Bush sides with HMOs on patient-rights issue

ORLANDO, FLA. — ORLANDO, Fla. - President Bush threatened yesterday to veto any "patients' bill of rights" that does not include limits on lawsuits filed against health maintenance organizations.

Speaking here at a convention of heart doctors, Bush said patients should be allowed to sue HMOs only after they have taken their complaints to an independent panel of physicians. The president's proposal also would put a relatively low but unspecified limit on court awards and require patients' cases to be heard in federal court.


In an era of consumer complaints about health maintenance organizations and their efforts to hold down medical costs, lawmakers from both parties back legislation to give patients more power in their dealings with HMOs. The key issues in dispute are whether to permit people to sue HMOs, if so under what terms, and at what levels to cap judicial awards.

Bush's remarks to the American College of Cardiology put him on a collision course with members of Congress who want to give patients more leverage in dealing with HMOs. On a more personal level, the speech seemed certain to heighten tensions between the president and Sen. John McCain of Arizona, Bush's rival for the Republican presidential nomination last year.


McCain, who also differs with Bush on legislation to overhaul campaign finance laws, has teamed with Democratic Sen. Edward M. Kennedy of Massachusetts on a patients' bill of rights that does not include the provisions favored by Bush. The McCain-Kennedy bill would permit lawsuits in state and federal courts and would permit punitive damages up to $5 million.

"I want to sign a patients' bill of rights this year, but I will not sign a bad one, and I cannot sign any one that is now before Congress," Bush said. "I will insist any federal bill have reasonable caps on damage awards. And the caps in proposed legislation before Congress are too high and will drive up the costs of health care in America."

House Democratic leader Richard A. Gephardt of Missouri attacked Bush's stance, saying "he wants to move America backward" by "throwing up roadblocks to bipartisan legislation and supporting instead watered-down measures that do more for HMOs than for average Americans. ... The president heeded the call of special interests, putting their needs first," Gephardt said in a statement.

Thomas R. Reardon, the immediate past president of the American Medical Association, commended Bush for pushing for a patients' bill of rights this year. But Reardon said the law should make HMOs accountable "to the same state judicial review that holds real doctors accountable. The only ones not facing this reality are the health insurers themselves."

White House aides said the president is willing to negotiate with Congress on the details of damage limits. As governor of Texas, Bush accepted a $750,000 limit on punitive damages, but he has not offered a specific plan as president. Instead, he outlined his views in a "statement of principles" last month.

In elaborating on his views, Bush said the independent review process would screen out frivolous claims and give patients a quick remedy if they are denied health care by an HMO. Patients who believe they have been harmed by an HMO's action could go to court after the review.

The president also favors giving patients the right to see certain specialists, including gynecologists and pediatricians, without permission from their HMOs.

Bush's appearance at the cardiologists' convention came two weeks after Vice President Dick Cheney was hospitalized with heart problems.


"I thought about inviting Vice President Cheney to travel with me today. He said he's seen enough cardiologists lately," Bush joked.