Congress, Lobbying, Public Opinion
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An Access to Emergency Medical Services Act, which would establish the "prudent layperson" standard for nationwide coverage of emergency health care, is in the pipelineand long overdue. Thirty-two states and the District of Columbia already have laws that mandate the prudent layperson standard, and Congress has applied the standard to Medicare and Medicaid services.
The bill, sponsored by Bob Graham (D-FL) and Lincoln Chafee (R-RI) in the Senate and Benjamin L. Cardin (D-MD) and Marge Roukema (R-NJ) in the House, would require an insurance company to cover emergency room visits as long as they are the result of symptoms that a prudent layperson would consider emergency in nature. Chest pain, shortness of breath, and blood loss are good examples. The bill would also outlaw the requirement of prior authorization for emergency medical treatment.
Understandably, the bill is being welcomedand promotedby the American College of Emergency Physicians and other physician organizations. "[The state] laws are making a difference," says Robert E. Suter, an emergency physician speaking for ACEP. "But millions of people do not have these protections, and it's time we have a national standard that covers everyone."
During his first day as HHS Secretary, Tommy Thompson vowed to beef up the nation's organ donation program. Good to his promise, he launched publicity campaigns, created medals to honor a donor's family, and began donor promotions with large employers, such as General Motors, American Airlines, and the Bank of America. He's also said the government will try to encourage Americans to donate organs while still alive. (According to HHS, living-person donations have been the fastest growing source of transplant organs.)
The federal government is planning to increase funds for organ donor programs. For starters, about $8 million more will flow into the Health Resources and Services Administration, according to Thompson.
Still, getting enough organs will be a tough job. Demand is increasing almost twice as fast as supply.
It's surprising that no one in Washington has suggested using the solution du jour to fix the problem. Charitable contributions are tax deductible. Why not give organ donations the same status?
In 2000, organized medicine scored a small victory for physician collective bargaining rights. The House passed the Quality Health-Care Coalition Act. But no senator so much as introduced a companion bill.
This year, the issue was dormant until early May, when the American College of Physicians-American Society of Internal Medicine released a position paper reiterating its stand: Physicians should have the right to negotiate with plans over issues of health care quality and access (including payment policies that hinder good medicine) but should not have the right to strike, boycott, or slow down the delivery of care.
On May 29, the Supreme Court weighed in, issuing a ruling that "will almost certainly make it more difficult, if not impossible, for most employed physicians in the private sector to bargain collectively," says AMA trustee Donald J. Palmisano. In direct contrast to an NLRB finding, the five-justice majority ruled that six nurses who oversee less-skilled workers in a facility for the developmentally disabled are supervisors and therefore not entitled to the protections offered by the National Labor Relations Act.
The Court's finding reopens the question of which doctors are supervisors. The answer, according to the AMA, will now be determined by a standard that's more favorable to employers than physicians.
Still, ACP-ASIM says physicians' interest in collective bargainingor, to use the organization's preferred term, "joint negotiations"is growing. Why? Because the number of physicians in independent practice is decreasing rapidly. Because more physicians are employees of multispecialty groups, hospitals, HMOs, and the government. Because managed care has left physicians feeling powerless.
Michael Pretzer. Washington Beat. Medical Economics 2001;14:16.