HEALTH-CARE CONSUMER COALITION
SEEKS IMPROVED STANDARDS, CHOICES

BLOOMINGTON, Ind. -- Is a consumer backlash developing in response to the upheavals in health care over the past 15 years?

Some experts think so. Indiana University's Marc Rodwin, a researcher in managed care and consumerism, wouldn't term it a "backlash" as much as a natural response to the narrowing of choices, corporate domination and feared abuses of a major industry, one that affects a primary concern of every American: their health.

The year ahead may be a turning point, as a national health-care consumers coalition formed late in 1996 initiates an agenda to organize consumers at the grassroots level, create models for legislative protection, demand standards for care providers, join forces with other organizations, and distribute information to help consumers make intelligent decisions about their care and, if necessary, challenge limits on their options.

Washington, D.C., was the site for the series of formative meetings of the new Consumer Coalition for Quality Health Care. Rodwin, associate professor of public and environmental affairs, is also an attorney with a doctorate in health policy and author of the book, Medicine, Money and Morals. He was invited to the coalition-creation meetings as a resource and "friendly critic."

Organizations sending participants included the American Association of Retired Persons, the Coalition for Nursing Care Reform, individual state organizations, representatives of organizations for persons with disabilities, and consumer unions, among others. Their common goal was to create a basis for joint action in health-care consumer protection.

"This was the first meeting of its kind, and it was both innovative and necessary," said Rodwin. "This is now a working group with a plan of action. The intent is to produce a blueprint for securing consumer protection in health care, using information and activism."

The new coalition won't reinvent the wheel. "We discussed how to obtain and use information already available," Rodwin said. "For example, the Kaiser Foundation and the Agency for Health Care Policy Research have released a national survey on consumer preferences and understanding about health care." The coalition organizers also heard from medical professionals, researchers and scholars.

Rodwin is not surprised consumers are organizing in reaction to managed care, even as he acknowledges the benefits of the system. "Managed care plans cut down on overuse of services and reduce financial barriers by cutting out-of-pocket costs. They have the capability to coordinate services, monitor quality and assess performance.

"But they have created incentives to skimp on service to ensure excess profits for shareholders and handsome salaries for top managers," he said. "They also restrict consumer choice with limited plans and endanger care by abuse of utilization reviews and referral restrictions."

Standards could prevent scenarios such as the so-called "drive-through deliveries" and other widely publicized tragic disputes. Other coalition proposals call for additional powers for most state and federal agencies to help aggrieved consumers and monitor program administration.

According to analysts, consumers are misinformed if they think adequate protections already exist. Almost 10 years ago, the Supreme Court held that the federal Employment Retirement Income Security Act (ERISA) of 1974 bars employees from bringing most state law tort suits stemming from denial of employment benefits covered by ERISA, including health benefits. Since the health coverage of 80 to 85 percent of Americans under age 65 is provided as a benefit of employment, all standard legal remedies concerning that coverage are therefore inadmissible based on the Supreme Court's ruling (most litigants so far have been public employees -- a group excluded from the ERISA coverage -- or they are Medicare beneficiaries).

Higher standards alone are not the answer, Rodwin warned. "They would only raise premiums and make insurance unaffordable for many Americans." Nor are legislatures in a position to set detailed standards, he added. "Elected officials are neither qualified nor able to determine proper medical treatment.

"It's preferable to first set broad standards for quality assurance, utilization review, out-of-network emergency care and other variables -- and then provide for accreditation and monitoring," he said.

For more information, contact Ellen K. Mathia, 812-855-0085 or 812-855-3911, emathia@indiana.edu