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Should a Patients' Bill of Rights Include Caps on Lawsuits?

Aired June 20, 2001 - 19:30   ET


ROBERT NOVAK, CO-HOST: Tonight: losing patience on the patients' bill of rights. Early fireworks light up Capitol Hill as Democrats demand action on their HMO reform bill.


SEN. TRENT LOTT (R-MS), MINORITY LEADER: The Democrats seem to think that the answer is a lawsuit. Sue everybody. Sue the employer, sue the doctors, sue the managed care. Sue right out the gate.


NOVAK: And Democrats threaten to cancel the July 4th recess.


SEN. TOM DASCHLE (D-SD), MAJORITY LEADER: There will be no July 4th recess. There will be no break until this bill is passed in the United States Senate.


NOVAK: Who will prevail?

ANNOUNCER: Live from Washington, CROSSFIRE.

On the left, Bill Press. On the right, Robert Novak. In the CROSSFIRE, Democratic Senator Paul Wellstone from Minnesota, member of the Health, Education and Labor Committee, and Republican Senator George Allen of Virginia.

NOVAK: Good evening, and welcome to CROSSFIRE. They're not really debating health care on the Senate floor, just debating whether to debate it. But believe me, the fix is in.

The Senate will vote to take up the so-called patients' bill of rights tomorrow morning at 9:30. That's the result of Democrats assuming majority status in the Senate. Under the Republicans, the bill would still be buried in committee. Republicans did hold up formal debate on the bill for three days, leading newly installed Senate Majority Leader Tom Daschle to threaten the Senate with massive retaliation, taking away their 4th of July holiday, no less, if the bill is not passed by then. The issue is the right for people to sue the institution they love to hate, HMOs. Republicans fight that, saying this a bonanza for trial lawyers that actually threatens health insurance -- Bill Press.

BILL PRESS, CO-HOST: Senator Allen, welcome. Let me a quick question for you, first of all. You know that the votes are there to pass McCain-Kennedy. You know the American people want this. Why are you Republicans trying to stop it from coming to the floor?

SEN. GEORGE ALLEN (R), VIRGINIA: I'm not sure if the votes are there. I think people need to understand that Republicans, and I think Democrats as well, probably understand the importance of making sure patients get good, adequate health care. The reality is, at least in Virginia and the vast majority of other states, most of these protections are already in law, and what we want to do is really follow a doctor's principle -- is first, do no harm. And so we want to make sure there's good, quality health care, recourse and access if there's any disputes.

But what we don't want to do is drive up the costs with litigation so that people become uninsured. And that is very harmful for health care, especially for lower-income people. Nor do we want to harm employers.

NOVAK: Senator Paul Wellstone, welcome.


NOVAK: When the Senate majority leader says pass this by the 4th of July or I'll take away your furlough, is this -- isn't this legislation by ultimatum? Is this the way the new Democratic majority is going to bully the Republicans?

WELLSTONE: No, I think, you know, if you're going to be there for working people then you've got to work hard. And I think what Tom Daschle is saying, seriously, Bob, is that this is a huge priority. It's about protection for people. It's about making sure people get the care for themselves and their loved ones that they deserve. It's about being on the side of consumers, versus these big insurance companies, and I think it's a serious enough and important enough issue for people in Minnesota and people in the country. We should work and work until we do the job.

PRESS: Senator Allen, it's pretty clear what's going on. It's obfuscation. It's obstructionism. I mean, what I find funny about this, two months ago, the Democrats with the education bill -- Democrats spent a whole week. They're putting up amendment after amendment after amendment, and the Republicans were whining and saying: "This is terrible. They're holding up what the people want. They're just delaying, delaying, and delaying.

And you guys now are going to do the same thing. Why was it wrong then, and it's right now?

ALLEN: First of all, I disagree with your premise. If we're going to do something as significant as this, that can have either a positive or a negative impact, we ought to do it right -- whether it takes two weeks or three weeks to get it done. What is wrong with that?

