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Recently in Salon Health & Body

Column
Lift those weights!
Kegeling promises to help prevent incontinence and "enhance physical intimacy."  
By Mary Roach
[07/16/99]

Spin doctoring
Expectations about your health or illness can cause reality to follow suit.
By Susan McCarthy
[07/15/99]

Urge
Nancy Chan: Diary of a Manhattan call girl
About the story and list of characters.
By Tracy Quan
[07/15/99]

Urge
Episode 2: The just-in-time orgasm
When love is your business, pleasure takes a serious toll.
By Tracy Quan
[07/15/99]

A thing of beauty
Should we flush our colons or leave them alone?
By Jon Bowen
[07/14/99]

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An outgoing woman in her late 40s, Casey owns a Parcel Plus business outside Baltimore with her husband Dave and is plagued by medical debts. Her sons were in car and bike accidents several years ago and she's still paying off their hospital bills. Dave got colon cancer last year and is still paying his bills. They pay $300 a month with a $1500 deductible for their insurance. So, when a trade group invited Casey to speak in Congress for holding down health-care costs, she said sure.

At a GOP news conference, she and two other small-business owners declared that increased premiums could sink their livelihoods. Senator Don Nickles, R-Okla., the slick floor leader in the health-care debate, put their remarks in perspective. "We're protecting the unprotected," he said. "These people are saying, 'Don't make it more expensive to stay in business.' They're saying, 'Government knows best is a bad idea.'"

By the time the conference ended, though, Casey was having second thoughts, and by the time the Senate passed a Republican bill, she was heartsick. "I guess I thought I was testifying about how important it was to keep insurance costs down, not to be a mouthpiece saying, 'Theirs is bad and ours is good,'" she said. What she really wanted went beyond what either party offered. "I think there should be affordable care for everyone. When I was growing up my father was in the military and we got great care. I guess that was socialism, but it was medicine."

This week Congress seriously discussed managed care for the first time in the decade since HMOs began metastasizing across the U.S. landscape. The Democrats, led by Minority Leader Tom Daschle of South Dakota and Edward Kennedy of Massachusetts, used a procedural tactic to force the Republicans to hold a debate on their proposals for reining in the worst abuses of managed care. It looked like savvy politics, and maybe something nobler, given how much fear and loathing health care inspires in Americans. But none of it got the country closer to what Casey and what most other Americans say they want.

The Patients Bill of Rights that Kennedy brought to the Senate was intended to reassert the primacy of the patient-doctor relationship. It guaranteed patients the right to see specialists and get the treatments their doctors order, to keep their doctors when their companies change health plans, to see an OB/Gyn or rush to an emergency room without getting permission from an HMO, and to sue, if necessary, when a health plan's refusal of coverage has led to injury or death.

The Republicans brought forth a dim reflection of the Democratic version and called it Patients Rights Plus -- the plus being various tax incentives. The GOP measure applied to the 48 million Americans covered by self-insured plans, which typically are offered by large corporations, and left in the hands of state legislators the reform of plans covering an additional 112 million Americans. The GOP spin was that their bill would be cheaper to implement, and thus prevent premiums from skyrocketing and companies from dumping coverage. The GOP said that liability would jack up prices and bring nasty lawyers swaggering into the pristine world of medicine. "You can't sue your way to good health," said Vermont Republican Senator Jim Jeffords.

Kennedy, red-faced and ornery, chuffed and shouted his way through the week. "The current GOP bill is a sham, a step back," he said. "It gives a false sense of security, it isn't worth the paper it's printed on."

Scores of patient-advocate and medical-professional groups -- nearly everyone in health care except those who control it --backed Kennedy's bill. The health-insurance and business lobbies supported the Republican bill. The insurance industry is said to have spent $100 million lobbying against managed-care reform in the past several months -- a modest slice of the $1.5 billion in profits reported by the five largest health insurers last year.

Next page | "I'm willing to die for my country, but not for my insurance company."