A discussion of the Health Care System in the United States is not complete without the examination of a topic concerning every American -- a STRONG "Patients' Bill of Rights." This means a Bill of Rights protecting the PATIENTS receiving health care and not the HMOs, health insurance companies, hospitals or the other PROVIDERS of health care.

After the new Health Maintenance Organizations, (the HMOs), the health insurance companies, and the Republican Party succeeded in destroying the Clinton Health Plan of 1994, the battles over health care in the Congress did not resume again until early in 1995. During 1995, the Democrats and Representative Bernie Sanders of Vermont made two attempts to pass comprehensive health care legislation, and 15 attempts to lower prescription drug prices and to push for STRONG ANTI-FRAUD laws in the Medicare and Medicaid programs.

It was not until September 1995 that the issue of a patient's "rights" began to manifest itself in the Congress, and when it did so, it was in the context of the Republican's so-called SEVEN YEAR BALANCED BUDGET RECONCILIATION ACT OF 1995. In his veto letter of December 6, 1995, President Clinton pointed out that the Act "would cut deeply into Medicare, Medicaid, student loans, and nutrition programs; hurt the environment; raise taxes on millions of working men and women and their families by slashing the Earned Income Tax Credit (EITC); and provide A HUGE TAX CUT whose benefits would flow disproportionately to those who are already the most well-off." [emphasis added]

"Moreover," he continued, "this bill creates new fiscal pressures. Revenue losses from the tax cuts grow rapidly after 2002, with costs exploding for provisions that primarily benefit upper-income taxpayers. Taken together, the revenue losses for the 3 years after 2002 for the individual retirement account (IRA), capital gains, and estate tax provisions exceed the losses for the preceding 6 years."

Specifically, the Republican Seven Year Balanced Budget Act of 1995 would have cut Medicare by $270 billion over the 7 years of the Act and Medicaid payments to the states by $163 billion over the same 7 year period. Now in the millions of dollars in advertising spent by the HMOs, the health insurance companies, and the pharmaceutical industry in defeating the Clinton health plan of 1994, there was the oft-stated claim that the Clinton plan would take away the patients' right to chose their own doctors. Yet this is precisely what the HMOs and health insurance companies began doing in 1995 to 200 million Americans -- not just the Medicare and Medicaid recipients but the Americans paying for the HMOs and health insurance companies.

For in addition to massive cuts in Medicare and Medicaid, the Republican "reform" legislation provided no protection for the beneficiaries of both programs. On September 14th, 1995, Representative Sherrod Brown (D-OH), introduced HR.2359, the Medicare Patient Choice Act of 1995. In introducing HR.2359, Brown said: "Many of the so-called reform plans include efforts to increase the use of managed care for Medicare patients. I believe that these plans must include safeguards to protect Medicare patients' ability to choose the person who provides them health care services." Hence HR. 2359. But Brown's bill went further than that, and this is what guaranteed its death in the Republican-controlled Congress. For the Brown bill wanted to insure "that patients get what they pay for under managed care arrangements by requiring plans to return to patients at least 85 percent of the aggregate premiums received in health care items, services, and treatment."

In other words, the HMOs would be limited to 15 percent of the premiums paid for the administration of the managed care programs and their profit. HR.2359 was killed in the normal Republican killing grounds for such PROFIT-KILLING legislation on September 14th (the House Ways and Means Committee), and September 15th (the House Commerce Committee).

By September 1996, complaints were flowing into Congress on the abuse of patients receiving medical treatment at hospitals under the control of HMOs and health insurance companies. The reports of abuse included, but were not limited to, the following:

1. The treatment of patients in hospitals by untrained or improperly-trained personnel on the grounds of cost savings.

2. Gag orders and the threat to fire doctors and other health care providers who advised a patient that they needed medical treatments beyond those approved by the HMO or health plan.

3. Improper health incentives -- providing incentives to doctors and other health care providers for saving money in the treatment of a patient even if the treatment was medically needed.