Now, here. I brought some statistics for you.

PRESS: But that's exactly what the Democrats were saying two months ago.

ALLEN: Well, fine. I wasn't -- they're the ones, had all the endless amendments on the tax cut bill. But nevertheless, I mean, that's a right of an individual senator.

Here's what most people care about -- not any of this process, or whether it takes two weeks, one week, or 17 days to do it. They care about making sure that they have good emergency medical care. They want to make sure that there's direct access, direct access for a women to her obstetrician, or to her gynecologist. In Virginia, when you look at all of these major patient protections, we already have them in place. Many of those I supported and signed into law, including maternity (UNINTELLIGIBLE) when I was governor.

Now, we have -- out of the 13 major, we have 12. Minnesota has 10. The reality is, is there are those protections. We do care about patients, but we don't want to be creating litigation and a bonanza for lawyers, which will drive up health insurance costs. And you know who gets hurt by that -- are those working people.

PRESS: Just a second.

ALLEN: Every percentage increase.

PRESS: Right.


ALLEN: This is not the speech on the floor of Senate, here, Senator.

ALLEN: Well, I know, but we want to make sure the American people are educated on the economic impact of this.

PRESS: Let me just...

ALLEN: ... and adverse health effects.

PRESS: If I may show you something else that people care about, which is the right to sue their HMO when their HMO goes wrong. Let me just show you a little poll here from the Pew Research Center just taken about a week or so ago, asking: Do you think patients should have the right to sue?

Democrats, 82 percent. You expect that. Independents, 79 percent. Seventy percent of Republicans, Senator Allen. You guys are committing political suicide by denying people the right to sue their HMO. Why? ALLEN: Because the way that this bill is drafted, in suing employers, what will happen there is that insurance costs, health insurance costs will go up. Their estimates are around 4.2 percent. The various groups, including the Congressional budget office and the Lewan Group, which is an independent group, have pointed out that for every 1 percent increase in health insurance premium cost, 300,000 Americans go without health insurance.

You know what that means, is that women are not getting diagnosed for breast cancer. Over 243. You know what that -- the result of all that, the extrapolation, is? With this bill, 30,000 women would have breast cancer and not have it properly and early diagnosed. So we want to make sure we do it in the right way.

NOVAK: Senator Wellstone, I want you to explain something to me.

WELLSTONE: And in explaining it to you, I want to respond little bit to you.

NOVAK: A little bit, not too much. But I want you -- I want you to explain something to me, Senator. Senator Daschle says, he has said many times: "I have given all I'm going to give on this bill."

I'm -- I don't know whether there's any compromise myself, but he said: "I'm not going to compromise anymore. This is it. Take it or leave it." And then he says, he said the other day on the Senate floor: "We want a bill. We don't want a veto."

If you're not going to compromise, you're going to get a veto, aren't you?

WELLSTONE: Well, I think we have compromised on the compromises. It's been going on for about five or six years.

NOVAK: When?

WELLSTONE: Well, if you go back to when I introduced this bill, a bill in 1994, and then we've been 1996, 1998. I mean, there's been a lot of give and take, and listen, there may be still a lot of give and take.

NOVAK: So it isn't the final vote.

WELLSTONE: Well, it depends -- it depends upon whether you're dealing with the core part of the bill or whether you're dealing with other aspects of it. I think George just protests a bit too much. I mean, if we can't take on the health insurance industry and be there for consumers and for patients, and for that matter, for doctors and nurses to provide the care they thought they were trained to provide, then we're never going to take on the pharmaceutical companies and get a decent benefit for people.

The estimates on the cost, by the way, independent estimates is 4.2 percent over five years. And then after that, not at all. Look, Texas has this legislation. And so does...

ALLEN: It's not the same law as Texas.

WELLSTONE: You know what? It's the exact same thing. You can go into state court, a doctor is held accountable. A nurse is held accountable. Everybody else is, but the managed care plans, they don't want to be. In Texas they are, and you haven't had a proliferation of lawsuits. You know what else? The premiums haven't gone up, and in Georgia they haven't had any lawsuits after having it for three years.


