Editorial: Rights of patients in need of aid

Sunday, Aug. 8, 1999 | 9:25 a.m.

The doggedness of Rep. Charlie Norwood, R-Ga., may be paying off. Along with other House Republican mavericks, Norwood's persistence in seeing a patient's bill of rights become reality has taken a step forward. Last week a group of House Republicans, led by Norwood, announced they had reached an agreement with House Democrats on HMO reform legislation.

Norwood, who used to be a dentist, had been working to draft a patient's bill of rights with other Republicans, including Rep. Tom Coburn of Oklahoma, a family physician, and Rep. Greg Ganske of Iowa, a surgeon. They know firsthand how frustrating it can be to deal with HMOs that sometimes stand in the way of patient care. The proposal by Norwood -- and embraced by Democrats -- would allow patients to choose their doctor, guarantee that emergency room visits would be paid for and ensure that women could see obstetricians and gynecologists -- and children could see pediatricians -- without the need for referrals. In addition, a patient could appeal to an external panel if care is denied. A patient's right to sue an HMO also would be allowed if a patient is injured as a result of a benefit being denied or delayed; punitive damages could be sought but only if a plan doesn't abide by an external appeals panel's decision.

Lobbyists for the insurance industry predictably denounced this common-sense proposal. "This legislation is built on the premise that trial lawyers are the sole guardians of medical care," Karen Ignagni, president of the American Association of Health Plans, said. What the insurance industry is ignoring, though, is that currently accountants -- not doctors -- often are the gatekeepers of medical care. The thrust of this legislation isn't to encourage more lawsuits, it is to provide prompt medical care when it is needed. And if a health plan decides to withhold medical treatment and causes harm, then it should be held accountable. As has been noted before, there are only two groups in this nation immune from lawsuits: foreign diplomats and HMOs.

While last week's agreement -- and President Clinton's endorsement of the plan -- is important, the fact is that a patient's bill of rights still faces an uphill battle. Even with House Speaker Dennis Hastert's support of the right to sue HMOs, don't count out the influence of the insurance industry -- a big contributor to Republican candidates -- that will try to strong-arm GOP lawmakers to vote its way. The clout of the industry already was demonstrated in the Senate, which last month defeated similar legislation. If, however, the House does pass a patient's bill of rights it could put pressure on the Republican-led Senate to rethink its position and adopt genuine reforms. This will be a critical test for Congress to see whether lawmakers can muster the courage to say no to the insurance industry and do what's right for patients.