Jewish World Review July 31, 2001 / 11 Menachem-Av, 5761
A patients' bill of rights is virtual legislation. It barely exists in the real world of people's everyday lives, unlike such issues as a tax cut, a prescription drug benefit, or even embryonic stem cell research. It exists chiefly inside Washington and in the minds of elected officials, lobbyists, political parties, and campaign consultants. Also, the need for a patients' bill of rights has come and gone. Its stated purpose is to protect patients from HMO abuses, but the managed care industry has largely cleaned up its act. And the backlash against HMO practices peaked four years ago when audiences cheered the obscenity-filled attack on managed care providers delivered by Helen Hunt in the movie As Good As It Gets.
Yet the drive to enact patients' protection rolls on. Majority leader Tom Daschle made it the first order of business when Democrats took over the Senate in May. The Democrats' (and John McCain's) liberal version of a patients' bill of rights was approved overwhelmingly in June. In the House, activity on the issue has been feverish. Democratic leader Dick Gephardt put together a collection of TV ads from the 2000 election in which Republicans promised to support a bill of rights. He wants to hold them to their word. When President Bush got back from his trip to Europe, he began a personal lobbying effort. He summoned dozens of House members to the White House, traveled to speaker Denny Hastert's office in the Capitol to lobby Republican members from New Jersey, and hit the phones to cajole others.
Why the frenzy on an issue that leaves voters cold? Two reasons. One is that important interest groups are involved. The American Medical Association is working hard for the liberal bill, which would allow lawsuits against HMOs in state courts, where judgments are usually higher. The AMA's goal is simple: to make life miserable for managed care, which doctors believe is robbing them of autonomy (and higher fees). To no one's surprise, trial lawyers are also pushing for a patients' bill of rights, the liberal version. On the other side, there's the HMO industry, which wants to save itself from costly lawsuits. Bush and most Republicans favor a moderate bill that managed care folks are willing to swallow.
The other reason is that Democrats and Republicans believe the issue is politically potent. Democrats think they can use it effectively in 2002 against GOP members of Congress who oppose a patients' bill of rights. Republicans fear this tactic may indeed work. Heaven knows why either party feels this way. The issue has been around for a half dozen years and Republicans haven't suffered for failing to enact a bill. Nor have Democrats gained. Bush adviser Karl Rove, for one, doesn't buy the idea that voters care enormously about the issue. "That's why the president can veto a bad bill," he said.
If he did veto the liberal bill, the best polling evidence suggests, there would be no explosion of public anger. It's not that no one cares at all. In some surveys, 70-plus percent of voters say, sure, they'd like a patients' bill of rights. It's that no one cares very much, and intensity matters. In June, an NBC/Wall Street Journal poll gave people a list of issues and asked for a ranking by importance. Education reform came in first with 26 percent, followed by energy exploration and conservation with 19 percent. Enacting a patients' bill of rights came in fifth with 7 percent. Gallup asked who was handling the issue better, Bush or the Democrats. Bush won, 51 percent to 28 percent, despite Democratic accusations (probably accurate) that he'd be happy with no patients' bill of rights. Indeed, the president's complaint about excessive lawsuits has touched a popular chord. In a Gallup poll in July, 51 percent said they most fear that lawsuits prompted by a patients' bill would drive up insurance costs. Only 36 percent said their main worry is the inability to sue HMOs.
Members of Congress know firsthand of the public's indifference. Fred Upton, the moderate Republican congressman from Michigan, asks voters to pick the issues (from a list of 25) that they want discussed at town hall meetings. "I've held meetings in every county this year," he says. "Not in one of them was a patients' bill of rights in the top five or six." Nor has he been asked about it on radio talk shows. "No one asks me at the grocery store, at church. This is not on anyone's radar screen back home." Other members of Congress say their experiences are roughly similar to Upton's.
Nevertheless, a patients' bill of rights in some form is likely to pass this
year. Hastert is so weary of the issue he'd like it gone from the calendar
before Congress recesses in August. The HMO lobby is no longer fighting
any of the rights that would be bestowed on patients. Most HMOs already
recognize most of them. Their concern is lawsuits. Democrats are sure the
time has come to enact their bill. And the media are primed to declare
Democrats the winners and Bush the loser, which would fit their current
assessment of the balance of power in Washington. The president, for all
his talk of a veto, would just as soon have the issue go away. Whatever
happens, patients will have had little to do with