By Ben Joravsky

For the last two years, Mayor Daley and his City Council allies have had a choice to make in matters of public health. They could either side with the patients or go with the providers.

Guess what they did? They passed a health-care regulatory ordinance so toothless and timid that even the HMOs, sensitive though they are to any regulation, have whispered not a word of complaint.

As a result, Daley and the aldermen find themselves the target of a vigorous campaign by Metro Seniors in Action, a coalition of senior citizens who just won’t quit their health-care crusade. “The city lost a chance to be a major advocate for health-care rights,” says Sydney Bild, a retired physician and chairman of Metro’s health committee. “We’re determined to get them to put some teeth into their ordinance.”

Those fortunate enough to be covered by a generous health plan will find it hard to understand what the fuss is about. For everyone else, health care has become a nightmare. “We’re not even talking about the 43 million people in this country who have no insurance–that’s a whole other disaster,” says Bild. “We’re talking about people who pay for coverage only to discover it’s not there for them when they need it.”

It’s a particularly bitter lesson for seniors on fixed incomes who are deceived into believing that medicare, the federally funded health insurance for people over 65, will meet their needs. “Medicare’s great when you’re healthy,” says Thelma Cohen, a member of Metro Seniors. “Just don’t get sick.”

For instance, medicare only covers major hospitalization (and even then with an $800 deduction). Other expenses, including routine doctor visits, remain uncovered, forcing seniors to dig deep into their pockets to pay for supplemental insurance. But affordable supplemental plans rarely cover prescriptions, eyeglasses, psychiatric counseling, or dental visits.

“Honey, let me give you some advice–don’t get old,” says an 80-year-old north-sider. “Everything you really need they don’t pay for. They don’t pay for teeth. They figure, who cares if you look like an old bat and you can’t chew your food? They don’t pay for eyeglasses. You know how much it cost me to get my new reading glasses? Two hundred and fifty bucks. What are you supposed to do, sit around and stare at the walls? They don’t pay for pills. I stopped taking my blood pressure medicine. I can’t afford it. I guess they’re just waiting for us to die.”

Like managed plans in general, most medicare supplemental plans also don’t pay for second opinions, emergency care, or visits to specialists unless they’re approved by the HMO’s internal review board. Such vigilance is needed to avoid lavish and costly health-care treatments that would drive up everyone’s health-care costs, the HMOs contend.

Bild disagrees. “They make it sound as though all senior citizens are going to run out and get MRIs–you know, ‘I had one yesterday, I want one today, give me another tomorrow.’ That’s absurd. Who wants to go to the doctor? Who loves to go to the hospital? It’s absurd. You shouldn’t have to get permission for a second opinion or emergency treatment. Under managed care, important health decisions are based on money, not medical needs. They have taken the power away from doctors and given it to utilization boards who pressure doctors to keep expenses low.”

Moreover, there’s no guarantee that HMOs will maintain medicare service. “The law doesn’t require HMOs to keep medicare patients once they sign up,” says Michael Brennan, a Metro Seniors member. “In Chicago, most HMOs get almost $600 a month from medicare for every senior they enroll. But if they decide to drop medicare coverage, those seniors are out of luck. It happens all the time. You’ll see these big ad campaigns as HMOs try to lure in seniors with glossy flyers. They’ll collect their money, decide it’s no longer worth it, then drop medicare. What are the seniors supposed to do? They have to scrounge around for another carrier. There’s no security.”

In 1996, Bild, Cohen, Brennan, Dorothy Peters, Alice Drell, and other Metro Seniors activists launched their Managed Care Accountability Project. After several months of study and debate (including a meeting with Mayor Daley), they proposed a Chicago Managed Health Care Consumer Protection Ordinance. This would forbid HMOs to prevent doctors from informing patients of alternative treatments. It would require HMOs to provide the Health Department with annual accountability reports specifying who had been denied coverage and why. And it would require HMOs to pay for any treatment authorized by the examining doctors, including visits to specialists and second opinions. It also would require the HMOs to pay for all emergency care, even if the patient is acting “on a lay person’s reasonable judgment of what an emergency is.”

