This substitute has several and severe flaws.

It preempts 200 years of state law without writing the proper federal jurisprudence to take its place. It would tie the federal courts in knots for years.

It places an additional burden on people who want to hold their insurance company to account. It makes you wait in line behind the drug and other cases in federal court. And it can force you to travel to a foreign venue with your lawyer.

It contains a loophole that allows insurance companies to escape all responsibility if they’ve made the wrong medical decision.

When HMOs have been held accountable under state law, like other providers and businesses, the litigation sky has not fallen.

But Mr. Houghton rejects normal state law accountability, in favor of an untested, weak, and exception-riddled federal action. The irony is that his proposal would likely create more uncertainty and litigation.

What can be reviewed would be limited, so that if the HMO hurts you prior to the "final decision" of internal review -- or if you die before your internal review is completed -- you and your family are out of luck. And under the Houghton amendment, only the person who has the sole authority to make the final decision is subject to liability. A plan may assign this authority to one person, but have someone else under the decision that leads to the injury. That way, no one would be liable.