Hippocrates' Children Conjure Up the Snakes


The longer this General Assembly session grinds on, the more tawdry it gets. Dangerous snakes are slithering out from under legislative rocks. Special interests with deep pockets are having a field day. Tempers are wearing thin.

A vicious shouting match at a Senate leadership meeting last week led one senator to call a liberal rival in the House of Delegates "communist." At that same meeting, the Senate president traded loud insults with a Baltimore County senator over a bill designed to line the pockets of doctors at the expense of patients and HMOs.

Over in the House, Old Guard leaders still "just don't get it." After women delegates delivered a telling blow against the "old boys' network" on the domestic violence bill -- they persuaded the entire House to reject a committee's neanderthal approach to the problem -- House bigwigs tried to tighten their control over members so such embarrassments won't happen in the future.

"It was the 'old men' against the younger members, the minority-race members and the women," noted one official. The revolt by the Women's Caucus, and its import, still hasn't penetrated the House's ruling class. "Unless they start to bend," said one close observer, these old hands "are going to get blown away" when the post-election House meets next year.

Meanwhile, the Senate is getting downright testy about the "any willing provider" bill. (The doctors' side refers to it

euphemistically as the "patient access act.")

Senate President Mike Miller and Finance Committee chairman Thomas P. O'Reilly hate this bill. They're not alone. So does House speaker Casper R. Taylor. And health secretary Nelson Sabatini. And HMOs. And insurance companies. And organized labor. And the Chamber of Commerce. And Hopkins President William Richardson, chairman of the state's Health Care Access and Cost Commission.

The underlying premise of the bill also has been denounced by the staff of the Federal Trade Commission and by the governor of Florida.

But Maryland's powerful doctors love this bill. So do other health-care providers not in HMOs. They are putting enormous pressure on legislators. Promises of big campaign contributions are potent incentives. Lobbyists for health-care groups -- with deep PAC pockets -- are flooding lawmakers with heart-rending examples of HMO screw-ups and instances where patients were forced to give up their long-term doctor because the physician wasn't in the HMO network.

The bill would cut the heart out of this state's HMOs and provide a massive bonanza for non-HMO health-care providers.

Under the bill, an HMO member could go to any doctor and the HMO would have to cover a portion of the cost. That would be great news for the docs but bad news for the HMOs and their rate-payers, who would end up with higher premiums. HMO subscribers who consulted doctors outside the HMO network would lose a second time, too: They would have to make up the difference between the doctor's fee and the amount covered by the HMO.

The price tag for patients and employers is $200 million a year. For the state, the bill means another $20 million in extra expenses. All this money goes directly to doctors and other non-HMO providers. The cost of health care in this state for folks with HMOs is expected to rise by 15 to 20 percent.

The power of the medical lobby in Annapolis, plus some internal disputes between Senate President Miller and his colleagues, forced a vote in the Finance Committee, where Mr. O'Reilly wanted to see the measure languish.

Proponents are playing to emotions. They want unlimited freedom for patients to choose their own doctors -- and to hell with the cost. That's fine in concept. But too-high medical costs created the health-care revolt in this country. This bill returns us to the bad old days.

No wonder so many officials are alarmed. This bill would demolish HMOs as we know them in this state and reverse much of the work done last year to contain and reduce health-care costs in Maryland.

None of this bothers senators who are intent on playing up the emotional issue of a patient's right to choose. It is the doctors' way of trying to kill the drive toward managed care. Not just in Maryland, but nationwide.

Will they succeed? Time is short. Even if this bill slithers out of the legislative thicket, Governor Schaefer could veto it. He hasn't said so definitively, but his health chief is vehemently against the measure. Signing the bill would reverse all the Schaefer administration has done to make Maryland a leader in health-care reform.

Stranger things have happened. Ex-Gov. Marvin Mandel is a doctors' lobbyist and remains close to Mr. Schaefer. Incumbent legislators crave PAC money from doctor and health-care provider groups. They know the rallying cry of "I let you keep your own doctor!" will sound great on the campaign trail. Right now, all they can see is the money and the stump rhetoric.

Barry Rascovar is editorial-page director of The Sun. His column appears here each Sunday.

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