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Supreme Court Sides With H.M.O.'s on Patient Suits

post #1 of 3
Thread Starter 
See the attached article on CNN at:

CNN article

One quote from the above:

"WASHINGTON (AP) -- The Supreme Court said Monday that patients who claim their HMOs wouldn't pay for needed medical care cannot sue for big malpractice damages, an issue at the heart of the long debate over efficiency versus service in managed health care."

From a legal viewpoint, this is a convoluted case to explain because it involves whether state law can take precedence over a federal law known as ERISA. But I have to cite this one quote from the Supreme Court argument:

An exchange during the March 23 arguments touched on issues beyond whether federal or state laws should prevail."To say that the plan condemned them to not using Vioxx is simply not true," Justice Antonin Scalia told George P. Young, a lawyer for the patients. "All you're talking about here is money."

"Well," Mr. Young replied, "the truth is, your honor, that neither of these claimants would have needed health insurance if they had the independent means to just whip out a gold card and pay for the drug."

(Source: NY Times, by David Stout; June 21, 2004)
post #2 of 3
I don't know all of the details, and may be missing something, but it seems to me that the court is missing the point about punitive damages.

If the health insurer can deny necessary and sometimes even life-saving treatment to save money and boost company and/or shareholder profits, and can balance that decision against the amount they stand to lose in a lawsuit (now often strictly limited), and decide that it's more profitable to deny care, they will.

If they run the risk of being forced to pay punitive damages, an insurer might think twice about denying/delaying necessary care prescribed by a doctor.
post #3 of 3
Here's another article: http://www.washingtonpost.com/wp-dyn...2004Jun21.html

It's a hard call. I personally would like to see a federal law in place. Germany has universal health insurance coverage, which is great, but the individual "quasi-public" companies are indebted and restricting coverage. I've been confronted with a "controversial case" this week. One of my students, female, 22, was the victim of a car crash while vacationing in France a month ago. The car she was in was sideswiped and overturned, and the other driver took off. Christina was in the back seat, but the car was an older model, lacking airbags and 3-point seat belts. She crashed through the windshield (from the back seat!) and suffered severe facial cuts. She returned to school this Monday, with reinplanted front teeth, 1" to 3" horizontal scars on her forehead, and her left cheek literally sliced open from the lower eyelid to her jaw. Her health insurance company has already decided not to cover the costs of cosmetic surgery - she was told to sue the driver of the other car. The police haven't found him/her. I really don't understand this - she's not asking to have her breasts, chin or cheekbones augmented, her nose bobbed, or her lips made fuller. The cut on her left cheek is really nasty, and I wouldn't consider an attempt to minimize the injury to be "cosmetic", but "restorative" surgery.
On the same note, my mother-in-law was here this evening, and related that her family doctor told her to have as many diagnostic tests done within the next year as possible, because her health insurance won't cover them once she reaches the age of 80 - she turned 78 in May.
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