“That way if you think your mother’s having a heart attack, you can take her to the emergency room without wasting time trying to reach your doctor, who’s not always reachable, for permission, or worrying if it’s going to be covered,” says James Thindwa, a Metro Seniors organizer.

The activists knew their proposal was bold, but they figured most politicians would support it, if only to cultivate the senior citizen vote. But Daley was cautious, telling them he didn’t think the city had the legal authority to regulate HMOs. Without Daley’s support, most aldermen backed away. “At first the aldermen were receptive–we got 36, including Alderman Ed Smith, who chairs the council’s health committee, to support the bill,” says Bild. “And then something happened, something changed. I don’t know what it was. I don’t know if someone got to the aldermen, but they soured on us. Smith stopped returning our calls. When we went to his office, he told us, ‘I don’t want to talk about this.’ Finally, we convinced him to give our ordinance a hearing.”

On April 8, 1997, about 300 seniors jammed the council chambers to support the ordinance. For three hours, seniors told tales of rising health bills, callous treatment, and inadequate coverage. The only opposition came from a city lawyer who said only the state or feds can regulate HMOs but cited no cases to support his position. Another lawyer, Myrrha Guzman, testified that no home rule restrictions prohibit the city from regulating HMOs.

Only five aldermen attended the hearing. “When it was time to vote, Alderman [Mike] Wojcik [30th] called for a quorum,” says Bild. “Had he not called for a quorum count, the five aldermen present could have passed our ordinance and sent it to the full council. But since there was no quorum it remained in committee and it’s never been heard from since.”

It was a sneaky and cowardly maneuver, activists say. “We asked our so-called supporters why they didn’t show up, and they had all sorts of excuses,” says Thindwa. “Dorothy Tillman and Carrie Austin said they were sick. Madeline Haithcock got angry at us for asking. She said, ‘I told you people that I didn’t come to the meeting because I was unable to. That’s all you need to know.’ I guess we didn’t realize the enormity of the power wielded by the HMOs. They didn’t even have to testify against the proposal. They just let the city do their dirty work for them.”

A few months later Daley introduced his own managed-care ordinance. It begins with a ringing preamble–a Health Care Consumers’ Bill of Rights–and goes on to ban the gag rule and establish an “office of managed care” in the Health Department. But it has no regulatory powers. “It doesn’t require the HMOs to give second opinions or emergency treatment or specialist care or to even provide the treatment they say they will cover,” says Brennan. “It’s nothing like our proposal.”

On July 30, 1997, the council unanimously adopted Daley’s bill after defeating an attempt by independent aldermen Joe Moore and Helen Shiller to toughen it. Metro Seniors activists cried betrayal, but Daley and his allies said it was the best they could do. “My hands are tied,” Smith told reporters. “The city cannot usurp state powers in regulating HMOs. It doesn’t make sense to pass something that will make us look like idiots.”

In a form letter sent to senior citizen groups, Daley proclaimed the ordinance a major accomplishment. Chicago is “the first city in the nation to formally address the quality of care received by individuals served by MCOs [managed care organizations],” Daley wrote. More stringent regulation would be unlawful because “under Illinois state law the city cannot comprehensively regulate the operation of MCOs.”

Health Department officials say they’re keeping an eye on the HMOs. “We set up a hot line for people to call in their complaints,” says Susan Cahn, director of the department’s Office of Managed Care. “We’re here and ready to help them.”

But Metro Seniors activists say many telephone operators in City Hall have no clue that the office exists. “When you call the mayor’s office with a complaint about HMOs, they say call the state,” says Bild. “We’re not giving up on our ordinance. If we keep pushing I think the city will take a tough stand. Their reasons for opposing us are weak. They say they have no authority to regulate and they don’t want lawsuits. But if they can’t regulate, how can they ban the gag rule? And since when are they afraid of lawsuits? On some issues, like gun control and his antiloitering proposal, Daley goes to court to defend a law others say is unconstitutional. He’s not worried about lawsuits there–why should he worry here? The issue, public health, is just as crucial.” o

Art accompanying story in printed newspaper (not available in this archive): Alice Drell, Sydney Bild, Michael Brennan, Dorothy Peters photo by Bruce Powell.