeniable good results of mass vaccinations, you have to accept that a few people are going to get hurt and not get the lottery sized compensation that he lawyers have trained us to demand.

You can’t have rich folks’ medicine at poor folks’ prices. We simply can’t afford everything for everybody.

I don’t think the coverage v treatment distinction is an artificial one. An HMO’s refusal to cover a procedure doesn’t keep a patient from getting it if its really needed or wanted. What keeps a patient from getting it is either the patient’s inability to pay privately thus choosing not to get the care, or a provider’s unwillingness to perform a needed but noncovered procedure at reduced or no cost.

I mean, sure – sue the HMO and get a court to say its covered. But we can’t pretend that patients and providers don’t make economic decisions about the care obtained/delivered in much the same way as an HMO does.