JIM LEHRER: Today's debate in the House over a Patients' Bill of Rights had everything going for it: The President's prestige, party discipline among both Democrats and Republicans, ideological conflicts, emotional rhetoric about life and death, and a possible cliffhanger result. We're going to sample that before talking to Senate Majority Leader Daschle and House Speaker Hastert. The sampling is the work of Susan Dentzer of our health unit, a partnership with the Henry J. Kaiser Family Foundation.
REP. CHARLIE NORWOOD: The bottom line and the goal is, we want to change the law. And the last time I looked, that's pretty difficult to do without the Presidential signature.
SUSAN DENTZER: After five years, an agreement on new protections for consumers dealing with their health plans seemed to come down to this: A deal between President Bush and one of the most fervent backers of patients' rights, Georgia Republican Representative Charlie Norwood.
PRESIDENT GEORGE W. BUSH: Today I'm very pleased to announce that Congressman Norwood and I have reached an agreement on how to get a Patients' Bill of Rights out of the House of Representatives.
SUSAN DENTZER: But today, as the House of Representatives prepared to take up patients' rights legislation, the backlash began.
REP. GREG GANSKE: Charlie was freelancing. And he did not have our authorization. This was basically Mr. Norwood's own deal with the White House. I just think that if his amendment passes, it's a step backwards rather than a step forwards.
SUSAN DENTZER: Criticism of Norwood spilled over onto the House floor. Michigan Democrat John Dingell had been another of Norwood's key allies on patients' rights.
REP. JOHN DINGELL: A member of this chamber went to the White House in a closed meeting. He worked out a deal. That deal was not reduced to writing until this morning. He didn't know what was in the deal at the time he appeared before the Rules Committee. Nobody else knew. I do not know now. None of you know. I seriously doubt that the member who cut the deal knows what he has done.
SUSAN DENTZER: There are plenty of general areas of agreement in the patients' rights debate. Under the major bills that have passed the Senate and are now under consideration in the House, health plans would be required to provide access to specialists, cover emergency medical care, pay the routine medical costs of patients in clinical trials, and allow independent medical review if the plan denies coverage or care. But there's bitter disagreement over the question of in which courts, and under what circumstances, patients should be able to sue their health plans and recover damages if the plans deny them coverage or care. Most Republicans favor tighter restrictions on when and where patients can sue than do most Democrats.
REP. ERNEST FLETCHER: Let's put patients above politics. Let's break away. Let's stop the logjam. Let's get a bill that the President will sign. But I think it's also important to realize that we do modify and reach a compromise on liability so that HMO's are held accountable but so that we don't drive frivolous lawsuits that drive up the cost and take money out of patient care and put it into personal injury lawyers' pockets.
SUSAN DENTZER: But most Democrats, and a number of Republicans like Ganske, want patients to be able to sue in state courts for any health plan decisions that deal with issues of medical judgment. They argue that these state courts have traditionally handled so-called torts, or wrongful acts that involve injuries. By contrast, President Bush had previously argued that suits against health plans should only be allowed in federal courts, where damage awards are usually lower. When the President forged his deal with Norwood, however, he split the difference. Suits against health plans for medical decisions would be allowed in state courts, but under unprecedented new federal rules that would place strict limits on damages. House Minority Leader Richard Gephardt was livid.
REP. RICHARD GEPHARDT: This is a stunning reversal for the patients and the people of this country! This is special interest legislation! This is doing the bidding of health insurance companies and HMO's over the interests of the people that we represent in our districts! This is a stunning abdication of what we should be fighting to protect for the people that we represent! I defy any of us to go into a hospital room of someone who has been done in by bad decisions made by HMO's and health insurance companies and look them in the eye and say, "I voted today to take away your rights, to preempt your rights, to set up a new federal tort law that has never existed in this country."
SUSAN DENTZER: But Norwood said patients would still have plenty of access to the courts.
REP. CHARLIE NORWOOD: To say that a patient that has been denied care has-- and is then harmed-- has no recourse through our amendments is just not true. If they are denied care through our amendment, they have a cause of action and they have a cause of action, most of them in the states, which is where we want to be. They have a cause of action for the denial or delay of care. My intent is to make sure in every way I can do that we do not preempt other causes of action at the state level, and that is going to be my intent through conference, and I'm happy that the President agrees that that is our intent. And if for some reason when we get into conference if that language isn't worked out, I'm going to be in there slugging out for it.
SUSAN DENTZER: As debate continued on the House floor, late this afternoon, Senators who had earlier passed a patient protection bill predicted that the Norwood-Bush compromise wouldn't survive a Congressional conference committee.
SEN. JOHN EDWARDS: The more we see of President Bush's proposal, the less we like it. The proposal of the seven principal sponsors, Democrats and Republicans, six of the principal sponsor in the House and the Senate oppose President Bush's proposal. It does not have the approval or concurrence of the United States Senate.
SUSAN DENTZER: A vote on a full patient protection measure incorporating the Bush-Norwood compromise is expected later this evening.