I DON’T WANT THE ABILITY to sue my health insurance company. Lawyers
are expensive, so if my insurance providers know that I might sue them,
they’ll charge me more. Other people, in contrast, might want to pay for
the ability to sue. A true patients’ bill of rights would give all of us
the choice.
Unfortunately, the congressional sponsors of the
patients’ bill of rights now heading for a House-Senate conference this
fall seem to have forgotten the difference between rights and obligations. They
want to force everyone to pay higher health insurance premiums in return for the
ability to sue. But if I hate broccoli, forcing me to buy it increases my
obligations, not my rights.
Those who believe that the legal system is an
ineffective instrument for resolving disputes between patients and health
insurance companies should not be forced to pay higher premiums for the ability
to sue our insurance providers. If Congress really cared about rights, it would
make the patients’ bill of rights voluntary. Insurance companies could be
required to offer some plans that permit consumers to sue them and others that
prohibit consumers from suing them. Consumers would then have the right to
choose the plan they wanted.
Liberals would obviously object to giving
patients the right to be free of lawyers’ fees. The Left would claim that
if insurance companies could sell policies that did not provide for the ability
to sue, they would do just that, in effect coercing poor or uninformed consumers
into forgoing their rights.

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The Left would also argue that, if given the chance, greedy insurance companies
would make it prohibitively expensive to buy a policy that provided the ability
to sue.
These arguments would be wrong—precisely because insurance
companies are greedy. If it costs, say, $100 to give a patient the right to sue,
then a profit-maximizing insurance company will happily provide this right to
anyone willing to pay more than $100 for it. Alas, liberals are unlikely to
accept any argument based on the assumption that markets work.
To satisfy
any genuine objections to making the patients’ bill of rights voluntary,
Congress could begin with a limited test. It could allow only a small segment of
the population to opt out of the bill’s provisions—only college
graduates making over $60,000 a year, say; or it could permit insurance
companies to sell such opt-out policies to up to 10 percent of their customers.
Allowing even 10 percent of Americans to forgo a patients’ bill of rights
would provide a useful market test of the bill’s value.
Normally,
it is difficult to determine the cost of governmental regulation. But the
difference in the price of health insurance policies with and without the opt-
out would quickly reveal the true cost of the patients’ bill of rights.
Such a test would also show whether health insurance companies treated those who
could sue them differently from those who could not. Would insurers withhold
vital treatment from those unable to file lawsuits? Would they practice wasteful
defensive medicine on those who could? The number of people who chose to buy
insurance without the ability to sue would provide Congress guidance as to
whether to make the bill voluntary for everyone. If only a very few people took
advantage of the right to opt out, then it would be reasonable to assume that
almost everyone would want the right to sue. If most opted out, then it would be
obvious that the patients’ bill of rights catered to trial lawyers but not
most patients.
As a rule, Republicans tend to incorporate choice in their policies, while
Democrats don’t. For example, President Bush’s Social Security proposal would
give Americans the right, but not the obligation, to invest part of their Social
Security retirement funds in the financial markets. Even though the president,
presumably, believes most people would be better off with their funds in the
market, he isn’t seeking to force this choice on all. Most Republicans believe
that the poor are ill-served by the public schools currently offered them. And
Republican proposals on school choice are designed to give the poor the right,
but again not the obligation, to send their children to private schools.
It’s easy to see why Democrats want to force all Americans to pay the freight
for the ability to sue their insurers. But why are Republicans going along?
Shouldn’t they insist on giving citizens the choice of opting out of the
patients’ bill of rights?
James D. Miller is an assistant professor of economics at Smith College.
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