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Patients’ Bill of Rights

June 29, 2001 at 12:00 AM EST
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KWAME HOLMAN: The Senators came to the Capitol this morning with more on their minds than the Patients’ Bill of Rights. Many had planned to be back in their home states by today to begin the week-long Fourth of July recess. But yesterday majority leader Tom Daschle made it clear work on the Patients rights bill had to be completed before the Senate adjourned. That led to a testy exchange with Alaska Republican Ted Stevens.

REP. TED STEVENS: Now I just speak personally to both leaders. My peninsula is on fire and that is where I want to go fishing next week, too. It is a disaster and the urgent call of the king salmon to respond to.

SEN. TOM DASCHLE: I said you give me a definitive list that will allow us to finish our work on the Patients’ Bill of Rights. Unfortunately our Republican colleagues have been unable to do that. Certainly we could agree it is more important than fishing, than any other kind of vacation we could be taking next week.

REP. TED STEVENS: I’d say to the leader, that is a cheap shot. I’m not talking about vacation. I’m willing to stay here as long as any other Senator. And leader, I won’t forget that. That was a cheap shot.

KWAME HOLMAN: Later in the day, Stevens home state colleague Frank Murkowski came to the Senate floor to say he had to leave.

SEN. FRANK MURKOWSKI: We have a wedding in our family that require me to travel to Juno, Alaska. I will try and be responsive to the leadership in whatever the calendar turns out to be.

KWAME HOLMAN: With that, the Senate moved ahead on amendments that tweaked but did not substantially change Patients’ Bill of Rights legislation supported by most democrats. In short the bill would: ensure patient access to emergency rooms, specialty care, clinical trials, direct access to obstetricians and gynecologists; allow patients and families to sue their health care plans in state court and federal court for administrative decisions that lead to injuries or death; and cap federal court-awarded civil penalties at $5 million.

In addition, the Senate last night overwhelmingly approved an amendment co-sponsored by Maine Republican Olympia Snowe. It would shield most employers from lawsuits by allowing them to designate an outside insurer that would make employee-related health care decisions and assume legal liability for those decisions.

SEN. OLYMPIA SNOWE: I think this strikes the right balance, Madam President, I think the consensus represents I think the optimum approach to providing the kind of basis from removing employers exposure to litigation when they are not directly participating in medical decisions.

KWAME HOLMAN: This morning the Senate unanimously approved Ohio Republican Mike DeWine’s idea to restrict the ability to bring class-action suits to employees of one company and one health care plan.

SEN. MIKE DeWINE: What we are simply trying to do is to balance the rights of the individual and the protection of the patient with the whole problem of increasing costs. We believe that the elimination of these national suits, class- action suits, will certainly help keep the costs down.

KWAME HOLMAN: Senators then went on to approve an amendment by Tennessee Republican Fred Thompson allowing patients to take their health care plans to court if an appeals process– called for in the legislation– takes longer than 31 days.

SEN. JOHN EDWARDS: It’s another example of what can be done when we tackle these problems together and try to find solutions. We’ve been able to do that on the issue of scope, on the issue of employer liability with a number of Senators on both sides of the aisle, now we’re doing it on the issue of exhaustion of administrative remedies, the exhaustion of appeals.

KWAME HOLMAN: However, an amendment by Missouri Republican Kit Bond was rejected by all 50 Democrats and a solid group of Republican moderates. It would have limited fees a patient’s lawyer could collect to expenses plus 15 percent of court- awarded damages.

SEN. RICK SANTORUM: Madam President, I call for amendment number 841 with the modification I send to the desk.

KWAME HOLMAN: But this afternoon the Senate encountered a closer vote in defeating an amendment by Pennsylvania Republican Senator Rick Santorum. He wanted to use most of the money resulting from punitive damage judgments against health care providers to create a trust fund for the uninsured.