4. Denying medical services because a patient did not meet ill-defined criteria established by the HMO or heath plan.

5. Denying medical services without an initial physical examination.

6. Punitive actions against health care providers who inform a hospital, HMO or health plan of potentially dangerous conditions in the medical treatment programs prescribed by these organizations. (See 1. above).

On September 28th, 1996, Representative Major Owens (D-NY) and nine other Democratic Representatives introduced HR.4315, the Patient and Health Care Provider Protection Act of 1996. HR.4315 prohibited all six of the practices described above, and further directed the Secretary of Health and Human Services to establish in each state an Office of Consumer Advocacy for Health to protect health consumers in each state and for the redress of medical grievances.

In introducing his bill, Representative Owens noted that "As a part of the transformation to remain competitive and save money, hospitals are replacing nurses with lesser-trained, lower-paid aides. Recent reports have noted that this de-skilling of America's hospitals has had an adverse and even fatal effect on unsuspecting patients. My proposal, the Patient and Health Care Provider Protection Act would ensure that patients, as well as nurses, aides, and doctors are armed with the adequate weaponry to fight the hazards associated with the restructuring of the health care industry."

[He continued] "Finally, the Patient and Health Care Provider Protection Act would outlaw the gag order on nurses and doctors who must be free to communicate effectively with their patients. This bill contains strong whistle blower protections that prohibit the discharge, demotion, or harassment of any nurse, doctor, or other health care professionals who assist in an investigation of his or her employer."

b HR.4315 was killed in the usual Republican-controlled sub-committees of the House Commerce Committee and the House Ways and Means Committee on September 30th, 1996.

HR.1191 of March 20, 1997 was the third attempt by the House Democrats and Bernie Sanders of Vermont to correct the abuses in the Brave New World of Medical Care in the United States.

HR.1191 -- The Patient and Health Care Provider Protection Act of 1997 addressed the same abuses that had been addressed in HR.4315, the 1996 proposed law killed by the Republicans. It also directed that each health plan establish and maintain an "Independent Consumer Advisory" committee in each community to ensure that HMO and health plan members could have their medical grievances quickly addressed. It further directed the Secretary of Health and Human Services establish a network of "Independent Consumer Advocacy" offices in each state to make sure the HMOs, health plans, and health care providers were not exploiting the health care consumers in those states. HR.1191 was killed in the usual Republican-controlled House Committees on March 20th and April 4th, 1997.

By the summer and fall of 1997, the Democrats were developing comprehensive legislation on the subject of the rights of Americans in the new corporatized health care system. This legislation was based upon the growing number of reports of the abuses of the system by the HMOs, the health insurance industry, and, in a few cases, by the health providers themselves. As we will see, from early 1998 to the present time -- November 2000 -- the Democrats made repeated attempts to get a STRONG Patients' Bill of Rights made into law. In late 1999, again as we shall see, the House Democrats were joined by a group of about thirty Republicans, and were able to get a STRONG bill passed in the House. It was then stopped by the Republican majority in the Senate. We still do not have a STRONG Patients' Bill of Rights.

Below is a summary of the features of a STRONG Patients' Bill of Rights that I have been able to extract from remarks in the Congressional Record and from the laws themselves that the Mainstream Media, for some reason, has TOTALLY IGNORED over the past five years. Some of these features are from 1995, others from 1996 and 1997, still others were incorporated during the UNREPORTED legislative battles in 1998, 1999, and the months leading up to November 2000.

1. The right to be treated by properly-trained medical personnel

2. The right to be informed of all of their medical options--not just the cheapest medical options approved by the HMOs and health plans.

3. The right to go to an emergency room and to be treated there.

4. The right to see a medical specialist when they need to.

5. The right to take their children to a pediatric specialist when they need to.

6. The right NOT to be denied medical treatment without an initial physical examination.

7. The right NOT to be denied medical treatment because of ill-defined criteria established by the HMO or health insurer.