ALLEN: It's not the same laws as the Texas law.

WELLSTONE: Here's the point -- let me finish. Let me finish. It's very, very similar, and you were talking about what Virginia has.

ALLEN: It's not -- sue an employer, period.

WELLSTONE: Let me be clear about what this legislation is, because people who are watching this debate need to know. First of all, states can move forward with this, and if states have a protection that's equivalent to what we're talking about at the federal level, they get to do it.

Second of all, you have the right -- you have...


WELLSTONE: Wait a minute. You have a right to see the kind of doctor that you need to see and for your loved ones to get the care they need, and boy, there are so many examples of people who have been turned down.

Third of all, you can appeal it, and fourth of all, if your doctor said you needed an MRI and the managed care plan says no, and it turns out you or your loved one had a malignant brain tumor and you die -- yeah, they can be taken to court at the state level under state law. And you, of all people, should support that.


ALLEN: Well, we have done it at the state level, so if you're going to say a state like Virginia, or any other state that has substantially the same protections as we do in Virginia, and many other states do, then they're not subject to these federal requirements and mandates?

NOVAK: Senator Wellstone, I want you...


WELLSTONE: The language is crystal clear, that if it is equivalent, or very close to equivalent, then that's fine.

NOVAK: Senator Wellstone, I want you to deal with something on this practical point. If you talk about taking on the insurance industry, taking on the pharmaceuticals, these are -- but behind you, you're not just little Paul Wellstone. You have one of the huge special interest groups in America that have put gazillions of dollars into the campaigns of Democratic senators, and that's the trial lawyers. They're going to make millions and millions of dollars over this. You can't deny that, can you?

WELLSTONE: Bob Novak, if were you in the coffee shops in Minnesota and you were listening to people who feel like this has become bottom line medicine and who have gone through living hell trying to get coverage for their loved ones, struggling with illnesses like cancer.

NOVAK: Am I wrong?

WELLSTONE: You are wrong. You would know what this debate is all about is being there for consumers. Look, the trial lawyers...

NOVAK: Are going to make a lot of money on this!

WELLSTONE: So do 550 different groups and organizations all across the country, for women, for children, for labor, for consumers. You oversimplified, Bob. This is about the interest of the consumers.



PRESS: Senator Allen, here's what I don't understand. I want to come back just to the basic principle. Because in this country today, your doctor screws up, you can sue your doctor. Or you go to a clinic, you can sue the clinic. You go to a hospital, you can sue them.

In state court. You want to say that there's a special category for managed care executives -- managed care groups -- that you can't sue. Why the hell not?

ALLEN: Well, obviously, in Virginia, there are internal reviews.

PRESS: We're not talking about Virginia. We're talking about the United States, Senator.

NOVAK: Hey, hey...

ALLEN: The point is that in Virginia and many other states, there are internal reviews and external reviews. The access to the courts in those situations -- obviously, if there's a breach of contract, if an MRI is to be covered and they don't cover it, you can sue them.

But it's after you go you through the review. The access to the courts should not be the first -- or the first thing should not be going to the court. The first thing should be to give treatment to that patient who needs it. I'm not...

PRESS: But... ALLEN: I'm not -- I'm not saying there should not be recourse. I think there...

PRESS: You have not answered my question. There's also review in this federal legislation that Senator Kennedy and Senator Wellstone and others are supporting. There's review in Texas! But after that review, the HMO has to be held accountable. If doctors...

ALLEN: Right. How come they're repealed? As opposed to this legislation which is a rush to the court.

PRESS: No, it's not. No, it's not.

WELLSTONE: George, you're not accurate. I'm sorry. The difference is this -- let me speak.

ALLEN: Wait a second.


ALLEN: The other people who are subject to being -- a lawsuit against them in this legislation, contrary to Texas and virtually about 40 states, is that employers who provide -- voluntarily provide health insurance for their employees. They are liable. What will happen -- what they will do is, will drop it and then the employees...

