Yet in the same poll, 54 percent said the state's health care system needs fundamental change, and 84 percent believe the system needs at least some change.

"What's happened is that many people either have their own horror story about HMOs or know someone who has," said Mike Dwyer, managing director of health care services with the Los Angeles office of accounting firm BDO Seidman. "It feeds into the perception that HMOs are insurance agencies and insurance companies are just not to be trusted."

One public relations disaster involved the policy of sending new mothers home only 24 hours after giving birth. Dubbed "drive-through deliveries" by consumer groups, it fed the perception that HMOs were willing to push patients out the door to cut costs. Many HMOs have dropped the 24-hour restriction.

HMOs took another P.R. beating in the courtroom. In one well-publicized case in 1993, a jury found Health Net Inc. guilty for refusing a bone-marrow treatment for a patient who later died. The jury ordered Health Net to pay $89 million.

HMO officials say such incidents are rare and they repeatedly point to surveys citing high satisfaction ratings.

But fed by the horror stories and widespread public distrust, the drumbeat for reform has become loud and steady.

Last year, state legislators drafted more than 80 bills aimed at tightening up HMO regulations. They took aim at the Department of Corporations, which has been criticized for lax enforcement, along with the HMOs' mandatory arbitration policies.

Most of that legislation was on track to sail through when Gov. Pete Wilson put on the brakes, saying that lawmakers had not waited for results from a panel that was meeting to discuss how best to reform HMOs.

The Managed Health Care Improvement Task Force, composed of 20 gubernatorial appointees and 10 legislative appointees and chaired by the godfather of managed care, Alain Enthoven, released its report this month. Among the more than 100 reform recommendations, a few stood out:

- Creating a new HMO regulatory agency run by a board or an elected or appointed official;

- Requiring HMOs to publish lists of approved drugs and allow patients to continue receiving drugs they are already taking even if they are not on approved lists;

- Requiring HMOs to release detailed information on patient complaints and requiring them to set up standardized procedures for dealing with those complaints;

- Requiring HMOs to publish standardized descriptions of their services that allow consumers to comparison-shop.

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