- The Washington Times - Saturday, June 26, 2004

Trust physicians, not HMOs

The Supreme Court has sided with the insurance industry against patients who suffered complications caused, in one case, by a premature, insurance-directed release from the hospital and, in the second case, by an insurance-directed downgrading of prescription drugs ordered by the patient’s physician (“Court shields HMOs from malpractice,” Page 1, Tuesday). In its ruling, the Supreme Court decided that HMOs cannot be sued in state court because federal law, namely the Employee Retirement Income Security Act, prevails. The court also ruled that HMOs can be sued only for reimbursement of benefits denied and not for consequential damages.

By denying a covered benefit to a subscriber and overruling the patient’s physician, the insurance company assumes the role of caregiver, not insurer. In such cases, the insurance company does not perform its own examination of the patient but instead relies on a board of physicians that it employs to rule on treatment, with the overriding goal of reducing cost.

Of course, you can always pay for what your doctor has recommended out of your own pocket and try to collect from your insurance company in federal court, but it is a risky proposition for most folks who cannot afford high-priced lawyers to go up against the high-priced lawyers employed by the insurance companies. And with limits on what you can recover, it’s unlikely that you will break even, assuming you win in court.

Because of this ruling, individuals should run, not walk, from HMOs. The insurance companies, armed with this Supreme Court ruling, will deny more and more covered benefits in the interest of increasing their profits.

So, if your condition matches the statistical profile used by the insurance company’s board of doctors, you’re probably OK. But God help you if your condition differs, because the treatment authorized by your HMO may not take that into consideration, and your life could hang in the balance.

The Supreme Court has unwittingly degraded our healthcare system by empowering insurance companies over physicians. Without accountability or liability for their claim decisions, insurance companies have been given a license to steal.

Congress needs to address this issue before we all fall victim to a system that is focused on cost containment and not physician-directed healthcare.

RICHARD W. RESSLER

North Olmsted, Ohio

Dethrone James Moran

In his Thursday Inside the Beltway column, John McCaslin mentions the 1999 incident in which James P. Moran, Virginia Democrat, borrowed $25,000 from a lobbyist for Schering-Plough Corp. and five days later co-sponsored a bill to extend Schering-Plough’s monopoly on Claritin. Mr. Moran’s bill, if it had passed, would have outlawed generic versions of Claritin.

Mr. Moran’s bill would have cost consumers here in the 8th District far more than the $25,000 that Mr. Moran received from the Schering-Plough lobbyist. Recently a supermarket here in Kingstowne posted the following notice:

“We now have Generic Claritin. Huge Savings on Allergy Relief. Loratadine 10 mg $24.99 (100 ct.) Compare to Claritin.”

Mr. Moran had no business taking that money unless the Schering-Plough lobbyist was also willing to lend us consumers the extra cash that we would have needed to pay for allergy relief. I am a Democrat who in January 2001 stood out on 20th Street in Washington waving a sign that said, “Count All Votes,” but I would vote for a pig or a monkey before I would vote for Jim Moran again.

I am even wondering whether I should ever vote for any politician who endorses Mr. Moran. Fortunately, Sen. John Kerry, Massachusetts Democrat, refuses even to be seen with him. When Mr. Kerry spoke at Northern Virginia Community College here in the 8th District earlier this month, Mr. Moran was not there.

I hope that conservatives all over the country will join us principled liberals and help Republican candidate Lisa Marie Cheney retire Jim Moran in 2004.

JONATHAN S. MARK

Alexandria in describing how National Public Radio is funded. Contrary to urban legend, NPR in fact receives no direct federal funding for general support.

NPR, a self-supporting nonprofit media company with hundreds of independent public radio stations as members, supports its operations through a combination of membership dues and programming fees from stations; contributions from private foundations and corporations; and revenue from the sales of transcripts, books, CDs and merchandise.

A very small percentage — less than 2 percent of NPR’s annual budget — comes from competitive grants sought by NPR from federally funded organizations, such as the Corporation for Public Broadcasting, the National Science Foundation and the National Endowment for the Arts.

The federally funded Corporation for Public Broadcasting does provide direct operating support to locally licensed, locally managed public radio stations, about $86 million this past year, but these funds account for only about 14 percent of the cost of operating local public radio stations, and the remaining 86 percent must be raised from a variety of sources, most importantly contributions from listeners.

KEN STERN

Executive vice president

National Public Radio

Washington

Navy deserves credit

Mike O’Rourke’s correction (“Air defense,” Letters, Thursday) of the role of the Navy during the time mentioned is appreciated and my apologies to the Navy for that omission. I was aware of the picket ships, but in my haste to reply to some of the September 11 commission testimony it just went by me.

For space reasons I also did not mention the deployment of Hawk Army air-defense missiles in the South Florida area after an embarrassing defection of a Cuban MiG pilot in South Florida that went undetected by air defense radar. For several years this deployment stood alert, but it was also eventually abandoned.

I think the thrust of my article is that eventually both the Navy and the Army opted out of continental air defense and it may have become a “stepchild” of other Air Force commands with higher priority missions. Even during the Reagan administration’s attempts to put some war-fighting capability back in continental air defense, the Army and Navy never returned to the mission in any meaningful way. The stale operations plans were on paper and never exercised. Even within the Air Force, the tactical control system was nearly incompatible with the NORAD system. For decades the command, control and communications systems of U.S. military systems had real problems communicating with one another because they were developed for separate missions. In recent years this has changed to an extent and after September 11 all of these systems need the capability to link with each other in a timely fashion. Once again, my thanks to Mike O’Rourke and apology to the Navy.

DARL STEPHENSON

Manassas

Private stem-cell research marches on

William F. Buckley Jr., of all people, has fallen into the trap of implying that if something is not federally funded, it therefore is censored, in his Wednesday column on the administration’s stem-cell policy. (“Stem cell collisions,” Commentary).

President Bush did not sign an order “releasing” a number of stem-cell lines in 2001; rather, he approved federal funding of research on a limited number of lines.

Privately funded research on all other stem-cell lines — indeed, on new lines created from destroying more human embryos — is, unfortunately, unimpeded. Critics of the current policy are looking for federal money, not permission, but it’s far easier to argue that the administration is standing in the way of science than that taxpayers ought to pay for it.

CATHY CLEAVER RUSE

Director of planning and information

Secretariat for Pro-Life Activities

U.S. Conference of Catholic Bishops

Washington

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