Editorial: Patients’ rights take another hit

Sunday, July 18, 1999 | 9:40 a.m.

Matthew Cerniglia, a 12-year-old who enjoyed skateboarding, died in February. So why did he pass away at such a young age? His father, Ray, said he died from cancer after the family was unable to convince their health plan to pay for treatment that the insurance company considered experimental. "I never realized our family would be fighting two battles -- one against cancer, the other against my HMO," Cerniglia told reporters at a Washington news conference last week before the U.S. Senate began its debate on a patient's bill of rights.

Unfortunately Matthew Cerniglia's story and the plight of countless other Americans who have suffered at the hands of their HMOs were not sufficient enough to persuade the GOP leadership in the Senate to pass a genuine patient's bill of rights. Sure, the Senate passed a Republican-authored "patient's bill of rights," but it is a sham. It covers fewer Americans than the Democrat plan and denies the right to sue an HMO if the insurer refuses to provide reasonable care.

The Democrat plan would have finally righted an imbalance that has developed over the years, as HMOs too frequently deny care to patients. Accountants, not doctors, now can decide whether a patient gets medical treatment. Managed care has helped curb medical costs, but it has done so at a considerable price, resulting in patients' lives being jeopardized. While the Democrat plan was better, it's a shame neither party's leadership was willing to give a little so a compromise could be reached.

An exasperated Sen. John Chafee, R-R.I., who tried to forge a bipartisan bill, believed the Senate's inability to reach a consensus means nothing will become law in light of the president's vow to veto the Republican bill. "It seems to me we've let down the American people," Chafee said. "We've got to ask ourselves could we have done a better job."

Even before the Senate started its debate on Monday it appeared Democrats and Republicans were more interested in jockeying for position in the 2000 elections than in passing legislation, but in the House at least it seems there is reason to be cautiously optimistic. For starters, the Republicans hold a slimmer majority in the House than they do in the Senate, allowing for a greater possibility for common ground to be reached. In addition, there is a devoted -- albeit small -- core of Republicans who are committed to passing HMO reform legislation.

Yet a patient's bill of rights has been bottled up in the House Commerce Committee, with an impasse over the right to sue delaying consideration of the legislation. A trio of Republicans on the House Commerce Committee have been working to budge the GOP leadership's opposition to a patient's bill of rights. Reps. Charlie Norwood of Georgia, Tom Coburn of Oklahoma and John Shadegg of Arizona have been trying to persuade other Republicans about the need to guarantee one of the thorniest issues in this debate: the right of patients to sue their HMOs if they've been harmed. Two members of this troika bring an intimate knowledge of health care to this debate: Norwood is a retired dentist and Coburn is a practicing family doctor.

Unlike the Senate Republican bill, most of whose provisions would apply to only the 48 million Americans who are covered by an employer's self-funded health plan -- and can't be regulated by the states -- the protections advocated by Norwood's bill would cover all Americans. The legislation would ensure patient appeals, afford the right to sue an HMO, provide that a patient could see a specialist and guarantee emergency room care. So far, however, the House GOP leadership has not given Norwood's bill a chance. It is hoped the Senate GOP leaders' capitulation on HMO reform won't result in their House counterparts also taking a powder on a patient's bill of rights.

We'll never know for certain if Matthew Cerniglia would have beaten cancer had a patient's bill of rights been in effect. What we do know, though, is that he never stood a chance under the existing system that places profits above patient care. Fortunately Nevada already has laws offering some protection from HMO abuses. But for those who have no recourse to get the medical treatment they need, Democrats and Republicans in the House should find common ground and pass a patient's bill of rights, keeping alive the possibility that the Senate and House can reach a meaningful compromise before the end of this year.