Patients' Bill of Rights Inching Forward

Debate on a patients' bill of rights is about to heat things up on the Senate floor--and in all of Washington, for that matter.

Legislation advanced by Republican John McCain of Arizona and Democrats John Edwards of North Carolina and Edward Kennedy of Massachusetts would allow patients to sue their HMOs in state and federal courts for up to $5 million.

But legislation supported by Republican William Frist of Tennessee, Democrat John Breaux of Louisiana, and independent James Jeffords of Vermont is backed by the president. This group believes, among other things, that patients' damages should be limited to $500,000.

Senators Edwards and Frist joined the Early Show from Washington, DC to talk about the two plans.

Both sides believe that any new federal law should guarantee patients access to emergency care and medical specialists, as well as an independent medical review of decisions made by payers to deny claims for benefits. The two sides are opposed over one question: What happens if a patient is dissatisfied with the outcome of a review?

Edwards believes patients should be able to sue HMOs in state court for injuries resulting from poor care. The patients could also recover damages for economic loss or pain and suffering in these federal cases. Patients could win up to $5 million in a "civil assessment," similar to punitive damages for "flagrant violation of rights."

But Republicans would expand the right to sue in limited circumstances--like if a patient successfully pursues an administrative appeal and a health plan does not comply with the decision of an independent reviewer. Frist's bill would not allow punitive damages and would set a $500,000 limit on damages awarded for pain and suffering.

Republicans ordinarily champion states' rights, but in this case, they want patients' lawsuits to be tried in federal court where judges can set uniform standards for employers doing business in more than one state. Democrats favor state courts because they have more experience with personal injury claims than federal courts do, and state juries often give more compensation for injuries.

Frist says that Edwards' bill would cost far more than his would. "The big difference is their bill allows employers to be sued," he says, adding that employers will drop insurance as a result. "170 million [people] get their health insurance through employers, and 1.2 million of those will lose their insurance because of this [Democratic] bill."

But senator Trent Lott of Mississippi, the Senate Republican leader, said Sunday on CBS News' Face the Nation that he "can see circumstances where being able to go to state court would be acceptable."

"Where you sue is an important point, but I think that is one [difference] that can be bridged," Lott said.

Much of the focus has been on the differences in lawsuits that the two plans would allow, but Edwards says the independent revie process is a key component of providing for patients' rights.

"The most important thing for Senator Edwards in the whole bill is independent review because that's where healthcare decisions are being made," says Edwards' press officer, Mike Briggs. Edwards and the supporters of the Democratic plan believe it is vital to ensure that the people who review HMO decisions are completely independent, and are not working on behalf of either the patient involved or on behalf of the insurance company.

Edwards also says that a government analysis shows that there is little difference in price between the Republican-backed plan and the Democratic one.
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