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Question 5 Aims for Health Care for All

Proposal Calls for Greater Patients’ Rights

By Michael J. Ring

CONTRIBUTING EDITOR

Health care, one of the most important issues in this year’s presidential election, is the subject of Question 5. If passed, this referendum would make many significant changes to the health care system in Massachusetts.

Supporters of Question 5 believe its sweeping initiatives are needed to fix several growing problems in Massachusetts health care. Opponents, however, argue that the measure would only add cost and inefficiency to the state’s health care system while repealing existing patient protections.

Initiative addresses patients’ rights

If voters approve Question 5, patients and health care workers would enjoy several new rights as of January 1, 2001. Among the rights for patients would be: greater freedom to choose one’s own doctor, greater access to specialists and emergency room care, and greater protection against the termination of health insurance coverage.

Health care professionals would have greater rights to make medical decisions in consultation with their patients, and the right to discuss health insurance benefits with patients. Additionally, Question 5 would mandate that insurers spend at least 90 percent of their Massachusetts revenue on health care services in this state.

Question 5 calls for universal care

Passage of Question 5 would mean the creation of a State Health Care Council, charged with guaranteeing that every Massachusetts resident has access to comprehensive health coverage by July 1, 2002. Until the Council ruled that all Bay State citizens had such access, it would prohibit the conversion of non-profit hospitals and insurers to for-profit status.

The Council would also review and recommend legislation guaranteeing that patients could choose their own health plans, appeal denials of care, prohibit financial rewards for denial of care, and insure that Massachusetts premiums rise no faster than the national average.

Proponents, opponents square off

Opponents of the referendum have seized on the proposal’s length and breadth, which has been the source of some confusion, as reasons for urging its defeat. They also believe the initiative will cause health care premiums to skyrocket and damage the state’s health care system.

“On face value, Question 5 sounds like a wonderful thing, but it’s really a wolf in sheep’s clothing,” says No on 5 Coalition spokeswoman Jennifer Szoke. “It seeks universal health care, but doesn’t say how it’s done or who would pay for it.”

Vote for Health -- Yes on 5, the organization supporting Question 5’s passage, could not be reached for comment. In a statement on their Internet site, supporters argue Question 5 “guarantees health care for all our fellow Massachusetts residents who don’t have insurance,” and further argues Question 5 “returns medical decisions to patients, doctors and nurses, not HMO business managers.”

Szoke expresses concern over the potential cost of Question 5. She cites a survey by the Massachusetts Taxpayers’ Foundation that concluded health insurance premiums could rise by as much as 40 percent if Question 5 passes. Vote for Health disputes that study, however, noting that the Massachusetts Taxpayers’ Foundation has contributed $6,000 of in-kind donations to the No on 5 Coalition.

Conflict over Patients’ Bill of Rights

Much of the discussion about Question 5 has focused on its effects on the Patients’ Bill of Rights passed this summer by the General Court. Many initial supporters of Question 5 have renounced their support for the measure since this legislation passed.

While Vote for Health calls the managed care bill “a modest but useful step,” it argues more action is needed. “The Beacon Hill plan does not guarantee access to health care for everyone,” said the organization in a printed statement.

Szoke believes that the managed care bill should be given a chance to work and notes that Question 5 would supersede existing patient rights if there is a conflict.

“This is a landmark managed care law and patient’s bill of rights,” said Szoke. “It’s a step in the right direction. ... Question 5 would undo this Patient’s Bill of Rights.”

Insurers struggle financially

The financial troubles of several Massachusetts insurers have been among the most prominent local headlines this year. Harvard Pilgrim, a non-profit HMO, was forced into state receivership earlier this year. Recently, Tufts Health Plan and the Partners system of hospitals fought over the level of reimbursement paid to the hospitals.

Szoke argued Question 5 would only worsen the condition of local insurers, particularly non-profit HMOs. “[HMOs] are how people receive their health care. And US News and World Report says that four out of the ten highest ranked health plans are right here in Massachusetts.”

Vote for Health, however, believes additional constraints are needed to regulate the behavior of HMOs. “These companies should be able to adapt to a world of greater patient autonomy, reduced bureaucracy, and diminished paperwork and middle management,” the organization wrote.