Patients' rights bill likely to be popular

December 16, 1997|By Ellen Goodman

WASHINGTON -- I tip my cap to the White House marketing genius who named the patients' ''Bill of Rights.'' It has all the Yankee Doodle sounds of fife, drum and trumpets.

But did the author forget that the original was the result of some knockdown drag-out fights among founding and feuding fathers? Now it seems that this knockoff is destined to go the whole 15 rounds.

True rights

The proposal dropped into the public domain by the president before Congress headed off for the holidays is a whole lot less clarion a call than its moniker suggests. What is a patients' Bill of Rights, after all, that doesn't contain a right to health care?

If there were truth in political labeling it might be better called the Consumer Protection Act For Those Who Already Have Health Insurance But Don't Trust Their HMOs.

As Harvard medical economist Robert Blendon says, this is a modest set of consumer protections like those enjoyed by airline passengers. Airline regulations don't, after all, ensure you a seat on the plane. But if you buy one, as Mr. Blendon put it, ''The airline can't decide for economic reasons not to de-ice the plane before it takes off from La Guardia.''

What are the medical de-icing rules in this chilly climate for new regulation? The Bill of Rights had to be agreed upon by a unanimous-- well, unanimous but for one holdout member -- commission. They passed up the toughest questions. But these ''rights'' do include some of the basics:

The right to appeal denials of medical coverage. The right to a reasonably large choice of doctors. The right to have emergency room visits paid if a reasonable patient would have thought her health was in jeopardy. The right to some information about the quality of her health care plan. The right to direct access to specialists.

But no matter how mild this list, it has garnered opponents who spend their holiday season hoping for the gift of a new Harry and Louise video. House Majority Leader Dick Armey et al. are declaring yet another moral equivalent of war against the nemesis -- regulation -- and some industry hard-liners are claiming that these ''rights'' will be so costly that people will be protected right out of their ability to buy insurance.

The opponents are right about one thing. This ''bill of few rights'' is not the whole wish list. We have ahead the debate about the second set of consumer protections left on the commission's cutting room floor. A debate about lifetime caps, about insurer discrimination against people with serious health problems, and about dealing with the discrepancies between what different insurance plans pay for the same illness.

Still, it's not at all clear that the anti-reg, anti-rights folks will win this time. For one thing, Harry and Louise are now in HMOs worrying about the lack of choice of doctors. The projected cost of an added dollar a month in health insurance seems like a good trade-off considering the well-polled anxieties about managed care.

At the risk of paraphrasing Christmas mall Muzak, it's beginning to look a lot like Consensus. Patient protection just isn't a right-left shootout sort of issue these days.

Already some health care companies have adopted consumer protections voluntarily. States with governors all over the political spectrum have passed a crazy quilt of protections -- though they don't all mesh, or cover the large number of folks in corporations that self-insure.

Even in Congress, a conservative, Charlie Norwood of Georgia, has introduced a bill that would go pretty far to regulate HMOs, hTC and he has 214 co-sponsors all the way from the extreme right to progressives. It's just the line-in-the-sand leadership, the regulation-free-or-die-hards, who are left in opposition.

With consumer anxiety rising, something is likely to pass next year. And when the fighting is over, this first draft, this Bill of Rights, may well be mainstream enough to make it.

Ellen Goodman is a syndicated columnist.

Pub Date: 12/16/97

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