TOPICS > Health

Background: Protecting Patients?

July 20, 1998 at 12:00 AM EDT

JIM LEHRER: The managed care debate. We begin with a backgrounder from Susan Dentzer of our health care unit, a partnership between us and the Henry J. Kaiser Family Foundation.

SUSAN DENTZER: The skirmish over patients’ rights legislation turned into an all-out brawl last week.

REP. DENNIS HASTERT (R-IL): This afternoon, we are introducing the Patient Protection Act because we are intent on protecting patients and guaranteeing choices without the heavy hand of big government.

REP. RICHARD GEPHARDT (D-MO): There are others in Congress who favor different approaches. They don’t agree yet that we ought to have strict enforcement of these rights and responsibilities. We reach out to them today because we want to pass legislation in this Congress.

SUSAN DENTZER: All three plans under consideration-the House and Senate Republican proposals, and the Democratic alternative backed by President Clinton-have elements in common, although the details very.

REP. DICK HASTERT (R-IL): We guarantee access to emergency rooms so that during emergencies, folks won’t be forced to drive miles past the nearest facility, in this case George Washington Medical Center, in order to get an ER that’s in their health plan.

SEN. TOM.DASCHLE (D-SD): This is not a bill designed to provide political cover. Our is a bill designed to provide medical Coverage–emergency care in an emergency– no questions asked.

SUSAN DENTZER: All the bills make explicit bids to appeal to women.

SEN. TOM DASCHLE (D-SD): Access to a specialist if your child needs one; the right of a woman to choose her own doctor.

REP. DICK HASTERT (R-IL): The Republican Patient Protection Act guarantees women and children the right to see an OB/GYN or pediatrician respectively-without first having to go through an insurance company gatekeeper.

SUSAN DENTZER: At the same time, there are also big differences among the three proposals in the number and scope of protections they would provide. One difference is just whom these proposals would affect. Depending on what health insurance plan an individual belongs to, existing state and federal regulation may impose different standards. Democrats and House Republicans think their proposed new federal protection should apply to all 161 million Americans with private health insurance, including those whose insurance is currently regulated by the states.

Senate Republicans point out that at least 33 states already have passed some basic managed care consumer protection. They would only extend new federal protections to the estimated 48 million Americans whose employers underwrite coverage that isn’t regulated by the states. Perhaps the biggest difference among the plans is how they would handle serious disputes that arise between managed care organizations and their patients–such as when health plans refuse to cover care that patients and their doctors think is needed. President Clinton cited several disturbing episodes that he had learned of last week.

PRESIDENT CLINTON: In all three cases, what the doctor told the patient the patient needed was ultimately approved, and in all three cases, it was approved so late that it was too late to do the procedure, so they died anyway. So, you can write all the guarantees you want into the law here in Washington, and if nobody can enforce them, the delay in the system will still cause people to die.

SUSAN DENTZER: To deal with such disputes, both Democrats and Republicans would create mandatory appeals procedures for health plans. But the big difference lies in what additional actions patients could take if they failed to get care and were injured as a result. House Republicans would allow patients to sue their health plans in federal court, as they can now, but the courts, in turn, could saddle health plans with penalties if they wrongfully denied coverage. Senate Republicans do not have any provision in their plan that would either expand the right to sue or increase penalties. Democrats want to go much further than both Senate and House Republicans. They would override an existing federal law. Patients could sue in state courts for potentially huge compensatory and punitive damages if they were injured because their health plans refused to pay for care.

SEN. TOM DASCHLE (D-SD): You know, there is something wrong in this country when the only groups of people who get immunity from our laws are foreign diplomats and HMO bureaucrats. It’s time for HMOs to understand: when their decisions cause the death or injury of a patient, they will be held responsible.

REP. NEWT GINGRICH (R-GA): Our goal is not to create more trial lawyer fees. Our goal is not to create more lawsuits. Our goal is to get the patient to the right doctor with the right knowledge to get the right care as rapidly as possible.

SUSAN DENTZER: While Senate negotiators debate the terms under which patients rights bills will be brought to the floor, the House is expected to take up legislation late this week.