By MILT FREUDENHEIM
After four years of trying, Congress may be close to passing
patients' rights legislation. A conference committee will work to
reconcile a Senate bill and a version that the House passed on Aug.
3 after the chief Republican sponsor, Representative Charlie
Norwood of Georgia, reached an agreement with President Bush on the
thorny issue of a patient's right to sue a health plan.
The Bush administration had said that such lawsuits should be
brought only in federal courts, where damages are rigorously
limited. Mr. Norwood's earlier bills and the Senate bill would have
allowed suits in state courts with no limits on damages. Under the
agreement with Mr. Norwood, the House voted to permit suits to
overturn denial of medical care to be filed in state courts. But
damages would be limited to $1.5 million.
The Senate and House bills are similar on most other points. Both
bills include guarantees of access to the nearest hospital
emergency room, to gynecologists and other specialists and to
prescription drugs, even those that are not on a health plan's
preferred list or experimental drugs still undergoing tests.
Charles B. Inlander, president of the People's Medical Society, a
consumer advocacy group that had supported the Senate bill, is a
longtime observer of the issue. He spoke last week about the
legislation.
Q. Will the legislation on patients' rights really make a
difference for consumers?
A. I don't think consumers are going to see a major difference.
The issue has been lingering so long that most health plans have
pretty much made all of the changes that any version of the
patients' bill of rights will have in it. The major plans have
dropped requiring prior permission to go to the emergency room and
for a woman to see an obstetrician or gynecologist. Most plans have
third-party, outside review for disputes over care decisions. The
new law would mean uniformity for the managed care companies, but
most people are not going to see much of an effect.
Q. Are you concerned that a federal law might weaken existing
state protections for consumers?
A. I don't think it applies to 99 percent of the bills, but I am
concerned in two areas - the lawsuit provision and the independent
review of medical decisions. The House version does not allow room
for stricter state laws on the issue of independent review. But
because this is such a hot- button issue, it will be fixed in the
conference committee or there will be no final legislation.
I think the issue of $1.5 million limits on damages for pain and
suffering and for punitive damages will also be worked out in
conference, because the administration has agreed to allow suits in
state courts, which the Democrats demanded.
Q. How important is the right to sue a managed care company?
A.
Very important. We should have a right to sue anyone who might harm
us - for example, a health plan that does something that is harmful
to our health. The American people believe in that; it's what the
tort system is all about. If you can sue a doctor for making a bad
medical decision, why shouldn't you be able to sue a plan if it
makes a decision that is harmful for your health?
This issue is being used as a vehicle for those who want tort
reform, ranging from a limit on damages for an 80-year-old tractor
that falls apart or a cup of hot coffee that spills as you are
going through the line at McDonald's.
The irony is that the American Medical Association strongly
supports a consumer's right to sue a health plan but at the same
time the A.M.A. is calling for tort reform, so you can't sue your
doctor.
Q. Will patients' rights legislation do anything for the 43
million people who have no health insurance?
A. Nothing at all. This isn't a health care bill. It is about the
business relationships between consumers and health plans. It
doesn't mean that your doctors are going to be better, that your
hospital room will be improved or that you will get better
medicines. The bill has nothing to do with improving the quality of
health care or lowering the cost and it offers absolutely nothing
for the uninsured. The only time this bill kicks into play is if
you are in a managed care plan. For many members of Congress, this
is their way of appearing to deal with the big issue.
Q. Will the debate on patients' rights affect efforts to
restructure Medicare and add a drug benefit?
A. I don't think it will have any bearing, unless a patients' bill
of rights is not passed. The Democrats have said that if this
doesn't get through, the administration will have a hard time
getting any health care legislation through. The administration
knows they could never get legislation through right now unless
somebody can claim victory on the bill of rights. That is why the
administration has been willing to be somewhat flexible on this
issue.
Copyright 2001 The New York Times Company
Date: Thu, 16 Aug 2001 12:29:47 -0400