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Connecticut Attorney General Richard Blumenthal said that the state’s suits against health maintenance organizations were likely to be settled, but that he would oppose judicial oversight of the settlements. Blumenthal sounded off in a philosophical defense of the lawsuits against HMOs in a May 8 debate at the State Capitol, sponsored by the Federalist Society For Law and Public Policy. The state isn’t seeking a penny in damages, only orders that would force some of the state’s top health care providers to obey federal law requiring them to place patients’ interests first, Blumenthal said. The event also featured Yale Law School Professor George L. Priest, who served as an adviser to President Ronald Reagan on privatization of government services. Blumenthal noted that the state has not sued all HMOs, determining that Aetna and United Health Care are already putting pressure on themselves to improve. Physicians Health Services, CIGNA, Anthem Blue Cross and Oxford are the current defendants. Blumenthal said the idea is to enforce the provision of the federal Employee Retirement Income Security Act requiring HMOs to “act solely in the interest of their enrollees.” He said that HMOs are “making arbitrary coverage decisions in the interest of controlling costs.” Litigation isn’t ideal, Blumenthal said. “We would much prefer these HMOs do the right thing on their own,” such as eliminating levels of their own bureaucracies and not second-guessing doctors’ decisions. Priest wholeheartedly agreed litigation was “not going to bring real reform to managed care.” He said the medical needs of Blumenthal’s eight representative plaintiffs were “peculiar” cases. Blumenthal resisted having his plaintiffs characterized as “peculiar,” saying they were people with asthma and heart ailments — “people with basic health conditions.” He said that people have different treatment requirements. To cut off Lyme Disease antibiotics after 30 days and to never give intravenous antibiotics in any case “seems to me to be one-size-fits-all principle.” THE SHRIMP BOWL SYNDROME Priest said that part of the difficulty with a pre-paid package deal like a health care plan is that the consumer doesn’t know what he or she will want or need, and when. The pay-in-advance system has its own costs. Priest used the analogy of a cruise ship in which food and drink are paid in advance. People’s natural tendency is to eat and drink more than they normally would have on a pay-as-you-go basis. “Cruise ships are not ignorant of this problem,” he said. They put the shrimp bowl at the end of the buffet table, or limit the number of times it is refilled. For people whose needs differ from the general norm, paying extra for special requirements is not unusual, Priest said. He used the example of homeowners’ policies excluding coin and stamp collections from ordinary coverage. “It’s a feature of every package system we see,” he said, to limit coverage for special circumstances. LOYALTY TO GROUP The ERISA concept that an insurer must act solely in the interest of the enrollees is fine, said Priest, if the term “enrollees” recognizes the group nature of the insured class. “If it were the individual personal interest of each enrollee, our health care costs are going to go through the roof,” he said. Blumenthal contended the HMOs fail to give adequate notice of the procedures for contesting claims and do not have standards that can be ascertained.

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