PATIENTS’ RIGHTS: Debate Opens with Predictable Rancor

      With each side featuring its own war rooms, "pep rallies, ad campaigns and procedural maneuvering," the Senate yesterday opened debate on HMO reform, setting the stage for three more days of voting, squabbling and sound-bite slinging (Meckler, AP/Philadelphia Inquirer, 7/13). Democrats early on countered Republicans' expected parliamentary move, by offering the GOP bill as a substitute amendment to the Democratic bill with which Republicans opened. CongressDaily/A.M. reports that throughout the week, Democrats "who want to offer an amendment will first offer the Republican bill as a substitute, then offer their amendment as a second degree to that substitute." At issue the first day was to whom patient protections should apply: Democrats want to extend the provisions to all 161 million Americans in private plans, but Republicans want to apply them to the 48 million Americans in self-insured plans, arguing that states have been enacting protections for the remainder (Morrissey/Wegner, 7/13). (See the Los Angeles Times for a breakdown of how many Americans are covered under the different types of plans.) But that debate merely mirrored a broader philosophical disagreement over how much government regulation is needed, and how much that regulation would drive up costs. Sen. Jeff Sessions (R-AL), who drafted much of the GOP bill, said, "The danger of what we're seeing here is we could destabilize and damage the greatest health care system in the world. We ought not to do that" (Scully, Washington Times, 7/13). Sen. Phil Gramm (R-TX) said, "The Democrat plan means more government, more lawyers, more rules, more uninsured and more government control, but the one thing it does not mean, the only thing it does not provide, is more freedom" (Dewar/Goldstein, Washington Post, 7/13). He added, "[C]hoose any lawyer they could pick out of a phone book -- that's their idea of health care freedom." But across the aisle, Sen. Edward Kennedy (D-MA), the architect of the competing bill, said, "The cheapest insurance policy is one that pays the fewest benefits when you get sick, and that seems to be the goal of too many unscrupulous managed care companies" (Mitchell, New York Times, 7/13). He added that the GOP bill is "a phony bill, a cynical bill, a minimalist bill, a bill bought and paid for by the insurance industry. [It is] a bill of wrongs ... an industry profit protection plan" (Hohler, Boston Globe, 7/13). Click here for a comparison of the two plans in the AP/Milwaukee Journal Sentinel.

Rah, Rah
      Both parties held pep rallies "drenched in alarmist rhetoric," the Washington Post reports (7/13). Citing CBO figures that say the Democrats' bill will drive up costs by 6.1% over five years, Senate Majority Whip Don Nickles (R-OK) said 1.8 million people would lose their insurance and premiums would rise $30 per month for the average family (Morrissey, CongressDaily, 7/12). But Kennedy said GOPers are "distorting and misrepresenting the facts. Our bill would increase premiums by about the price of a Big Mac a month." Picking up on the fast-food metaphor, Republicans countered that the cost increase would be more like "32 billion Big Macs" a year (Hamburger/O'Rourke, Minneapolis Star-Tribune, 7/13).

What's on Tap
      Today, the Senate will mull patient access, "including a Republican proposal offered as an amendment late Monday to give self-employed persons an immediate 100% tax deduction for health insurance" (CongressDaily/A.M., 7/13). Wednesday will be devoted to the doctor-patient relationship; Thursday, to accountability, "meaning a patient's right to sue" (CongressDaily, 7/12). But all the trouble may be for nought, as Scripps Howard/Detroit News reports that "the odds are still long that patients protection legislation will actually become law" (Bowman, 7/13). The White House issued a statement saying that "the president's advisers would recommend a veto if the GOP version cleared Congress." It read, "It covers too few people, it provides insufficient patient protections, and it contains inadequate enforcement provisions" (McGinley, Wall Street Journal, 7/13). CNN's Jonathan Karl reported, "Democrats very much feel they are in a win-win situation. Even if they lose this and do not get the bill they want, they will take the issue to the election" (CNN, "Inside Politics," 7/12).

Key Figures Take Debate to PBS
      PBS' "The Newshour with Jim Lehrer" featured a debate with several key players on patients' rights. Sen. Kennedy pointed out that "every single medical organization basically is supporting our proposal. It isn't because it's a Democratic proposal. It's because it's in the best interest of their patients." But Sen. Bill Frist (R-TN), allowing that you "will have certain special groups wanting more and more protection," stressed that "at the same time you don't want to go to the extreme throwing $20 billion at trial lawyers because that raises premiums up. As premiums go up, it drives people to the ranks of the uninsured." Ron Pollack of Families USA said, "Those who have not been to the table in trying to expand coverage for people who are uninsured are now using the uninsured as a shield to protect against legislation that would protect all of us." Karen Ignagni of the American Association of Health Plans said, "We have to step up in the industry and clearly talk about what's in the interest of patients versus what's in the interest of special interest protection" (7/12).

Opinion Roundup

• Daschle and Kennedy, in the Washington Post: "The Senate will pass a Patients' Bill of Rights this week. The American people deserve a genuine bill that lives up to the name, not a phony bill of wrongs" (7/13).
• New York Times: "The Republicans argue that more regulation will increase costs to industry and consumers. But that argument could apply to all consumer protection laws designed to limit marketplace abuses. The need for a basic framework of rights is particularly strong in a health care system where a patient has very few options once a plan decides to deny coverage" (7/13).
• USA Today: "Studies by the Congressional Budget Office and the non-profit Kaiser Family Foundation find HMO liability would produce negligible premium hikes. Only industry-sponsored studies find otherwise. Lawmakers would do well to look to [sic] the facts before leaving this critical patient right on the cutting room floor" (7/13).