In Congress and each state, scores of anti-HMO laws are being passed or considered under the guise of improving the quality of healthcare. Recently, court rulings have been speeding the process when it seems that legislators are acting too slowly. HMOs have controlled the double-digit inflation in healthcare that we saw in the 1980s by limiting benefits, eliminating waste and unnecessary care, and managing delivery of care more efficiently. Both employers and consumers have appreciated the cheaper healthcare, but consumers do not like being told how, where, and by whom they are to receive care, and physicians do not like being told what constitutes appropriate care. Now, consumers complain that cost-control measures are responsible for reducing the quality of healthcare.
Times are ripe for a legislative counterrevolution to the systems of managed care.
In the past 5 years, we have seen a massive movement toward healthcare legislation at both the state and federal levels. However, more recently, a court decision in Pennsylvania allowed an HMO to be sued because of the care provided by a contracted physician, the claim being that the HMO is responsible for using competent physicians. Next came legislation that was seen as quality-directed. In the early days, HMOs had much power to manage healthcare, and this was sometimes abused, resulting in substandard quality of care. As legislators began to debate corrective measures, HMOs moved forward on their own to correct abuses and improve access.