Four days of partisan warfare on the Senate floor ended Thursday night, giving legislative preference to large insurance companies and leaving doctors and patients continually dependent upon the decisions of health maintenance organizations.
The Patients’ Bill of Rights, a piece of legislation originally drafted by Democrats to protect consumers in managed care plans and other health-care coverage, was rejected in favor of the Republicans’ version, which permits a more hands-off governmental approach to regulating managed health care.
President Clinton announced his intention to veto the legislation shortly after the vote was counted.
Critics of the approved legislation say the Republicans’ watered-down bill addresses larger issues like physician accountability, political posturing and the degree of governmental involvement in health care, but allows only for nominal gains for patients.
Many students covered with private health insurance will receive little direct benefit. Medicare and Medicaid patients will not be affected by the legislation.
“It is often said that the devil is in the details,” said Bryan Dowd, a professor in the University’s Institute of Health Science Research. “That is not true of this issue. Rather, the devil is in the big picture,” he said, explaining that both Republicans and Democrats use ‘patient protection’ rhetoric to leverage their respective ideals for regulating HMOs.
Dowd explained that although senators on both sides with different motives championed a fight for patients’ rights, they really questioned three larger issues: the role of the physician in society, the degree of the federal government in the health care system and the next election.
“This is a convenient example to talk about bigger issues,” Dowd said.
Although both parties asked that the bill remain a nonpartisan issue, the Democrats lost each of the 12 amendments they proposed.
The Republicans and Democrats squared off in a tumultuous debate with nearly fruitless results. Almost every vote on each of the 12 amendments was decided along partisan lines.
The largest blow to the Democratic version of the bill was a 53-47 vote defeating a proposal to allow patients to sue their HMO. Republicans claim that such legislation would drive up health care costs because of excess and unnecessary litigation.
Democrats delivered horrific testimonial accounts of suffering, paralyzed or dead patients because of HMOs’ failure to provide adequate coverage. They called for autonomy for physicians, asking that doctors make decisions about patients’ care rather than HMO cost accountants.
Republicans responded by cautioning that the Democrats’ legislation would only raise premiums and make coverage unaffordable.
But by late Thursday night, with the Democrats failing to pass a single amendment, the partisan voted yielded the Republicans’ Patients’ Bill of Rights Plus.
The Republicans’ version of the bill calls for less government intervention and more individual choice in the health care industry. The new bill allows long-term premiums to be tax deductible, removes restrictions on medical savings accounts and provides for 100-percent tax deductions for health insurance costs for the self-employed.
The Republicans consistently shot down Democrats’ amendments, which included clauses to allow women to chose obstetrical and gynecological physicians as their primary physicians; the right for patients to participate in clinical trials; and to extend the bill of rights to all patients with private health insurance — a provision that would have included more than three times as many Americans under the protection.
“If it’s the Patients’ Bill of Rights, where is the patient in all of this?” asked Susan Hadley, a Minneapolis health care consultant for women’s health. Hadley said that a number of the Democrats’ amendments would have afforded patients a right to make their own health care decisions.
A spokesman for Sen. Rod Grams, R-Minn., considers the bill a victory for patients. Steve Behm said the Republican version of the bill will not raise insurance premiums. Behm said the Republican plan will help make health insurance more accessible to more than 43 million uninsured Americans; more than half a million Minnesotans have no health insurance.
But Jim Farrell, a spokesman for Sen. Paul Wellstone, said the republicans intentions rest not in making health insurance more accessible or protecting patient rights, but rather protecting big money.
“There’s only one group that opposes the Patient’s Bill of Rights and that’s the health care industry,” Farrell said. “The Republicans are doing a great job this week for the HMO’s but a terrible job for the American people.”