January 31, 2005

Erisa excitement

Jeremy Blachman's reaction to the first session of a law school class called "Health Care Institutions" is one that I can sympathize with:

But it seems like the most interesting parts of some of the subjects we can study -- the most compelling pieces of the puzzle, the most engaging angles to look at -- are not the legal ones. I think talking about how to improve patient care is a lot more interesting than talking about the legal regime surrounding managed care health insurance programs.

Fortunately for Jeremy, I can offer some encouragement. If his class is good, he'll soon be wrestling with the issue of whether changes to the legal regime governing managed care plans can, in fact, lead to improved patient care. My whole Note is focused on that exact topic.

Ordinarily, I would not have given two stones about managed care or ERISA. That all changed this summer when I was working for a managed care organization. The Supreme Court decided Aetna v. Davila in a way that preserved (and strengthened) the virtual immunity from liability that MCOs enjoy under ERISA for a very particular type of decision (a type of prospective utilization review). This kind of decision is one that often has profound consequences for the quality of patient care, and yet the Supreme Court had treated it as merely a decision about payment.

Bullshit, I thought. These are effectively medical decisions, and MCOs ought to be held accountable when they are made negligently. Unjust! Unfair! Meanwhile the managed care industry was practically peeing in their pants with excitement, which made it all worse.

Maybe I'm just fortunate that my experience last summer sparked an interest in ERISA. More likely I'm just weird. But I still think there's hope that Jeremy's class will get much more interesting in a few weeks.

Posted by Carey at January 31, 2005 09:47 PM