Americans are demanding reaffirmation of our fundamental right to control our own medical care with the advice and help of doctors we choose.

A Maryland Healthcare Opinion Poll last summer confirmed near unanimity among Maryland's citizens that "managed care companies are making health decisions that should only be made by patients and their doctors." One in every three Marylanders reported that their managed care companies (MCOs) had recently denied necessary medical care to a family member.

Nationally, 72% of doctors blame MCOs for a reduced quality of care for people who are sick. It is not surprising, therefore, that Dr. Wayne Spiggle, the head of Maryland's Medical Society, recently called upon Congress to pass H.R. 2723, the Bipartisan Consensus Managed Care Improvement Act of 1999.

As Maryland's Medical Society President has observed, America needs and deserves this "patients' bill of rights with real teeth." It is far too early, however, to celebrate our House victory.

We face a $100 million campaign by the insurance industry to substitute a far weaker MCO bill passed by the Senate earlier this summer. We will need intense and sustained public pressure on the Republican leadership of both the House and the Senate in order to enact our more protective Patients' Bill of Rights into law.

Current federal law gives virtual immunity from legal accountability to the employer-funded healthcare plans upon which 45 million Americans depend - even when they unreasonably deny us care or otherwise harm us. In addition to its substantive protections, our Bill of Rights would hold MCOs accountable in our Courts when they fail us. The weaker Senate bill, favored by the Republican leadership in both the House and Senate, would not.

Republican leaders claim that holding MCOs legally responsible for harming us would increase insurance premiums. The Congressional Budget Office, however, estimates the impact on insurance costs at less than 5 percent.

Republicans say that the threat of lawsuits would cause MCOs to practice "defensive medicine." Don't we want caution to govern the high quality of medical care our families receive? Isn't our control of our families' medical care worthy of judicial protection?

What the managed care organizations, big business and the Republican leadership seem to be saying to the American public is this: "Trust us. We know what is best for you."

According to Dr. Thomas Reardon, President of the American Medical Association, however, "Republicans have chosen big business and insurance companies over the people of this country."

In the case of Republican Senate and House leaders, I must agree. Just before losing last week's vote, the House's top Republican, Speaker J. Dennis Hastert, held a breakfast fundraiser with business lobbyists who oppose any strong Patients' Bill of Rights. In the Senate, the No. 2 Republican, Sen. Don Nickles, has vowed to stop many of the reforms we passed in the House.

Americans are demanding a strong Patients' Bill of Rights, but we can expect attempts by Republican leaders to weaken or eliminate key patient protections when their hand-chosen conference committee meets to reconcile the House and Senate measures.

The public can still win this struggle to control our own health care decisions; but we must make it crystal clear to the Republican leadership that their continued control of the Congress is at stake.

Nearly one-third of House Republicans deserted their Republican leaders and voted for our bill because their constituents told them to do what is right. Now is the time for Republican leaders to do the same, earning America's informed consent to their continued right to lead.