"Far-reaching legislation extending new rights to all Americans in managed-care health care plans," was the description offered by another daily. Sen. Edward Kennedy, a sponsor of the bill, was even more enthusiastic: "At long last, the Senate has acted to protect patients and doctors. This is a giant step forward in giving power to the powerless, the victims of exploitation by HMOs."

Top Democrats in the Senate were all smiles with puffed-up chests, citing their ability to get 50 legislators from their party and nine from the Republicans to vote for the bill as a big step forward for working people.

This is way the "patients rights" legislation passed by a bipartisan majority in the Senate June 29 is being touted in the big-business media and by its backers in Congress. Have working people been resurrected to a medical heaven? Or should they read the fine print to find out if the bill is what its promoters claim and see what attacks on working people it may contain?

With its passage in the Senate, the bill now moves to the House, where there are amendments being readied to ax some of the more controversial aspects of the bill, such as limited rights to sue health maintenance organizations (HMOs). The final Senate bill already made a number of last-minute changes to accommodate objections and veto threats by Bush. More are expected after the House debate.  
 
Those without insurance excluded
What are the facts about the legislation?

First, the name "patients' rights" is a misnomer since the bill does not concern all people who receive medical care but only those who have private health insurance or who are enrolled in Medicare and Medicaid. The estimated 44 million people in the United States who lack health insurance will not be affected by the legislation if a version of it becomes law.

Second, most of the "rights" listed are Band-Aids over a few of the most egregious cost-saving and bureaucratic practices that insurance companies and "health-care providers" have devised to prevent working people from getting adequate medical attention.

The short list the Senate bill addresses is itself an indictment of the capitalist for-profit industry that is called the "health-care system" in the United States. These changes, however limited, will be welcomed by working people enrolled in health plans. They are:

žAllowing patients to go to the nearest emergency room if they believe they have a true medical emergency, even if the hospital is not affiliated with their health plan;

žStipulating that health plans allow patients to see obstetrician-gynecologists and pediatricians without first getting permission from their primary doctor and that these plans cover any hospital stay deemed necessary by a doctor caring for a woman after a mastectomy;

žAllowing doctors to discuss all treatment options with patients and prescribe medically necessary drugs, regardless of whether the treatments and drugs are covered by the health plan. HMOs are to end financial incentives offered to doctors to curtail a patient's care and are not to retaliate against nurses or doctors who advocate on behalf of their patients or report problems in care; and

žMandating that HMOs allow patients access to medical specialists when needed and, if the HMO ends a contract with a doctor, that the physician be allowed to continue to treat patients for three months if they have serious or complex medical problems or if they are in the last three months of pregnancy.

It is a partial list of the wide-ranging abuses in the health-care companies' drive to maximize profits every working person and medical personnel know all too well.

Third, in adopting the bill the Senate included a reactionary provision that defines a fetus "born alive" as a "person" with the same "patient rights" under the law. The Washington Post noted this was passed "without objection from abortion rights supporters" even though opponents of abortion rights are sure to try to find a way to use the language to attempt to curtail women's access to abortion.

Fourth, the aspect of the legislation that was much heralded by its supporters--and opposed by the Bush administration and several big corporations such as Motorola that run their own health-care plans--gives those enrolled in a health plan the right to sue the provider in federal or state court. But the bill extensively limits this "right." Suits can only be for decisions that cause injury or death or over contract disputes. It shields most employers from legal action, even if they are the provider of the health plan but do not make decisions on treatment issues.  
 
Protection for employers
HMOs and other companies that provide medical insurance plans are also protected from most class-action lawsuits in the draft legislation. And before filing a lawsuit, a patient must exhaust all administrative appeals through their health plan and with an independent medical review of their claim. Establishing an independent medical reviewer, who has 31 days to rule on an appeal, is a new bureaucratic hurdle in the bill that patients will now have to surmount in their quest for adequate health care.

The Bush administration threatened to veto the measure, claiming "excessive, unlimited litigation in state courts would drive up premium costs and cause many American families to lose health insurance." The president demagogically added that the bill "puts the interests of trial lawyers before the interests of patients."

Neither the Senate nor the House versions of the bill require HMOs or other health plans to absorb the cost of the measures stipulated in the legislation. The Congressional Budget Office estimated the law would result in a 2 percent increase in insurance premiums.

Meanwhile, deterioration of health care for working people continues apace. New York City hospital officials have announced that the state will shut down more than two dozen clinics based in schools and neighborhoods where children from working-class families receive basic medical care--from immunizations to treatment for asthma. The state cited budget constraints for the closings, as the number of people without health insurance climbed by 30 percent over the last four years and reimbursements from "managed-care" companies and Medicaid declined.
 

Buoyed by the passage of a section of the "patients' rights" legislation that defines a fetus "born alive" as a person, the Bush administration is moving to define "an unborn child" as a person eligible for medical coverage under the Children's Health Insurance Program (CHIP).

In most states the CHIP program underwrites a range of services, including prenatal care and delivery for families with incomes up to twice the poverty level of $17,650 for a family of four.

In a letter to state health officials on behalf of the secretary of health and human services, CHIP director Dennis Smith announced "a new opportunity to provide health-care coverage to low-income children" by allowing a fetus to qualify as a "targeted low-income child." This would mean more pregnant women would qualify for medical care under the program.

Douglas Johnson, director of the National Right to Life Committee, an anti-abortion rights group, praised the move, stating, "An unborn child ought to be recognized as a full-fledged member of the human family in law and public policy."

Laurie Rubiner, vice president of the National Partnership for Women and Families, a group that defends a woman's right to abortion, replied that the new rule is a "back door attempt by the Bush administration to perpetuate its opposition to abortion rights. The real goal is to establish a legal precedent for granting personhood to fetuses."

Another bill passed by the House that is awaiting action in the Senate would also grant a measure of legal protection to a fetus by establishing new criminal penalties for anyone who injured or harmed a fetus while committing another federal crime. --G.M.
 
 
Related article:
Health care vs. capitalism  
 
 
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