WELLSTONE: I have to spend my time just getting correct information from people. No. 1, employers aren't liable at all unless they become a managed care plan and tell someone directly they can't get the coverage.

ALLEN: So all this business is wrong?

PRESS: One at a time.

WELLSTONE: Second of all in our legislation, the difference is we have an appeal process, but what you have in your bill is, the appeal process managed by the managed care companies. That doesn't give the consumers much of a break.

PRESS: Speaking of a break, we will take a break right there, and when we come back, we'll talk a little bit more about the politics of this whole issue: will President Bush dare veto this bill if it lands on his desk?


PRESS: Welcome back to CROSSFIRE.

We are debating the patients' bill of rights. Same debate now before the U.S. Senate but two senators can't get enough of it over there. They have brought their differences over here tonight.

Democrat Paul Wellstone of Minnesota who supports the Kennedy- Edwards-McCain legislation, and Republican George Allen of Virginia, who does not. Robert Novak.

NOVAK: Senator Wellstone, let me quote you from a report from the Congressional Budget Office, which is not a partisan organization. In fact, a lot of times Republicans are not happy with the CBO. The report from the Congressional Budget Office says:

The Kennedy-McCain-Edwards bill will increase health insurance premiums by 4.2 percent. And 1.2 million more Americans will be without health insurance.

What happened to the old Democratic ideal of making sure that every American has health insurance? You are taking away another million Americans -- taking away health insurance from another million Americans.

WELLSTONE: The only thing I can tell you, first of all, 4.2 percent over five years is like a $1 a month for people. That's what the increase is, and what they spend on a premium. And I think the difference between this plan and one other competing plan is 50 cents, a cup of coffee.

All I can tell you, is the states that are moving forward, including the president's Texas. In Texas, the president vetoed the first bill and then didn't sign the other. So he hasn't had a strong interest in this. But since the bill passed in Georgia two years ago, we have not seen people drop.

In fact, I would like to note, since you're so concerned about the premiums going up -- these insurance companies are jacking premiums up ten percent a year. The pharmaceutical costs are going up by that as well. Not 4 percent over 5 years. And yet, I don't hear my Republican colleagues talking about taking on these increasing costs. I don't hear my Republican colleagues talking about universal coverage. I'm all for doing that.

But I don't think you can pin this on paper.

NOVAK: Senator...

WELLSTONE: And can I tell you one other thing? Please remember, when the gate-keeping is over, and people get access to the care they need for themselves and their loved ones, then you don't have the catastrophic expenses, subtract any estimate. You save money.

NOVAK: Let me suggest what is really going on here.


NOVAK: And I think you're probably -- in your heart you will agree with me.

WELLSTONE: In my heart, I'll agree.

NOVAK: And that is, Senator, that you know this is going to create a tremendous mess. You're going to find a lot of companies, rather than -- once this bill is passed, if it is passed and signed, they will drop their health care. More people will be without health insurance. The system will be worse.

And this is all to move the country inexorably towards a Canadian single payer, socialized medicine system, which has always been your goal, isn't it?

WELLSTONE: Well, a couple of things. First of all, the Canadian system, the government doesn't run it. It's decentralized.

NOVAK: Well, sure.

WELLSTONE: You should know that. This isn't about any of that. I think...

NOVAK: You want a single payer system?

WELLSTONE: Actually, what I would like to have is health security for all Americans.

NOVAK: You want a single payer system?

WELLSTONE: I would like the states the option to decide.

NOVAK: Didn't answer my question.

WELLSTONE: No! I would like states to decide, But Bob, that's not the point.

NOVAK: That's what you want, though.

WELLSTONE: No, what I want right now is to make sure there's basic protection for people so they can have access to the care that they need. That's what I want and right now that is not happening.

PRESS: Just for the record...

WELLSTONE: I want to have universal coverage later.

PRESS: For the record I'd say I want a single-payer system. Unfortunately we are not headed that way.