SEN. RICK SANTORUM: So this is an amendment that will take 75% of all punitive damages awards that occur as a result of the causes of action provided for in this bill and create a trust fund, which will be used to finance those who do not have employer-provided health insurance, in other words, the uninsured. I think that is a way to ameliorate some of the damage caused by this legislation.

KWAME HOLMAN: But Massachusetts Edward Kennedy called the appeal by Santorum and many of his Republican colleagues disingenuous.

SEN. EDWARD KENNEDY: The record has not been there, and to try to offer some amendment this afternoon and crocodile tears all over the floor about what we’re doing for children in here when they basically have refused to address this issue in a serious way is something the American people see through.

KWAME HOLMAN: Throughout the afternoon, Senators took frequent time-outs to determine how many amendments were stacked up and still to be debated.

SEN. EDWARD KENNEDY: If we could take a quick quorum call — a very short quorum call.

KWAME HOLMAN: They came up with a number that ensured a final vote on a Patients’ Bill of Rights would not come until at least late this evening.

TERENCE SMITH: Mark Shields and Paul Gigot are still with me. A week ago we sat here and we talked about President Bush’s threat to use a veto if he didn’t like the bill.

PAUL GIGOT: Right.

TERENCE SMITH: Is that threat still credible today?

PAUL GIGOT: I think it is fair to say that it did work. I mean there are– you can define route in several ways politically and this was a route. I don’t think the veto threat moved a single vote. And I think it’s probably in part a consequence of his flip-flop last week on the price controls for energy, because when people see that you can be moved by public opinion like that and senators and they see that, they’re willing to move in the face of negative opinion polls and pressure, I think a lot of Democrats are looking at this opinion poll, the opinion polls on this which are supportive and saying we’re not sure he is going to veto this. So let’s look out for ourselves.

You’re seeing a solid group of Democrats vote on most amendments and you’re seeing a half dozen or more Republicans break on just about every single amendment. And so I think that the White House ought to go back to the drawing board and think a little bit about its credibility on Capitol Hill.

TERENCE SMITH: A political achievement for the Democrats, Mark?

MARK SHIELDS: Yes, I mean we acknowledge that President Bush’s victory on taxes was a victory for him. I thought the victory on education passing both Houses was a victory for the President as well. I think this is a victory for Tom Daschle in his maiden voyage as the skipper of the Senate Democrats majority. He held the Democrats on every amendment, some tough ones. He assured them that they would have further amendments to vote on if they needed political cover but he had the 50 when he needed them.

And I think that Paul’s right. The polls are not helping right now. I think that there’s a certain nervousness in the Republican ranks. We saw it in the House. We’ve seen it on votes as disparate as Mexican trucks coming into the United States under NAFTA to drilling in the Great Lakes to drilling off the Florida coast. There’s a certain independence there. I think it’s reflected in the President’s numbers. The Wall Street Journal-NBC poll this week showed him at 50 percent favorable which isn’t a bad number, don’t get me wrong and not a lethal number but this is after the victory on taxes, after the victory on education and after a pretty good trip to Europe.

And so there’s a sense of, look, I’m up in 2002, says Joe Republican House member. The White House isn’t up until 2004. This happens in every administration. And I think that is contributed to it. I don’t think– and I think the third thing is the importance of a Jeffords switch.

TERENCE SMITH: Senator Jim Jeffords.

MARK SHIELDS: Enabling the Democrats to set the agenda. They wouldn’t be voting on the patients’ bill of rights in the Senate right now. It has changed the political terrain. The Republicans are playing defensive ball and the Democrats are on offense.

TERENCE SMITH: What are the implications, Paul, for the relationship between this White House and this Congress or this Senate from this bill?

PAUL GIGOT: Well, it’s a warning to the White House for sure. I mean this is the first test ever since the Democrats took the Senate. The President isn’t doing very well on that — in the showdown with Tom Daschle. Now he does have the House to help him. And they’ve been working in the House now. Republicans still have a majority. They’re going to try to pass a bill that’s different from this one that can get to conference and maybe then the veto threat would seem more credible and will make a difference. But you have to wonder about setting a precedent. This is not a good precedent.

