PATIENTS, NOT PROSECUTORS

July 15, 1999
		Republicans rejected a provision that would have allowed patients to sue their HMO's. Kwame Holman reports on the Senate debate as it wraps up. The Health Unit is a partnership with the Henry J. Kaiser Family Foundation.

A Health Spotlight Report: Patients' Bill of Rights July 14, 1999: A partisan debate. July 13, 1999: Should patient's be able to sue HMO's? July 8, 1999: An Alzheimer's vaccine? Remaking Medicare June 24, 1999: Should doctors unionize? June 7, 1999: Mental Health Conference July 20, 1998: Three patients' rights bills. July 1998: Forum: Should the government manage care? July 9, 1998: Debating managed care The NewsHour's Health Spotlight. Browse the NewsHour's coverage of Health   Health Insurance Association of America Texas Medical Association The Democrats' 'Patients' Bill of Rights Families USA The Business Roundtable	KWAME HOLMAN: Senate Democrats have been keeping score, and by last evening, after nearly three days of debate and votes, not one Democratic amendment to the patients bill of rights had passed. SEN. BARBARA BOXER, (D) California: It may not be an all-star game, but it's 7-nothing, HMO's over patients. That's where we are. Every single amendment they have won on their positions, and every single amendment has basically been party line. KWAME HOLMAN: And the shutout continued. Before the Senate adjourned for the night, another Democratic amendment-- this one giving patients in HMO's greater access to specialists-- also was defeated. SPOKESPERSON: There are 47 yeas and 53 nos. The amendment fails. KWAME HOLMAN: Democrats have spent the week criticizing HMO's. And in response, Texas Republican Phil Gram came to the Senate floor to remind his Democratic colleagues that five years ago they were the ones who got behind the effort to foster HMO's as part of the Clinton health plan. SEN. PHIL GRAMM, (R) Texas: They loved HMO's so much, they were so confident in them that they said, "if you refuse to join your local health cooperative HMO government- run health care system, we're going to fine you $5,000 now, that was their position in 1994. Now, today they've taken a poll. They've done a focus group. And they don't love HMO 's anymore. SPOKESMAN: Who yields time? SEN. EDWARD KENNEDY: Yield myself one minute on the bill. I'm a good friend to the Senator from Texas, but I'll tell you, Mr. President. The Senator is as wrong about his explanation about the debate here on the floor of the United States Senate and wrong about President Clinton s bill on healthcare, as he was about President Clinton's proposal about economic recovery in 1993, when he predicted the end of the free market system, inflation going up through the roof, unemployment lines around the capital of the United States. He predicted that deficits were going to grow and it was going to be the end of the American free enterprise system. And he was wrong then, and he's wrong tonight. Mr. President, I yield the last minute to the Senator from South Dakota. SEN. TOM DASCHLE: Mr. President, I don t know how you top that. I was just going simply going to say -
	Sueing HMO's
	KWAME HOLMAN: Both Democrats and Republicans agree some HMO reform now is needed. The Republican amendments improve patient protections, but not to the extent Democrats want. Republicans would increase emergency room access, enabling patients to go to an emergency room outside their plan's network. They call for requiring coverage of overnight hospitalization for mastectomies; guaranteed coverage of clinical trials for cancer and experimental drugs; and guaranteed, timely access to specialists within a plan's network, including gynecologists. Democrats tried and failed to guarantee access to out-of- network specialists as well, but Republicans also let HMO's retain final say on which treatments are "medically necessary." Democrats sough to give more of that power to doctors. And most of the provisions in the Republican bill would cover only the 48 million people in self-insured and federally regulated health plans. Democrats called or covering all of the more the 160 million people enrolled in health insurance plans. SENATOR: Is somebody going to cover Ethan? Is somebody going to take care of this issue? KWAME HOLMAN: Debate on the most contentious issue in the patients bill of rights debate, whether patients should be allowed to sue their HMO, was left for this last day. Democrats were in unanimous agreement. SEN. RICHARD DURBIN: This is the heart of the debate. This is what the patients' bill of rights is all about. The insurance companies hate the idea of being sued in court like the devil hates holy water; they don't want to be held accountable for their actions. They want to be protected so that they can make the wrong decision when it comes to medical care for American families and never, never be held accountable. The amendment being offered on the Republican side is an effort to take away from 123 million Americans the right to hold health insurance companies accountable. That is the bottom line: 123 million Americans will be denied an opportunity to go to court when a health insurance company makes a decision, which costs them the health or their life. SEN. ROBERT TORRICELLI: Senator Durbin now brings to the floor of the Senate one last chance for the Senate to do something fair and decent for the American people in this plan to protect people in health maintenance organizations, to give them the right afforded every other American with ever other industry, to bring their grievance to a court of law. It is ultimately the choice between a patient's bill of rights or an insurance protection. And if we fail, make no mistake about it, this debate and this vote will be noted for the fact that the Senate balanced the interests of 120 million Americans against several dozen insurance companies and made the wrong choice.
