Online NewsHour: A Patient's Bill -- July 12, 1999



	A HEALTHY DEBATE?

July 12, 1999

The Senate has begun to debate patients' rights legislation. Following a background report, Margaret Warner talks with two key senators and health care experts about Republican and Democratic proposals.

The Health Unit is a partnership with the Henry J. Kaiser Family Foundation.

July 12, 1999:
A discussion on patients' rights.

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

Families USA

American Association Of Health Plans

The Democrats' 'Patients' Bill of Rights

The Republican Patients' Bill of Rights Plus

The Business Roundtable

MARGARET WARNER: Managed care has become the dominant form of private health insurance. More than 160 million Americans, or roughly 85 percent of those with employer-sponsored coverage, are enrolled in managed care plans. They include HMO's and networks that let patients select from a wider but still limited list of doctors. Five years ago fewer than half of working Americans were covered by managed care. But complaints are also growing about the way plans decide what to cover. Harvard University's Bob Blenden studies public opinion on health issues.

BOB BLENDEN, Harvard University: Most of them actually haven't had experience. They say they've heard about it from a family friend or family member or the media. But they are convinced that the changes of the last five years as everybody shifted into managed care have put them at risk for personal safety when they are very, very sick.

MARGARET WARNER: Previous congressional proposals to impose federal standards on managed care have foundered. But this week the issue is back in the Senate.

SEN. TOM DASCHLE, (D) South Dakota: There are no bills pending in this Congress, which will have a greater impact on the lives and health of America's families than this bill. There are no decisions we will make that will have more of a profound effect than the decisions we make this week. The truth is, this whole debate comes down to one critically important question: Who should make medical decisions -- doctors or insurance company accountants?

SEN. PHIL GRAMM, (R) Texas: What we do is give people freedom. It is an interesting paradox that the Kennedy bill debases the very term "choice;" it debases the very term of rights because it contains no rights, that is, no rights that are really meaningful to somebody who has a child that's sick or whose momma is ill.

Dueling bills of rights

MARGARET WARNER: Each party is offering a so-called patient bill of rights and there are similarities. Both bills require health plans to pay for emergency room access when a person's health appears to be in serious jeopardy: And both proposals would increase patients' access to some specialists like obstetricians and gynecologists. But there are key differences. The Democrats' version would cover all 160 million people in managed care. Many of the Republican bill's provision would cover only the 48 million Americans in self-funded employer health plans. The Democrats' bill would give doctors a greater say in determining what services are medically necessary, both in original coverage decisions and on appeal.

SEN. PAUL WELLSTONE, (D) Minnesota: If people are not able to go to an independent external appeal from these managed care plans dominated by these insurance companies and make sure that those independent panels are not picked by the companies, I don't call that independent.

MARGARET WARNER: In addition, the Democrats' bill would give patients the right to sue their health plans in state court if coverage decisions led to personal injury or wrongful death. The Republicans disagree.

SEN. SUSAN COLLINS, (R) Maine: If your HMO denies you treatment that your physician believes is medically necessary, you should not have to resort to a costly and lengthy court battle to get the care that you need. You should not have to hire a lawyer. You should not have to file an expensive lawsuit to get the treatment.

MARGARET WARNER: The Republicans offer two things the Democrats don't. A ban on discrimination based on genetic testing and a tax deduction for self-employed Americans who buy their own health insurance. The lobbying over these billings has been intense. A coalition of business groups and health insurance industry is running a $5 million national advertising campaign warning that new regulations mean higher costs.

WOMAN IN COMMERCIAL: I'll lose my coverage if costs go up. What if the kids get sick?

MAN IN COMMERCIAL: I could be sued for providing health insurance for my employees? That could cost me my business.

MARGARET WARNER: On the other side, the American Medical Association representing the nation's doctors, is funding newspaper and radio ads.

SPOKESPERSON: Patient rights must include the right to include health care decisions with an independent review, the right to have a doctor decide what is medically necessary, and the right to hold health plans accountable when they make the wrong decision.

MARGARET WARNER: The Senate began debating the Democratic bill today. Debate on the Republican proposal and a final vote is expected as early as Thursday.