Supreme Court
Immune from liability
The Supreme Court blocks a potentially important legal path for people who want to sue HMOs. Now, the spotlight is on Congress.
In a major setback for patients’ rights activists, the U.S. Supreme Court Monday blocked a potentially important legal path for people who want to sue HMOs for delaying or denying care.
The unanimous decision involved a seemingly technical contract issue with enormous implications for patients: Can HMOs be sued for “breach of fiduciary responsibility” if they give doctors financial incentives to limit treatment? Because such incentives are the lifeblood of HMOs, the justices ruled, the court could not endorse these lawsuits without triggering an unprecedented legal attack on the managed care industry as a whole.
The court, in a sense, punted the issue to Congress. Lawmakers are debating legislation that could give patients broader rights to sue HMOs.
“With this ruling, the Supreme Court isn’t just asking for congressional action, they are shouting at the top of their lungs for us to act,” said Rep. Charlie Norwood, R-Ga., co-sponsor of the legislation in the House.
“No other industry in America has immunity from liability for its mistakes, and HMOs don’t deserve immunity either,” Sen. Edward Kennedy, D-Mass., said in a statement. “Nothing is more likely to persuade an HMO to do the right thing than the knowledge it will be held accountable if it doesn’t.”
The court struck down an appeals court ruling allowing a woman to sue her HMO after the company’s delay in diagnosing her stomach condition resulted in a ruptured appendix.
“Congress, which has promoted the formation of HMOs for 27 years, may choose to restrict its approval to certain preferred forms, but the [Supreme Court] would be acting contrary to congressional policy if it were to entertain [a] claim portending wholesale attacks on existing HMOs solely because of their structure,” Justice David Souter wrote on behalf of the court.
The managed care industry, not surprisingly, cited the decision as a major victory.
“There is a recognition here of the value that (HMOs) bring to the health care system,” American Association of Health Plans spokesperson Susan Pisano said. The court recognized, too, “what a different decision would have done in terms of unraveling the system,” she said.
Nearly a decade ago, Cynthia Herdrich sued the Carle Clinic in Illinois. The HMO had made her wait eight days for an ultrasound after she complained of stomach pains. While she was waiting, Herdrich’s appendix ruptured, causing an infection that required surgery.
While Herdrich received a modest malpractice settlement, she also sought to sue Carle for operating in a way that encouraged doctors to delay tests.
Managed care companies have long rewarded physicians who keep a lid on costs by reducing “unnecessary” prescriptions and referrals. HMOs are typically protected from lawsuits for refusing or stalling care by arcane legislation called Employee Retirement Income Security Act. ERISA sets federal standards — and the court’s decision Monday applies to federal courts. Patients may file malpractice claims against doctors or medical facilities in state courts.
A federal judge dismissed Herdrich’s claim, but a federal appeals court allowed her to sue.
Although the court all but invited Congress to act, don’t expect groundbreaking legislation anytime soon. The House passed the Norwood bill last October, but lawmakers have yet to come up with an acceptable way to marry the bill with far narrower legislation drafted by the Senate.
Partisan bickering has bogged down the conference process. Congressional observers say the court’s decision will do nothing to light the fire of lawmakers.
David McGuire is a reporter in Washington. More David McGuire.
John Roberts’ Gilded Age SCOTUS
Jeffrey Toobin shows how the Citizens United ruling challenged a century of efforts to rein in corporate power
John Roberts (Credit: AP/Pablo Martinez Monsivais) The most important revelation in Jeffrey Toobin’s 10,000-word New Yorker piece on Chief Justice John Roberts’ takedown of campaign finance laws in the Citizens United case is the extent to which modern conservatism is trying to restore the Gilded Age. That was a time when corporations had more rights than individuals, when a conservative Supreme Court did its best to protect those corporate rights, and wealth and corruption ran unchecked. Of course, we live in a neo-Gilded Age, when income inequality is more pronounced than at any time since the Great Depression, and the Roberts court’s decisions in the Citizens United case helps bring us all the way back to those bad old days.
