At the startof the debate in the Senate last week on legislation regulating health plans,Phil Gramm, a conservative Republican from Texas, blasted the Democratic billbecause "the one thing it does not provide is more freedom." DoesGramm believe that freedom currently reigns in the U.S. health care system?Actually, it does to a degree-for the insurance companies. They're free to telldoctors and patients what to do, and they're free of retribution should theyact negligently, for patients are prevented by law from suing negligent HMOsthat cause injury or death.
Gramm wascorrect in that freedom is indeed at issue. Under the Democratic bill, a womanin an HMO could choose a gynecologist as her primary care doctor. But Republicansvoted against this. In fact, Gramm and his GOP colleagues opposed a string ofDemocratic provisions that would provide consumers more options, such as thechoice of staying in the hospital after a mastectomy, the choice of retaininga doctor for a few months if forced to switch health plans and the choice ofgoing to the closest E.R. Republicans, however, argued that his package representedintrusive government and would cost too much. To cover their cheeks, though,the Republicans did vote for their own mastectomy hospital-stay provision.