8. The right of transportability of medical care. A patient being treated for an illness or a pregnant woman has the right to stay with their own doctor, even if an employer changes health plans.

9. The right of medical accountability. This is the right to hold HMOs and health insurers accountable for their decisions. If an HMO or insurer refuses to cover a prescription or procedure, patients have a right to immediately appeal that decision to an independent third-party.

10. The right to sue. If a patient suffers serious harm as a result of an HMO or health insurer's decision to delay or deny needed care, that patient has the right to sue their HMO or insurer.

11. The right NOT to be treated by health providers who are offered incentives to recommend cheap medical options to save the HMO or insurer money, particularly if the disallowed options are actually medically necessary.

1. The right NOT to be gagged by HMOs and health insurers or to be threatened with firing if they recommend medical treatments beyond those approved by the HMO or health insurer.

2. The right NOT to be threatened with punitive actions if they inform a hospital, HMO or health insurer of dangerous conditions in medical treatment programs prescribed by those organizations.

1. Insure that participating doctors and pharmacists are involved in developing that formulary.

2. Disclose to providers, and upon request, disclose to the HMO and other health plan members full information on formulary restrictions.

3. Provide for exceptions to the formulary restrictions if a non-formulary alternative is medically needed.

Because there was only sporadic reporting in the Mainstream Media of the increasing number of abuses of Americans by their HMOS, health insurers and health care providers, most Americans were not aware of this growing national problem because they were not informed. In our Orwellian world of modern journalism, if something is not reported, it does not exist. Besides, this kind of information is bad for business. All those health care industry advertising dollars, you see.

Profit-optimizing techniques were being developed and then widely replicated throughout the corporatized health care industry. For example, the HMOs and health plans had established lists of approved providers. If a member of an HMO or health plan went to a non-approved provider, for whatever reason -- traveling outside the service area, for example, -- the member would have to pay a much higher cost for this service -- no exceptions allowed. Pre-existing medical conditions were used as an excuse not to enroll a person in an HMO or health care plan or to hit them with massive increases in premiums to maintain corporate profitability.

But information on these abuses was flowing into Congress. During 1998, the Democrats made six attempts to get a STRONG Patients' Bill of Rights passed, and were now being joined by a small number of Republicans (mostly ex-doctors and ex-dentists) in the House.

On March 31 1998, three bills were introduced in the Congress, all three bearing the same title, "The Patients' Bill of Rights Act of 1998." HR.3605 in the House has 194 co-sponsors, including three or four Republicans. Because of the different rules in the Senate, two bills, S.1890 and S.1891, had to be proposed, one to amend the IRS code and the other to change the Health Service Act and the ERISA Act; both had 32 co-sponsors, all Democrats. HR.3605 was killed in the usual House committees on April 13th and May 5th, 1998. S.1890 and S.1891 were effectively killed on the day they were introduced.

Senator Kennedy (D-MA), proposed an amendment on March 31st to a Senate Continuing Resolution that began with the following set of proposed "findings" on the enactment of a patient's bill of rights.

"(1) patients lack reliable information about health plans and the quality of care that health plans provide;

(2) experts agree that the quality of health care can be substantially improved, resulting in less illness and less premature death;

(3) some managed care plans have created obstacles for patients who need to see specialists on an ongoing basis and have required that women get permission from their primary care physician before seeing a gynecologist;

(4) a majority of consumers believe that health plans compromise their quality of care to save money;

(5) Federal preemption under the Employee Retirement Income Security Act of 1974 prevents States from enforcing protections for the 125,000,000 workers and their families receiving health insurance through employment-based group health plans; and

(6) the Advisory Commission on Consumer Protection and Quality in the Health Care Industry has unanimously recommended a patient bill of rights to protect patients against abuses by health plan and health insurance issuers."

