Perspective               

The Debate Over a Patients' Bill of Rights

When the Democrats gained control of the Senate earlier this month, Senate Majority Leader Tom Daschle took up the patients' bill of rights as the first major piece of legislation. Currently, Congress is looking at two versions of a patients' bill of rights, the McCain-Edwards-Kennedy bill and the Frist-Breaux-Jeffords bill.

The issue at heart in the patients' bill of rights is what protection would be offered to patients whose HMOs fail to give them important care and whether HMOs will be held accountable for providing poor care or causing serious injury or death to a patient. Any good patients' bill of rights should include four main guarantees. Firstly, patients should have the right to an impartial, fast review if an HMO is ending their care or refusing to give them care and their life or health is in jeopardy. Secondly, patients should have the right to sue in state court if their HMO's actions have harmed them in any way. Thirdly, patients should have the right to compensation for harm they suffered and punitive damages to provide an incentive for HMOs to provide good care. And finally, patients should have the right to a health care provider who can help them challenge the HMO and who can speak freely without fear of retaliation from the HMO.

The McCain-Edwards-Kennedy bill and the Frist-Breaux-Jeffords bill differ significantly on these four main points. While the McCain bill includes all of the rights mentioned, the Frist bill does not. The Frist bill does not guarantee you the right to an independent review if the HMO is ending your care, nor does it provide for an impartial review. Under the Frist bill, the HMO picks and pays for the reviewer.

Patients do not have the right to sue in state court either, and instead must take their suits to federal court. The right to sue in state court is important because state courts are convenient, often have shorter waiting lists than federal courts, and have the expertise to deal with health care lawsuits.

In addition, the Frist bill would cap non-economic damages for pain and suffering at $500,000 and would not allow punitive damages. But without the threat of having to pay large amounts in damages, HMOs may find it more cost-effective to deny patients necessary treatment. Caps are needed to deter HMOs from denying care.

Finally, the Frist bill does not protect doctors from retaliation by HMOs if the doctor challenges the HMOs' health care decisions. It also allows HMOs to offer bonuses to doctors for limiting the number of referrals and test they recommend, which encourages doctors to deny care.

If you are concerned about the issue of a patients' bill of rights, contact your members of Congress. To find out how to contact your Congress members, go to www.visi.com/juan/congress.

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