Patients’ Bill of Rights: Good Bill or Bill of Goods?


The Patients’ Bill of Rights currently under debate in Congress is deliberately misnamed. It is really a “Corporate Protection Act,” intended to minimize employer liability when patients are improperly diagnosed, improperly treated, or denied treatment.

Most Americans with health insurance are part of a so-called Health Maintenance Organization (HMO), which offers corporations and smaller businesses lower costing and lower quality health care for their workers. The HMOs have extracted untold billions in super-profits in the process of fundamentally restructuring the U.S. health care industry.

HMOs increase profitability by raising premiums, restricting their members to younger and healthier patients, denying lengthy and expensive treatment, and requiring doctors to see more patients in less time, thus generating larger revenue.

Doctors in HMOs are salaried workers who are expected to meet a patient quota and abide by a cost-per-patient cap set by the insurance companies, regardless of patients’ needs.

The Tufts Health Plan in Boston, for instance, awards its doctors a bonus of up to 20 percent of their salary if their patient costs come in below the cap. Similarly, doctors who exceed the allowable limit can face up to a 20 percent cut in salary.

Neither version of the proposed patients’ rights bills that are before Congress remedies a situation that pits doctors’ financial interests against their patients’ medical needs. The Democratic-supported Senate bill would allow HMOs to reward or fine doctors up to 25 percent of their salary per year. The Republican-supported House version sets no limits at all.

Neither the Senate nor the House bill would require HMOs to disclose to patients the company’s payment incentive/penalty arrangement with doctors. The people most affected by and likely to suffer from these schemes may never even know they exist.

Doctors today have a strong incentive to provide fewer services to each patient. The health care industry is an increasingly impersonal system that treats people like products on a medical assembly line and rewards doctors who see more patients but do less for them.

Further, the House bill favored by the president sets unreasonable constraints on a patient’s right to sue HMOs for damages. The bill would handcuff patients in two important ways:

1) By requiring that corporate-friendly federal law will prevail even in state courts.

2) By limiting the amount of money that an injured patient can collect. Without adequate information, treatment, and protection, a patients’ bill of rights is hardly worthy of the name.

The Patients’ Bill of Rights does assert an essential principle: patients are not helpless victims of HMOs and insurance companies but are citizens with legal protection. This principle, however, is more theoretical than real. In practice, most employers will be shielded from litigation, and an appeals system is in place to give HMOs nearly insurmountable advantages in court.

Debate on the Patients’ Bill of Rights has certainly highlighted this administration’s priorities. President Bush, who has consistently threatened to veto a more liberal version of the bill, has shown greater concern for the financial resources of the insurance companies and HMOs than he has for the natural resources of the Alaskan coastline.

While the Democratic-controlled Senate passed a more liberal proposal than the House, the Patients’ Bill of Rights is not a story of good Democrats versus bad Republicans. For one thing, both parties agree on the essential outlines of this bill. And when they differ, each side scores points by citing the real flaws in the other side’s program.

The Democrats charge that the Republicans favor the HMOs and insurance industries; the Republicans counter that the Democrats favor a bill that will be a boon to lawyers. Despite the rhetoric, however, it’s clear that both parties pander to the ruling rich as they maneuver to craft a bill that defends their interests.

The twin parties of the rich are racing to a “compromise” that will reduce to a minimum patient access to litigation challenging harmful or illegal hospital practices. The very bill that is allegedly designed to grant patients the right to sue in reality limits the right.

Indeed, in an industry already operating as a near monopoly, HMOs can be expected to use the bill as an excuse to further increase premiums, while employers simultaneously attempt to increase the amount that workers who are covered must pay.

As health costs rise, more families will be forced to do without medical coverage, especially likely in a period of economic downturn and increased unemployment. Already 44 million people, 10 million of them children, have no medical insurance-as opposed to 37 million when Bill Clinton took office. The Patients’ Bill of Rights will do nothing to assist these families.

An Aug. 5 New York Times editorial gushes crocodile tears when it calls for a stronger bill than the one favored by President Bush: “With fewer options for building profits, managed care plans may have to get tougher in denying care to their members. That is why it is critical to get a strong patients’ rights bill.”

The question left unasked in The Times editorial and in the entire debate on the Patients’ Bill of Rights is why workers need such a bill to protect them from a system that is supposed to ensure their good health. The answer is quite clear: patients need protection because insurance companies and HMOs need profits.

No wonder, then, that public opinion polls consistently register disapproval and outrage with the state of health care in America. In fact, the system was never designed to work in the first place. The goal of the medical industry was never health care for all but profit for a few. Popular sentiment in favor of better health care has pressed politicians to pretend to grant reforms. The debate is to determine how little workers will accept.

Quality health care for all is a battle that should be at the center of labor’s agenda. But the bureaucratic officials at the head of this country’s unions, who are completely wedded to capitalist politics, long ago subordinated a fight for universal socialized medicine to contract negotiations with individual bosses.

In most of Europe, in contrast, government-paid socialized health care is available to all citizens-although in some countries, such as Britain, steps have been taken in recent years to privatize and increase costs for many health benefits.

Where socialized medicine exists, it was won in struggle by workers in past decades who used their class power to build mass working-class political parties to counter the parties of the ruling rich.

The United States is virtually the only advanced industrial country where working people have no political party based on the labor movement. This is the job of the emerging generation of youthful fighters.

A revitalized, militant, and democratic U.S. labor movement will provide the social base for a mass labor party that enters the economic and political arena to struggle for the interests of all working people and their allies. Free quality health care for everyone must be at the core of its program.

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