The Kennedy amendment was tabled (killed) in Senate Roll Call Vote 73 on April 2, 1998 by a vote of 51 YEAS (51R) to 47 NAYS (3R, 44D). Of the 54 Republicans voting, 51 (94.5%) voted AGAINST and 3 (5.5%) FOR the Kennedy amendment. Of the 44 Democrats voting, 44 (100%) voted FOR the Kennedy amendment.

In July 1998, Representative Dingell proposed an amendment to HR.4250 which included the full text of his HR.3605, "the Patients' Bill of Rights of 1998" In House Roll Call vote 336 on July 24th, 1998, the Dingell amendment was voted down by a vote 212 AYES (10R, 201D, 1I) to 217 NAYS (217R). Of the 227 Republicans voting, 217 (96%) voted AGAINST the Dingell amendment. Of the 201 Democrats voting, 201 (100%) voted for the Dingell amendment.

On September 29th, Senator Daschle and Senator Kennedy made the sixth and last attempt in 1998 to get a "Patients' Bill of Rights of 1998" before the Senate. S.2529 died quietly on October 2, 1998.

The 1999 legislative year began with three Democratic attempts to get a STRONG Patients' Bill of Rights through the House. On January 19th, 1999, HR.358 was introduced in the House by Representative Dingell and S.6 and S.240 were introduced in the Senate by Senator Daschle. S.240 was killed on January 19th, HR.358 on February 24th, and S.6 on March 11th.

On July 8th, Senate Majority Leader Trent Lott introduced S.1344 "to protect consumers in managed care plans and other health coverage." On July 13th, Senator Robb (D-VA) proposed an amendment to provide additional coverage for breast cancer, access for appropriate obstetrical and gynecological care, and to accelerate the deductibility of health insurance for the self-employed. This was voted down in Senate Roll Call Vote 198 by a vote of 48 AYES (3R, 45D) to 52 NAYS (52R). Of the 55 Republicans voting, 52 (94.5%) voted AGAINST, and 3 (5.5%) voted FOR the Robb amendment. Of the 45 Democrats voting, all voted for the Robb amendment.

On July 14th, in Senate Roll Call Vote 204, the Senate voted down a Kennedy amendment to "ensure that the protections provided for in the Patient's Bill of Rights apply to all patients with private health insurance" by a vote 48 AYES (2R, 46D) to 52 NAYS (52R). Of the 54 Republicans voting, 52 (96%) voted AGAINST, and 2 (4%) voted FOR the Kennedy amendment. Of the 46 Democrats voting, 46 (100%) voted for the Kennedy amendment.

Later that day, in Senate Roll Call Vote 205, the Senate voted down a Kennedy amendment to provide for access to specialty care by a vote of 47 AYES (1R, 46D) to 53 NAYS (53R). Of the 54 Republicans voting, 53 (98%) voted AGAINST, and 1 (2%) voted FOR the Kennedy amendment. Of the 46 Democrats voting, 46 (100%) voted FOR the Kennedy amendment.

In August, Republican Representative Norwood of Georgia and Democratic Representative Dingell of Michigan jointly introduced HR.2723, the Norwood-Dingell "Bipartisan Consensus Managed Care Improvement Act of 1999" -- essentially the STRONG Patients' Bill of Rights of 1999. In October, the Democrats and a rump group of Republicans led by Norwood beat back three amendments proposed by the Republican leadership in the House to emasculate HR.2723. HR.2723 was then incorporated into a much weaker Republican bill, HR.2990. On October 7th, 1999, HR.2990, a STRONG Patients' Bill of Rights, was passed in House Roll Call Vote 490 by a vote of 275 AYES (68R, 206D, 1I) to 151 NAYS (149R, 2D). Of the 217 Republicans voting, 149 (69%) voted AGAINST a STRONG Patients' Bill of Rights and 68 (31%) voted FOR it. Of the 208 Democrats voting, 206 (99%) voted FOR, and 2 (1%) voted AGAINST a STRONG Patients' Bill of Rights.