I think especially because there is an irony here. I think the political potency of this issue really crested two or three years ago when HMO’s really were in the popular culture then demonized and were seen as a negative. I can’t think of too many races that they’ve really affected and really cost Senator or House member their seat. And since then the market has adjusted; a lot of HMO’s themselves have changed and about 40 states have passed something. So in a way, you’re thinking about health care issue that really carries clout at the polls, prescription drugs carries a lot of heft, a lot more than this. So you have to wonder if there– if they’re having trouble on this one, what’s going to happen on prescription drugs.

TERENCE SMITH: You mentioned, Mark, the House Republicans thinking about in 2002. Is this bill, this issue, something people are going to remember at the polls?

MARK SHIELDS: I think it is. I guess what I saw in the campaign of 2000 as I covered it was that the Republicans, led by Governor Bush very adroitly neutralized the issue – we’re for Patients’ Bill of Rights, we’re for absolute…and we just want to work this out..

TERENCE SMITH: And prescription drugs et cetera.

MARK SHIELDS: We’re for prescription drugs. And they really did neutralize it — on every exit poll and again on the Wall Street Journal-NBC News surveys — the Democrat, Al Gore had an edge on these issues -but Governor Bush was able to neutralize this issue as to which party “I’m for it as well.” And I think the fact in the House is that 60 House Republicans as recently as two years ago voted for this Patients’ Bill of Rights, or quite similar legislation. So what you see in the White House doing I think right now is they’re scrambling, Terry, to get President Bush out in front of the parade which has just marched over the Republicans in the Senate. And I think….

PAUL GIGOT: That’s why his veto threat has no credibility — because people see him scrambling and see him, well, wink, wink, we really do want to sign this. When people sense, okay, no backbone, we don’t have to give at all. Let’s keep moving.

TERENCE SMITH: So both sides want it.

PAUL GIGOT: I don’t think Bush wants to be seen as vetoing it. I think the Democrats sense it and they’re going to exploit that whiff of nervousness.

TERENCE SMITH: We saw one other interesting policy shift this week, actually in recent weeks — on foreign policy President Bush started both as candidate Bush and President Bush making it clear that he wanted to hold at arm’s length North Korea. He wanted to reduce U.S. military and diplomatic involvement abroad. And now he has assured that the troops will remain in the Balkans. He has sent Secretary of State Powell to the Middle East again. He was on the phone today himself talking to the leaders of Ireland and Britain about Northern Ireland. Sounds sort of Clintonesque.

PAUL GIGOT: I think you overstate the case, Terry. Certainly there is no question that he has changed on the Balkans.

TERENCE SMITH: In keeping the troops there.

PAUL GIGOT: In keeping the troops there, but you have to do that. The troops are on the ground. You can’t cut and run. He basically told his European allies we’re there for the duration. I think the two more prominent examples that go the other direction are missile defense and the Kyoto Treaty where he just said to the Europeans no, we are going to pursue a different policy. You may not like it but we’ll pursue it and he’ll try to persuade them.

TERENCE SMITH: Mark, very quickly.

MARK SHIELDS: Well, I call it the soul train, Terry. He said that Putin, he is an honest, straightforward man who loves his family, remarkable leader.

TERENCE SMITH: Vladimir Putin.

MARK SHIELDS: If Bill Clinton said the same thing, I think we would have said naive, unsophisticated, who is he. My conservative friends would have. It strikes me that he understands now that Russia is central, Russia is central to the missile defense, Russia is central to the expansion of NATO. I think you’ve seen a far more approachable attitude toward Russia than we saw at the lone ranger outset of this administration’s foreign policy.

TERENCE SMITH: Okay. Mark, Paul, thank you both very much.