Action on Health Care in 2002?
Guglielmo, Wayne J., Medical Economics
The wars, foreign and domestic, continue to preoccupy Washington, but issues like patients' rights, Medicare hassles, and the uninsured won't go away.
No one knows what last year's Washington health care agenda might have looked like had the events of Sept. 11 and its aftermath not taken place.
Perhaps 2001 would have been the year, finally, for an acceptable patients' bill of rights, including at least an attenuated right to sue health plans. Perhaps doctors struggling through the thicket of Medicare red tape would have been granted some long-sought regulatory relief. Or perhaps, despite budget woes, a potentially costly issue like expanded medical coverage for the uninsured might have gained some traction among lawmakers willing to split the difference between Democratic and Republican approaches.
Perhaps. But Sept. 11 did take place, of course. And that fact not only radically altered last year's health care agenda-redirecting lawmakers' attention to matters of war both foreign and domestic-but could very well do the same this year.
"If the war goes on for a while, its needs will dominate," says Harvard health care pollster and political analyst Robert Blendon. Certainly, a deep recession could alter the picture somewhat, he acknowledges, giving prominence to issues like the uninsured. But short of that, it's the war, stupid.
Most groups previously focused on health care won't let mere Congressional inattention stop them from pursuing a range of issues, though. After all, priorities can turn on a dime in Washington. And, in any case, just because health care isn't grabbing the headlines doesn't mean it's completely out of the legislative picture.
With that in mind, we look at the issues left over from 2001 and assess which are most likely to survive our current preoccupations.
Patients' rights redux: Is fatigue setting in?
The tortuous road to a patients' bill of rights looked like it was coming to an end last summer, at least in Congress.
In late June, a bill sponsored by Arizona's John McCain and Massachusetts' Edward Kennedy, among others, passed the Democrat-led Senate by a vote of 59 to 36. Backed by the AMA and a host of other medical organizations, the bipartisan bill granted patients wide-ranging rights in their dealings with health plans, including the right to sue in state or federal court. On the House side, similar legislation sponsored by GOP Rep. Greg Ganske of Iowa looked like it might carry the day as well.
But support in both houses didn't guarantee a presidential signature-something co-sponsor Charlie Norwood (R-GA) knew full well. On Aug. 1, a day before debate on the House bill was to begin, Norwood met with President Bush and worked out an amendment to his own legislation. Essentially, the amendment scaled back liability provisions, limited federal remedies, and imposed caps. The bill as altered passed the House the next day by a 23-vote margin.
With two competing versions of patient protection, the next step would have been to reconcile House and Senate differences in conference committee. Then Sept. 11 occurred, and all bets were off. "The only way a reconciled bill would happen is if the people who wanted a bigger bill just gave in and agreed to the president's more limited bill," said Harvard's Blendon in November. "The president has no need to even look at this thing."
The prospect for legislation this session depends on the war, of course, but also on the ability of backers like McCain, Kennedy, the AMA, and consumer groups to rally public support for a stronger measure. But is the public still interested, even assuming terrorism concerns abate? Some people are clearly suffering from patient-protection fatigue after seven years of dead-end debates.
Others think health plans have already come a long way, at least in the areas of access and choice. "Right now Congress isn't getting pressure to pass a bill of rights," says Rosi Sweeney, vice president for socioeconomics and policy analysis at the American Academy of Family Physicians. …