The Terms of The Great Debate: Bush vs. Webster's
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Jul 27, 2001

The Terms of The Great Debate: Bush vs. Webster's

by Jamie Court
When Ari Fliescher, the White House Press Secretary, said recently, "The President wants to work with Congress on specific terms of the Patients' Bill of Rights," he was not talking simply about making policy but changing vocabulary.

Thursday, at President Bush's request, Republican leaders of the House of Representatives prevented a floor vote on a bi-partisan patients' rights bill because of a failure to agree not on principles but definitions. Everyone in Washington DC, including the HMO industry, supports the "Patients Bill Of Rights" in principle, even the controversial "right to sue." The question is what do those words mean.

"Political speaking and writing is largely a defense of the indefensible," George Orwell wrote."Political language -- and with variations this is true of all political parties, from conservative to anarchists -- is designed to make lies sound truthful and murder respectable, and to give an appearance of solidity to pure wind." In the patients' rights debate, a bi-partisan majority in both the House and Senate has passed the same patients' rights bill of rights, only in different legislative sessions or the bill would now be on Bush's desk. (The Senate by a vote of 59-36 this year and the House 275-161 in 1999.) Remarkably, there is general agreement on terms between politicians of the two parties.

The battle for HMO reform has now boiled down to a debate not between Republicans and Democrats but between President Bush and Webster's dictionary. The lives, health and safety of over 200 million patients will be determined by President Bush's understanding of these key words.
  • Bipartisan: Does this mean "supported by two parties," (Webster's) or "whatever the President dictates for his political party." (Bush)

  • Cost of health insurance: Is this "the amount of money asked or paid" for health insurance (Webster's), which the Congressional Budget Office says will be very minimally effected by a extending a full right to sue to patients, a few dimes difference in health premiums each month? Or is it "whatever the HMO industry says it will be, which will be an astronomical increase that creates more uninsured if patients can hold their HMO fully accountable in court." (Bush)

  • Employers: Are they all those who "employ others for wages and salaries," and have been increasingly paying greater health premiums for less healthcare benefits? Or are they "the insurance companies, HMOs and some large employers ---members of the pro-HMO Health Benefits Coalition" that have contributed $14 million in campaign contributions to the Republican Party and its candidates from 1995 to 2000

  • GOP: "Grand Old Party," as in Lincoln's, or "Graft Over Patients," as in Bush's.

  • Independent Review: Does independent mean doctors deciding appeals of HMO patients who are "free from the influence or control of others" or doctors who "are picked by the HMO and follow a definition of 'medical necessity' determined by the HMO."

  • Medical Necessity: "What independent doctors say it is," or "What HMOs say it is."

  • Right To Sue: "Legal recourse for harms" vs. "Legal recourse for harms so long as there are strict limits on how much an individual can collect from an HMO no matter how egregious the conduct or serious the injury."

  • States' Rights: "The right of states to jurisdiction over issues not enumerated in the U.S. constitution," including legal accountability for HMOs. Or "a principle favored by Republicans unless a cash-rich industry like the HMOs' is endangered by it, in which case all HMO lawsuits should be put in overcrowded federal courts."

  • The Texas Law: Is it "one of the first patients' bill of rights, praised by Bush in his campaign for the White House, that included a right to sue without limit as to how much a patient can be compensated for their injury, but with a $750,000 limit on punitive damages?" Or is it " a model for the nation, but one that needs to be adjusted to limit compensatory damages so that a patient cannot recover more than $500,000 for their pain and suffering, and no punitive damages"?

  • Trial Lawyers: "One whose profession is advising others in matters of law or representing them in lawsuits," and so work for both the HMOs and patients? Or "those greedy, ambulance chasers who want only money not justice or representation for their client, unnecessary in life's scheme because HMO lawyers are so much better behaved that they deal faithfully with patients?" "They dispense justice" vs. "They drive up health care costs."

  • Uninsured: "Those without insurance who politicians care about all the time," or "those without insurance who a politician cares about when they want to veto a bill opposed by the insurance industry and need an excuse."

Jamie Court is executive director of the Santa Monica-based Foundation for Taxpayer and Consumer Rights and co-author of Making A Killing: HMOs and the Threat To Your Health.

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