WELLSTONE: Excuse me, one payer and the insurance industry not being involved is absolutely the way I would eventually like to go, but that's not what this debate is about.

PRESS: Senator Allen, here is what gets me: I come from California. We have a lot of complicated ballot initiatives in California. And when I don't understand these initiatives you know I look -- I look to see who is for them and who's against them. I think you can tell a lot and I think you can tell a lot on this legislation as well.

I think Senator McCain said it best yesterday at a news conference. And here he is.


SEN. JOHN MCCAIN (R), ARIZONA: There are 500 organizations: Doctors, nurses, national cancer, all of the health care advocates in America are supporting our legislation. On the other side are the HMO's. So we have a fairly clear choice here as to who's supporting what. I'll stick with the doctors and nurses of America most any time in a fight against the HMO's.


PRESS: Why do you pick the HMOs over the doctors and nurses if you are talking about health care?

ALLEN: I do care about health care and Republicans do as well, and we all want to sure that patients get good adequate care.

PRESS: Are you (UNINTELLIGIBLE) Republican

ALLEN: Yes, and Republicans may disagree. And there may be some Democrats that vote with us on various amendments here to make sure we don't drive up the cost because of litigation. No one thinks that adding lawyers to the mix and more litigation and no limits and no caps on noneconomic damages and having $5 million of punitive damages, no one in their right mind, economically and logically thinks that that will make health care insurance more affordable.

We want people to have it through the private sector and in fact there'll be amendments I hope to make sure that health insurance is 100 percent deductible for the self-employed, and by doing that people will have health insurance, and when they do have it, as opposed to the million two who don't, then they'll get the diagnosis for early detection of breast cancer or cervical cancer or others. And that's the way we want to do it.

Now it's not just HMOs. You know who else is against it? Small businesses. Folks like WaWa (ph), McKee Foods, others. These are small family businesses who are against this bill because they realize it will hurt their employees.

PRESS: Almost out of time, Senator, but I have to call you on this because you keep putting up these strawmen about these costs and about these lawsuits. In Texas in four years, ten lawsuits. In Georgia, in two years, four lawsuits. In Texas the premiums went down last year. Senator, everything you say is going to happen has not happened.

ALLEN: It's a different proposal. One, it says very clearly, in Texas employers cannot be sued. No. 2, Texas has caps on these damages. This bill doesn't.

NOVAK: You're going to have to you continue this on the Senate floor. Thank you very much.

WELLSTONE: I think consumers and patients and doctors and nurse are going to win.

NOVAK: Thank you, Senator Wellstone. Thank you, Senator Allen. And Dr. Press and I will be back with closing medical comments.


NOVAK: Bill, you usually don't know what you are talking about but you're very often candid. You were candid tonight in saying that what you really do want is a single-payer system. You want an elimination of the private health insurance companies. You want no more freedom for patients to just pick their own doctors, the doctor is picked for you. You want, to use the old-fashioned term, socialized medicine in America. A lot of these politicians do too, you admit it, they don't.

PRESS: Well, I agree with Harry Truman. I think that's the kind of medical system we have. But Bob, I'm not a United States senator. I don't think any of these senators up there want what you were just talking about, what I want. What they want is for people to have the right to sue their HMO. And you side with insurance executives and I side with doctors and nurses. That's the difference.

NOVAK: Just politically speaking, you used to know something about politics. We are walking the way back to Hillary-care which was defeated by and rejected by the American people in 1994. They elected a Republican Congress and seven years later the ghost has reappeared. Well you can put a stead through his heart.

PRESS: No. This isn't it, Bob. We are walking our way to a patients' bill of rights and I'll bet you Bush will sign it. He will have to.

NOVAK: I bet you he may veto if it's this bill.

PRESS: From the left, I'm Bill Press. Good night for CROSSFIRE.

NOVAK: From the right, I'm Robert Novak. Join us next time for another edition of CROSSFIRE!



4:30pm ET, 4/16

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