	Differing viewpoints
	KWAME HOLMAN: An overwhelming number of Republicans saw the issue entirely differently. SEN. CHARLES GRASSLEY: This is in fact a Democratic leadership war on health insurance coverage. They do not care if they drive up the cost of care, employers eliminate their coverage, their employees go naked with coverage because they stand by willing and able to have the taxpayers and the federal government provide that insurance. And that sort of environment will hasten their day when they want the federal government and the federal bureaucracy to take over healthcare coverage in America. KWAME HOLMAN: Pennsylvania Republican Rick Santorum said he opposed the Democratic plan because it would allow employers to be sued as well. SEN. RICK SANTORUM: Once these employers drop heir insurance as a result of this bill, who would be the first person to run to the Senate floor and say, these nasty employers, look at them they're dropping their insured. We need the government to take over the health care system. Yes, the Senator from Massachusetts would be the first person here on the Senate floor calling for a government health care system. KWAME HOLMAN: New Hampshire's Judd Gregg outlined the Republican alternative to the right to sue. SEN. JUDD GREGG: Under our bill, a patient, rather than having to go to court to get their concerns addressed, gets to go to have their concerns addressed by first a doctor in the specialty dealing with the type of problem that the patient has within the clinic or the group that the person is being served, and that doctor is dependent, and that doctor makes a decision, did that patient have right care or did that patient have wrong care or should that patient get more care? And if the patient isn't comfortable with that decision, then the patient can go outside the clinic, outside the insurance group and have another doctor who is appointed after having been pre-qualified by a certified either state or federal agency, have another doctor review that patient's care. And if that doctor decides that that patient needs some other type of care, something that the clinic or the insurance group did not decide the patient should have, then that is binding, binding on the insurance group. KWAME HOLMAN: As expected, the Democrats' right-to-sue proposal was defeated, and the Republicans' plan for internal review was substituted in its place. At one point during the day, Senators Chafee and Specter, two Republicans who sided with Democrats on most votes during the week, appeared with a group of Democratic moderates; they proclaimed that only a new bipartisan bill had a chance of becoming law. SEN. JOHN CHAFEE: It seems to us that the track we're now on is as follows: That a Republican bill will pass, the President will veto it, the veto will be sustained and the American people won't be one bit better off than they were before we started this whole exercise. And to us, that seems unfortunate. SEN. ARLEN SPECTER: The bill, which we are pushing today, is a centrist bill which reaches middle ground on an accommodation of many of the key issues. KWAME HOLMAN: However, the small coalition admitted their proposal was likely to fall short of the 51 votes needed for passage. And by late this afternoon, neither Republican nor Democratic leaders had agreed to clear the way to bring the bipartisan bill to the floor. And as the Republicans' version of the patients bill of rights moved toward a final vote this evening, Democrats continued to update the scoreboard.