WASHINGTON -- The House will begin wrestling today with legislation nominally aimed at protecting patient rights. But the theme of the debate might be called the doctors strike back.
After years of falling incomes and growing bureaucratic obstacles to delivering treatment they deem necessary, physicians are leading the drive to regain some control from managed-care plans.
Both in front-line roles as lawmakers and behind the scenes as lobbyists, medical professionals are venting frustration with an upheaval in the health insurance industry that has left many of them as unhappy as their patients.
"I've been watching the deterioration of the health care system since 1970," said Rep. Charlie Norwood, a Georgia Republican who is a dentist and is the lead sponsor of a patients' right bill that's expected to be approved by the House tomorrow. "When I got to Congress in 1995, this was the first thing I wanted to do."
The two-day debate will resonate with stories of patients who say they were denied life-saving care by cold-eyed HMO bureaucrats. But doctors have their own catalog of complaints: bewildering red tape, inadequate reimbursement rates, and restrictions on their ability to prescribe drugs and refer patients to specialists outside their networks.
Willarda Edwards, a Dundalk internist for 20 years, says she is paid only $4 a month for most of her patients, regardless of how often she sees them. Some doctors she knows are working sec ond jobs and selling Amway products, she said, to meet their rising expenses.
"Physicians are mad," says Sen. Bill Frist, a Tennessee Republican who is a specialist in heart and lung transplants and is the only physician among the 100 senators.
"They feel oppressed and are oppressed. They have experienced a loss of autonomy in the decision-making, a loss of power in the doctor-patient relationship and falling incomes. They are reaching out for every weapon possible to reverse these trends.
"And I don't blame them, because I do believe patient care is suffering because the pendulum has swung too far toward HMO power in dictating care," the Tennessee Republican added.
Frist, who, along with his brother, owns a stake in a chain of hospitals, is himself is under criticism from his fellow physicians. Though he is the lead sponsor of a patient protection bill that passed the Senate last summer, Frist will not go as far as his nine fellow medical professionals in the House -- many of whom are also conservative, and all of whom are also Republican -- to mandate stronger consumer protections.
The American Medical Association says Frist is too sympathetic to the insurance industry and is mobilizing against him back home in Tennessee.
"I'm glad to see activism; doctors should be involved in this debate," Frist said. "I just don't agree with them, and they don't agree with me."
All the doctors in Congress support basic reforms similar to those approved in Maryland and other states that would expand access to specialists, to obstetrician-gynecologists and to emergency care. All advocate requirements for an outside panel to review health plan decisions disputed by doctors or patients.
But many physicians in the House, as well as the AMA and other association of medical professionals, prefer the Norwood approach because it would expand the rights of patients to sue health plans if they feel they have been harmed by a denial of coverage.
Most Americans covered by private health insurance cannot now file such lawsuits. The HMOs' unusual freedom from most legal liability particularly grates on doctors, who live under threat of malpractice suits.
"Nobody likes to go to court, certainly not doctors," said Republican Rep. Tom Coburn of Oklahoma, an obstetrician who is sponsoring a more restrictive alternative to Norwood's bill, one that would allow lawsuits only as a last resort. "But there has to be some recourse."
Most Democrats support an expansion of the rights of aggrieved patients to claim damages in court. And they are backed by their traditional allies: trial lawyers, unions and consumer groups.
The Republican congressional leadership opposes expanding patients' right to sue. Behind the Republican leaders is another familiar line-up: health insurers, small businesses and the U.S. Chamber of Commerce.
These critics contend that increased regulation, particularly the threat of litigation, would drive up costs for everyone. They warn of higher premiums, of employers being forced to drop insurance plans, and of more Americans being added to the pool of 44 million with no health insurance at all.
"Congress should be passing legislation that makes it easier for people to be covered, not harder," said House Speaker Dennis Hastert. He urged his colleagues to vote instead today for a package of tax breaks to make health insurance more affordable.
Doctors, many of whom have long been stalwart Republicans resistant to government regulations, are starting to feel more comfortable with Democrats.
"Republicans have chosen big business and insurance companies over the people of this country," said Thomas R. Reardon, a general practitioner from Portland, Ore., and president of the AMA.
Featured speakers at an AMA gathering last month were Vice President Al Gore and Sen. Edward M. Kennedy, the Massachusetts Democrat whose advocacy of government-run health care was once anathema to doctors.
Doctors are feeling so squeezed by managed-care plans that many are beginning to wonder whether a single-payer, government-run health insurance program -- like that in Canada, might not be so bad, said Michael Preston, executive director of Medical and Chirurgical Faculty in Maryland, the state medical society. "The level of anxiety and frustration has reached colossal proportions," he said. "The reforms in this legislation are only at the margins."
Both sides of the debate have poured millions into advertising and lobbying campaigns.
"We're prepared to spend whatever it takes to defeat this thing," said John Murray, a spokesman for the American Association of Health Plans, which says its members fear that they would be put out of business.
The campaign is also feverishly under way at the grass roots.
Rep. Wayne T. Gilchrest, a Republican from the Eastern Shore said he received calls last week from Chamber of Commerce officials in each of the 10 counties he represents.
And Rep. Benjamin L. Cardin, a Baltimore Democrat, says he is buttonholed by doctors -- "every day, all the time, every place I go" -- asking for help in reining in managed-care companies.
Pub Date: 10/06/99