Judy Waxman: Should Hill Enact Managed-Care Reform?: Patients' Rights Activist Backs Democrats' Plan
Goldreich, Samuel, The Washington Times (Washington, DC)
Lobbyist Judy Waxman should have mourned last month, when leaders of Senate Republicans and Democrats declared an impasse on patients' rights legislation.
Majority Leader Trent Lott of Mississippi and Minority Leader Tom Daschle of South Dakota accused each other of inflexibility on the rules of debate and warned that the Senate might not vote on the issue before adjourning for the year in October, when members will leave the Hill to campaign in their own states.
But Ms. Waxman, government-affairs director for Families USA, remains hopeful that public discontent with health maintenance organizations will force a vote. And she says Democrats will prevail in their effort to erect a new patient-protection system, including access to emergency care and specialists, external appeals and the right to sue health plans, many of which now are shielded from liability by the 1974 federal Employee Retirement Income Security Act (ERISA). Ms. Waxman is counting on a vow made by Sen. Edward M. Kennedy, Massachusetts Democrat, to attach his patients' rights bill to every piece of legislation until there is a vote.
"It is possible, if you really are serious, to bring the system to a halt," she said.
The last time anyone talked like that in Congress, the public blamed GOP leaders for shutting down the federal government in a failed effort to force budget cuts.
But Ms. Waxman, a veteran of past battles to expand benefit mandates and create a national health insurance system, says this time, Congress will be swayed by patients who complain that they have no place to turn when their health plan denies coverage.
Question: The insurance industry takes the position that the patients' bill of rights and all these regulations should be left up to the marketplace and everything will be taken care of as the industry evolves. Why do you feel it's necessary to have federal legislation?
Answer: We don't believe that a voluntary system has worked or will work. There are just too many stories out there of people who have problems. If it's not their own, it's their cousin or their friend or their neighbor. A voluntary system doesn't work and it never has worked.
Q: But the industry cites studies that show that managed-care plan members are satisfied with the care they are getting, and in some cases find it preferable to their old traditional insurance.
A: But they also say they already do all this, and if they do, I would think they would want to restore confidence in the health care delivery system, which definitely has eroded. One would think if they already do it, they would have no problem with enforceable federal laws.
Q: The main difference in the bills in the public mind and in the rhetoric between the Republicans and the Democrats is the right to sue health plans that currently are protected under ERISA. Why is that necessary if you have all of these other rights and an external grievance system to protect them?
A: That is not the only difference. There are vast differences between what I call the real patients' bill of rights and either of the Republican leadership bills. Even on the issue of being assured of getting emergency-room coverage, there are vast differences. The Republican leadership bills slice and dice and make a provision that is weaker than what most states already have in place or what is covered in Medicaid and Medicare. And in the Senate Republican bill, they don't even apply it to everybody. They only apply it to about a third of the people with employer-based coverage. So, really, to say the right to sue is the major difference vastly oversimplifies.
Q: You didn't mention the compromise bill proposed by Sen. John Chafee, Rhode Island Republican. Why is that not acceptable?
A: We think it has some pieces that are missing. So we remain committed to [the Democrats' bill].
Q: Would the most important missing piece be the question of liability? …