Report From the States

Missouri --- The Spin-Meister Visits My Town

Conrad F. Meier

On July 6, 2000, President Clinton came to Columbia to "lobby" for his so-called patient rights bill. Without saying so, Clinton was here to support Governor Carnahan (a staunch supporter of the original Clinton socialized health care plan and author of the state's failed universal health care legislation) in his bid for John Ashcroft's Senate seat. Clinton's patient rights bill failed passage in the Senate by one vote - none other than Senator Ashcroft's. Hmmm!

The event here in Columbia was anything but democratic. Tickets for the speech at the University of Missouri were given out only to the state's party faithful and politically connected. The rest of us got politically correct sound bites and the predictable media coverage.

Incorrectly, Clinton compared his patient rights bill to a three year-old Missouri bill that allows an insured to sue his or her HMO. The Missouri bill, written and sponsored by Columbia Democrat Tim Harlan, has been touted as one that did not produce the negative results argued by those in opposition.

Both Harlan and Carnahan took the opportunity to claim the Missouri plan is a model for managed care around the country. They cite an independent study that claims insurance premiums have increased only 1.5 percent and that the scare mongers were all wrong.

So much for their fiction. Here's some non-fiction:

In the two years since passage of the Missouri patient rights bill, the following consequences have been documented:

° Several HMOs have withdrawn underwriting insurance policies from the populated Springfield market as well as the Missouri boot-heel region.

° The state's managed care consolidated health insurance plan for employees and other public entities is being withdrawn and replaced with a traditional "fee-for-service" model and a POS option.

° Premium increases for individual and small group health insurance coverage have increased in the last two years on average, and with regional variances considered, more than 20 percent.

° There has been no research done to evaluate the additional cost attendant to administration and compliance to the law; added cost related to collecting, assessing and divulging information to the Department of Insurance and other state agencies; and the added cost of vagaries arising from unclear language regarding the HMOs liability in emergency room cases.

While not all of these consequences can be attributed exclusively to the patient rights bill, that also is precisely the point: Health care legislation does not take place in a vacuum. Years and years of bad social policy have been followed by more bad social policy, with each subsequent layer of regulation adding one more burden to an already over-regulated free market.

As a citizen of the "Show Me" state, I would caution the nation when it comes to letting us show you a model patient rights bill.


Mr. Meier is Health Policy Advisor at The Heartland Institute. His e-mail is

Originally published in the Medical Sentinel 2000;5(6);216. Copyright©2000 Association of American Physicians and Surgeons (AAPS)