The Patients' Bill of Rights Compromise, Explained

The President pulled a major coup early this month when he and Rep. Charlie Norwood (R. GA) reached a compromise on the House version of the Patients' Bill of Rights (PBR) that would allow Mr. Bush to sign the legislation.  Supporters of the original version of the PBR were outraged at the compromise, claiming that it completely eviscerates the intent of the bill.  A typical comment comes from Rep. Marge Roukema, (R. NJ,) who said the compromise "is absolutely an atrocity."

Before coming to the President's desk for signature, the House and Senate versions of the PBR will have to be combined into a single bill in conference.  Given the level of rhetoric between the two sides, reaching such a compromise, on the surface, seems a difficult assignment.

DrRich comments:

Applying the framework of "Clintonians vs. Gekkonians" - a framework that nicely describes ALL the political machinations surrounding health care - the Patients' Bill of Rights is unabashedly a Clintonian construction.  If the Senate version were to become law, the life span of HMOs and of employer-provided health insurance would be severely shortened - and when the people have no means of getting health insurance, the government would have no choice but to step in and provide it.  The Senate version, therefore, means ultimate - and rapid - victory for the Clintonians.

The way the supporters of the Senate version of the PBR are carrying on, one would think that the Bush-Norwood compromise - the version passed by the House - completely negates the provisions of the original version.

Comparing the two versions, however, reveals that they are almost identical on most of the particulars.  Both versions award patients the same new rights: the right to appeal any denial of care by an HMO, the right to get emergency care in the nearest hospital, the right to see specialists, the right to receive prescriptions for any drug, the right to access to clinical trials, and the right of women to see an ob-gyn doctor without prior authorization.  Both versions provide the right to sue HMOs, and to receive unlimited compensation for actual damages, including economic damages.

The only difference is that the House version (the Bush-Norwood compromise) places a limit on damages for pain and suffering ($1.5 million) and on punitive damages ($1.5 million,)  and makes it somewhat more difficult for patients to sue their employers for denial of care perpetrated by their HMOs.  

Both versions, in other words, place HMOs in grave jeopardy.  Each of the "rights" they award patients remove tried and true methodologies by which HMOs hold down the cost of care.  And the provisions allowing lawsuits will mean that the health insurance premiums paid to HMOs (which now are used for essential items such as providing health care to enrollees and providing profits to shareholders) will instead be distributed to successful litigants and their attorneys.  Taken together, the PBR - either version of the PBR - will destroy the HMOs ability to do that which society has commissioned them to do, i.e., to covertly ration our health care.  (Like the Supreme Court says, HMOs are supposed to ration health care.) Either way, HMOs lose - it's just that they stand to lose more quickly with the Senate version of the PBR.

The fact that the Bush team is hailing the compromise a major victory speaks to the level to which the Gekkonians have fallen.  The Bush-Norwood compromise is nothing more than a desperate rear guard action, giving the HMOs just a little more time (during which, apparently, the hand of God might reach down and solve the health care crisis.)

And the protestations of the opponents of the compromise (i.e., the Clintonians) clearly amount to little more than the battle-frenzy of victors, smelling the blood of their vanquished enemies.

August, 2001

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