Continue Reading CloseJoan Walsh is Salon's editor at large. More Joan Walsh.
Obama destroys Constitution with mild Supreme Court criticism
Conservatives and moderates declare SCOTUS-bashing to be "intimidation"
(Credit: AP) Ruth Marcus is unsettled. Maybe even queasy. There is probably some light nausea. What has her worried for the future of the nation, today? President Obama’s shameful, horrific, vicious attacks on those nice people in the Supreme Court.
Obama said that the court overturning Congress’ healthcare reform law would be a textbook example of “judicial activism” as “conservative commentators” define it: “that an unelected group of people would somehow overturn a duly constituted and passed law.” And hey, that seems like an eminently defensible and not particularly unsettling point! Conservatives made “judicial activism” into a talking point and rallying cry and defined it vaguely enough to encompass judges striking down basically any law or statute.
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Alex Pareene writes about politics for Salon and is the author of "The Rude Guide to Mitt." Email him at apareene@salon.com and follow him on Twitter @pareene More Alex Pareene.
Justices run amok: Fixing the Supreme Court
Judges on the right and left legislate from the bench. So why don't we just elect them?
Antonin Scalia, John Roberts and Clarence Thomas On Monday, we had another example of the Supreme Court’s ideological division: a 5-4 ruling, along partisan lines, giving police the right to conduct strip searches for any offense. This came on the heels of last week’s oral arguments before the Supreme Court about the constitutionality of the individual mandate provision of the Affordable Care Act, which led many observers to predict that the nation’s highest judicial body will strike down part or all of the controversial healthcare reform package. But the hearings were instructive in other ways. They showed once again that political partisanship is closely correlated to a justice’s view of the law. And they proved that the Supreme Court once again is functioning, not as a court, but as a third house of the federal legislature.
Continue Reading CloseMichael Lind’s new book, "Land of Promise: An Economic History of the United States", will be published in April and can be pre-ordered at Amazon.com. More Michael Lind.
Why I need Obamacare
I'm sick, and I will be for the rest of my life. Knowing I won't be denied the insurance I need matters
Supporters of health care reform stand in front of the Supreme Court in Washington, Wednesday, March 28, 2012, on the final day of arguments regarding the health care law signed by President Barack Obama. (AP Photo/Charles Dharapak)(Credit: AP) Dear healthy people,
It’s great that you’re deriving intellectual pleasure from debating Obamacare. I love that this theoretical dance you’re engaged in has no repercussions to you, a healthy individual. I would love to join you some evening for a spirited discussion on the pros and cons of healthcare reform. Maybe over a glass of wine? Heck — over two or three glasses of wine. I’d love to lean forward, my arched brows furrowed, my full lips purple with the stain of a good Zinfandel, and throw out statistics and well-crafted one-liners about the plight of the uninsured, the underinsured, the sick. Those poor, poor sick.
Continue Reading CloseCedar Burnett is a freelance writer and toddler wrangler living in Seattle. She is currently working on a book about living with ulcerative colitis. More Cedar Burnett.
The conservative grip on power
A ruthless GOP power grab, centered around the Supreme Court, has cemented conservative control in Washington
Clarence Thomas, George W. Bush and Antonin Scalia (Credit: AP) Writing in Salon, Natasha Lennard proposes that with the warm weather we can again expect the Occupy movement to shoot up. Arab Spring, American Spring. She’s right about one thing: Like in the decades before the Arab Spring, it has been a long, cold, American winter. In the 30 years since coming to power here, Republicans have used their initial ascent to power to seal themselves into office as tightly as the pharaohs. Smart commentators have noted how lawless the conservatives are in making substantive decisions, but that’s not the worst of it. The worst of it is how they use their tenure to make it increasingly impossible to oust them.
Continue Reading CloseLinda Hirshman is the author of “Victory: The Triumphant Gay Revolution,” forthcoming in June 2012. Follow her on Twitter @LindaHirshman1 More Linda Hirshman.
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