which prevent doctors from revealing information on health care options. And this year the bill includes a controversial proposal allowing patients to sue their HMOs. Only Texas allows this, and it has been challenged in federal court. (In this state, patients can already sue doctors.)

Illinois' comprehensive reform bill is sponsored by Chicago Democratic Rep. Mary Flowers, who chairs the Health Care Availability and Access Committee. The measure remains in the Republican-controlled Senate.

A second, more modest proposal has been introduced in that chamber by Sen. Tom Walsh, a Republican from LaGrange Park. It would define emergency room visits and prevent gag clauses. "We can try and go for the Cadillac plan and find a few businesses who can afford it, or we can go with my bill, the Chevy," Walsh says.

A similar debate is taking place in Congress. And Illinois Republican U.S. Rep. Harris Fawell's chief of staff uses a similar analogy. "We can have a Cadillac in a few garages or a Chevy in every one," says Fawellaide Alan Mertz, referring to the federal comprehensive consumer-rights bill his boss opposes. (Another "Patients' Bill of Rights" was co-sponsored in the U.S. Senate by Democrat Richard Durbin.)

The House measure is sponsored by Georgia Republican Charles Norwood. He argues it would cover millions of Americans in unregulated health plans by allowing states to preempt current federal restrictions against regulating certain plans. In Illinois, 2.3 million consumers are enrolled in health maintenance organizations regulated by the state, but another 2.7 million to 3.7 million are enrolled in unregulated plans.

"HMOs are the only industry in the nation not regulated," says John Stone, Norwood's communications director. "You can't touch them, not even for medical malpractice. They can kill you and you have no rights."

Such rhetoric has scared many members of Congress into supporting Norwood's bill, says Mertz. But he counters the larger companies that provide unregulated plans also offer some of the best health care coverage.

Any managed care reforms adopted this year at the state and federal levels will likely be just the beginning. Now may be the time to study up.

"What we should be worrying about," Mertz says, "are the millions who don't have any health insurance at all." Fawell has introduced a measure he believes will address that problem by allowing smaller companies to band together to save on the costs of employee insurance plans.

Despite the divisiveness on managed care reform, Congress is expected to pass something before its October adjournment.

Yet any managed care reforms adopted this year at the federal and state levels will likely be just the beginning. "At this time, there is no single best regulatory solution that satisfies the expectations of consumers, providers, regulators and purchasers," according to the National Governors' Association's Center for Best Practices.

So this summer may be a good time to study up on the issue.

The Idiot's Guide targets the consumer who knows little beyond the name of his HMO. The authors — an economist with a national consulting practice on health care and pensions, and an attorney specializing in employee benefits, pension and health law — say their information "is not written down in any one place — and some of it's not written down anywhere!"

Sophie M. Korczyk and Hazel A. Witte break the information into five easy-to-digest parts: a basic description of managed care; how to get coverage; how to use it day-to-day; how to find specialists; and how to exercise consumer rights. There are special tips and references for more information. In fact, just inside the front cover is a list of government-sponsored consumer- oriented health web sites.

When Doctors Join Unions should be of interest to anyone who wants to know the ways in which managed care is pushing doctors to organize.

Author Grace Budrys, a DePaul University sociologist, says doctors "feel increasingly divorced from the decision-making centers of the organizations they work in." While they are struggling with a loss of status, however, many are reluctant to join unions, organizations that traditionally have represented trade workers.

For doctors, Budrys offers some history, as well as information on the international status of doctors' unions. For HMO bureaucrats, she provides a glimpse of the physician psyche: why they would find unions attractive in today's health care climate. She stops short, however, of predicting a surge in unionization.

Managing Managed Care II: A Handbook for Mental Health Professionals, written by a psychiatrist, a psychotherapist and a quality consultant for health care organizations, promises to go "step by step through the managed care review process." With charts, sample cases and a suggested common terminology, Michael Goodman, Janet A. Brown and Pamela M. Deitz show doctors how to "articulate the clinical rationale for their services." How to get paid, in other words.

"Unless mental health care practitioners can articulate what they are doing for their patients and also convincingly explain why they are doing it, purchasers and providers are going to be increasingly unwilling to pay for their services."

"Once upon a time, when you got sick, it was just you, your doctor and a few basic rules," Korczyk and Witte write in the Idiot's Guide. "Now it's a cast of hundreds, their voice mail and a list of rules as long as your arm ... in small type."

It's true. Marcus Welby, if he really ever existed, could not survive in today's managed care world. But states and Congress, with their increasingly stringent patient-rights bills, seem to be trying to salvage what they can of the old idealized doctor-patient relationship. 

Illinois Issues June l998 / 33