Editorial for Nov. 1, 1999
The Patients' Bill of Rights: The right vote at the right time
The U.S. House of Representatives' passage of the Norwood-Dingell Patients' Bill of Rights was a memorable vote. It was a "Mr. Smith Goes to Washington" moment, with members voting their consciences and putting what's right for their constituents above the marching orders from the House leadership. Yet, unmistakably, it was also a pragmatic recognition that voters back home will not forget about this issue at election time. A "no" vote would have put many members on the fast track to one of the least sought after titles in politics -- "former Congressman."
Both those elements stem from something else notable about the bill. It is among those rare pieces of legislation that the public could recognize as unambiguously to its benefit. Unlike past health care proposals, with their devilish details, the elements of this Patients' Bill of Rights make sense immediately to anyone already enrolled in a managed care plan or fearful of being forced into one. The House version provides for medical necessity determinations made by physicians, a guaranteed independent appeals process, direct access to ob-gyn and pediatric care, a "prudent layperson" standard for emergency care and no more gag clauses.
Its crown jewel is a sensible guarantee of health plan accountability -- the right to sue in state court if a managed care plan denies a patient necessary medical treatment. At last, patients would have the leverage they need to keep health plans honest.
At the final tally, the House approved the measure by a margin of 275-151. It was a bipartisan victory that stunned even seasoned Capitol Hill observers. Now that the House has spoken so forcefully on this issue, only one question remains: Will the Senate get the message and be open to strengthening its limp version of a patients' rights bill of earlier this year?
Although the House and Senate versions share some common elements, the Senate version is far more limited, especially in critical areas. It doesn't allow patients to sue and its protections apply to far fewer Americans. But it could be fixed in the next step of the process, a conference committee where members of both houses can craft a compromise bill. Knowledgeable observers expect that committee will not meet until next year.
Certainly, the delay will give the aggressive and well-funded managed care lobby, and its business association partners, a second chance to distort the issues. They can't hope to fool the public much, so expect them this time to put Harry and Louise in pinstripes and to direct efforts to have the business community pressure the Senate on their behalf. The goal will be to spread fear and confusion among businesspeople about the accountability provisions of the House version.
However, the simple fact is that Norwood-Dingell expressly prohibits these lawsuits against employers, except in the unlikely event that they make the actual treatment decisions (a message the AMA recently underscored in letters directly to top business leaders). Regarding concerns that the law will create an epidemic of costly litigation against health plans, consider the real-life experience of Texas. For two years it has had its own state law allowing Norwood-Dingell-style lawsuits, but a recent tally there revealed the number of suits actually filed could be counted on the fingers of one hand.
Fortunately, the coming months also provide the AMA and its allies in the patient protection movement with the chance to set the record straight on this and other issues. The AMA has worked for the past five years to move this package of protections forward. It heads into what may be the final leg of the long campaign with a major boost from this remarkable House action. This measure provides protections patients need and that the Senate should not ignore.