This week's senate debate over managed health care results from two ultimately irreconcilable demands: Americans want the best-quality health care possible - but they don't want to pay a lot for it.
Lawmakers' dilemma: If quality is emphasized, with doctors making decisions regardless of cost, prices inevitably rise, forcing more people to forgo insurance. On the other hand, if cost concerns are primary, with insurer claims officers making treatment judgments, the system would probably exclude expensive procedures and experimental treatments some patients want.
So the issue becomes how to strike the proper balance between preserving the needed cost efficiencies of managed care and allowing health-care professionals to make humane treatment decisions. Also, a way must be preserved to rein in costs from patient demand for drugs or treatment not deemed necessary.
Reasonable health-care reforms should:
Respect state jurisdiction. Insurance regulation is a state matter; more than 40 states already have patient-protection laws. Congress should stick as much as possible to guarantees for Americans not covered by state-regulated plans.
Contain an internal and external appeals process. This should require second and third opinions from health-care professionals and guarantees against insurer foot-dragging. But allowing individuals to sue their plan or employer for malpractice would mean a return to the skyrocketing costs of the '70s and '80s and benefit few except trial lawyers.
Avoid legislating treatment decisions and protect patient choice. Medical opinion on best treatment varies over time and evolves far more rapidly than congressional fiat can anticipate. Legal requirements would prevent insurers and health-care professionals from responding to changes in best practices. Patients should be able to choose between treatment alternatives.
In the end, however, Americans may be asking for more than medicine or government can deliver.
No government program can guarantee treatment success. Nor can any government program mandate the quality of individual thought and lifestyle fundamental to good health.
(c) Copyright 1999. The Christian Science Publishing Society