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The supremes have removed the last obstacle to corporate profiteering at the expense of your health
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Moses, you aren't usually given to hyperbole. What gives?
The point of the
Davila and
Calad cases is that plaintiffs who sue their HMOs, claiming that the HMO's cost-containment efforts resulted in clinical harm to the patient, have to sue in Federal court, not State.
The patient originally sued their HMO for medical malpractice, a "Tort" claim. The lower court distinguished that from a "denial of benefits" claim and ruled for the plaintiffs. The Supreme Court said that it doesn't matter how you style the action: the HMO's liability is to be determined under the federal ERISA statute (which covers retirement benefits and has been extended to HMO coverage). And the proper place to bring an ERISA action is in FEDERAL court, not STATE court.
Now, state courts generally, not always, return bigger verdicts for plaintiffs, and they are easier to access, again generally.
Successful malpractice claims hurt the HMO, in the form of higher insurance premiums, direct settlement costs, and legal fees (the lawyers ALWAYS win). So moving the claim to federal court probably reduces the HMOs costs from med-mal claims.
And yet you say that's a bad thing?
Does the HMO's benefit design or formulary necessarily mean that patients are going to get substandard clinical treatment?
Isn't this a matter of contract, e.g., if you want better care, aren't you free to purchase traditional indemnity insurance? If you want an off-formulary drug (in the cases cited, Vioxx) can't you buy it yourself?
Ahh, but the answer is, you can't afford traditional indemnity insurance, you can't afford to buy branded drugs for cash, they are too expensive!
But the HMO was developed as a legal healthcare purchasing cartel, to negotiate with physicians and hospitals and defend med-mal suits in scale, to reduce the monthly premium to a level that ordinary people can afford!
So we're back to the whole clinical care debate: do Americans have a RIGHT to clinical care at any cost, whether they've contracted for it or not?
Would your answer change if the plaintiff were seeking heroic end-of-life surgery to prolong her life and didn't get it because the HMO's medical management committee said it wasn't likely to result in a meaningful increase in life span? What if they sued based on that, claiming it was a violation of standard of care?
Here are the cases FYI.
http://caselaw.lp.findlaw.com/cgi-bin/getcase.pl?court=US&navby=case&vol=000&invol=02-1845