On October 14th, the bill went to the Senate which then struck all of the language of HR.2990 and substituted the language of the much weaker S.1344. The bill then went to a Senate-House conference for reconciliation between the HR.2990 and S.1344. On November 3rd, Representative Dingell proposed that the House conferees be instructed to to insist "on the provisions of the bipartisan Consensus Managed Care Improvement Act of 1999," and this was agreed to in House Roll Call Vote 558 by a vote of 257 AYES (52R, 204D) to 167 NAYS (165R, 2D). Of the 217 Republicans voting, 165 (76%) voted AGAINST the Bipartisan Consensus Managed Care Improvement Act of 1999, and 52 (24%) voted FOR it. Together with the 204 Democratic votes, the House stood for a STRONG Patients' Bill of Rights.

And that is where the action on the Norwood-Dingell bill ended until February 2000.

On June 29th, 2000, the Republican majority in the Senate voted down Senator Dorgan's (D-ND) amendment to the 2001 appropriations bill for the HHS, which proposed adding "all of the American people with private health insurance, rather than just the 48 million Americans proposed to be covered in the Republican Patients' Bill of Rights." He continued: "We believe the Patients' Bill of Rights should cover all 161 million Americans in private health insurance plans, including the 75 million people whose employers provide coverage through an HMO or private insurance." In his remarks introducing the amendment, Senator Dorgan provided a short history of the Norwood-Dingell "bipartisan Consensus Managed Care Improvement Act of 1999" the Republican leadership had short-stopped in the Congress. Dorgan said:

"The Senate passed a piece of legislation last year that was called the Patients' Bill of Rights. Some of us called it a patients' bill of goods because it was a relatively empty shell. The House passed a Patients' Bill of Rights that is a good bill. It is a bipartisan bill sponsored by Republican Congressman Norwood and Democratic Congressman Dingell. It passed by a 275-151 vote. Since that time, the Senate appointed a set of conferees on October 15, and the House appointed its conferees on November 3. It wasn't until the end of February that there was a meeting of the conference committee. As I said previously, the conference committee isn't making much progress." [Remember, he said this at the end of June of this year.]

(1) On February 1st, the Democrats once more were able to get a House vote instructing the conferees to the Senate-House conference to insist on the provisions of the Norwood-Dingell bill. In House Roll Call Six, this was approved on a vote of 207 AYES (6R, 200D, 1 I) TO 175 NAYS (173R, 1D, 1I) with a bloc of 28 Republicans led by Norwood voting PRESENT. Thus 34 (16.43%) Republicans of the 207 Republicans voting, effectively voted FOR the Norwood-Dingell bill, and 173 (83.57%) voted AGAINST. Of the 201 Democrats voting, 200 (99.5%) voted FOR the bill.

(2 and 3) On June 14th, the Democrats made two last attempts in the House to amend the appropriations bill for the Department of Health and Human Service to incorporate additional rights for patients of the HMOs and health plans into law. In House Roll Call Vote 272, on a motion to recommit HR 4577, the Democrats lost on a vote of 212 AYES (3R, 208D, 1 I) to 219 NAYS (217R, 1D, 1 I). In House Roll Call Vote 273, HR.4577 was passed without the Democratic changes in vote of 217 AYES (213R, 3D, 1I) to 214 NAYS (7R, 206D, 1I). A change of just two votes would have stopped the bill.

(4) On June 29th, the Dorgan amendment was defeated in Senate Roll Call vote 167 by vote of 47 AYES (3R, 44D) to 51 NAYS (51R). Republican Senators Fitzgerald of Illinois, McCain of Arizona and Specter of Pennsylvania voted with all of the Democrats voting.

(5 and 6) On September 15th,2000, Senator Kennedy (D-MA) introduced S.3057 and S.3058, the STRONG Patients Bill of Rights Act of 2000. No action by the Republican-controlled Senate has been taken on these bills.