A patients bill of rights did get introduced Tuesday by a bipartisan crew led by Sen. John McCain, R-Ariz., and its sponsors expect that they will even get the 60 votes necessary to avoid a filibuster in the Senate. And that's much to the chagrin of the White House, which had done its best to put the patients bill on ice, and almost succeeded.
On Monday, the White House summoned Rep. Charlie Norwood, R-Ga., who had helped draft the legislation last year, and another main supporter, Rep. Greg Ganske, R-Iowa, to meet with President Bush's advisors on healthcare, including Bush's deputy chief of staff for domestic policy, Josh Bolten; Ann Phelps, a former legislative aide to Sen. Bill Frist, R-Tenn. -- one of the only physicians in Congress who seems to have good feelings about HMOs -- and senior advisor Karl Rove, Mephistopheles to Bush's Faust.
During the three-hour meeting, Norwood and Ganske, a dentist and a reconstructive surgeon, were asked not to introduce their bill. The dentist reacted by extracting his spine from his body; the plastic surgeon, though, stood by the legislation, trying to put a pretty face on an ugly situation.
After the meeting, Norwood announced that this year he wouldn't introduce the bill, once commonly referred to as "Norwood-Dingell," after him and co-sponsor Rep. John Dingell, D-Mich. "Norwood says that while he fully supports the most recent bipartisan patients rights legislation," according to a Monday press release from Norwood's office, "he has chosen to give the new Bush administration more time to formulate their position on the issue before cosponsoring the new bill."
The latest incarnation of the bill -- "Ganske-Dingell," apparently -- would allow women to see obstetricians and gynecologists without prior approval, allow parents to list pediatricians as a child's primary-care provider and force HMOs to cover reasonable emergency room treatment without prior plan approval. To critics, the major snag consists of provisions that would lift federal restrictions preventing HMO patients from suing their providers over unfair coverage denials.
At Tuesday's press conference announcing the bill, Rep. Marion Berry, D-Ark., praised Ganske and the other Republicans for standing up against the GOP leadership "and now against their administration" for the HMO reform legislation. Ganske, however, was quick to take the microphone out of turn to correct Berry, saying, "We're not taking a position against the president."
But while the Bush White House and Norwood are claiming that the only friction is over the issue of timing, Ganske and his staff are well aware that that's just the first line of attack. So at the press conference -- featuring Ganske, McCain, Republican Sens. Lincoln Chaffee of Rhode Island and Arlen Specter of Pennsylvania, liberal icons Sen. Ted Kennedy, D-Mass., and Sen. Tom Harkin, D-Iowa, and moderate Democrats John Edwards of North Carolina and Bob Graham of Florida -- a document was distributed comparing the patient protections in Texas with the proposed Bipartisan Patient Protection Act.
"Frankly, I don't see a lot of differences between this and Texas law," McCain said.
Of course, that's almost beside the point. Despite his campaign rhetoric in favor of a patients bill of rights, Bush fought such a bill tooth and nail as Texas governor, vetoing a bill coauthored by Republican state Rep. John Smithee in 1995. He had his insurance commissioner draft into law some of the less controversial bits of the bill -- like letting women choose gynecologists as their primary-care doctors -- but constantly opposed a patient's right to sue an HMO over coverage denied that resulted in adverse health effects. Faced with a vetoproof majority in 1997, he had his legislative aide, Vance McMahan, do everything he could to sabotage the bill, to the point that Republican legislators complained on the floor of the Texas Senate. Then, faced with a vetoproof majority, Bush let the bill become law without his signature.
"I just want the people in the House and the Senate to know that I'm coming with a plan," Bush said Tuesday afternoon. "You heard me in the campaign several times talk about the fact that our legislation in Texas, our patients bill of rights in Texas, was a pretty strong piece of legislation. And one of the things I am concerned about is to make sure that the federal government law doesn't override what we did in our state."
Ganske, however, says that it was made fairly clear from his White House visit that Bush is not close to introducing a bill, that administration officials are "not exactly sure what they want to do on this issue." Since this bill passed the House last year, and seems to have the votes to do so in the Senate now, he wants to push forward, before it all gets buried in the partisan politics of the 2002 election cycle.
Norwood's press secretary, meanwhile, the normally aggressive John Stone, had bragged to reporters Friday that the bill had reached a filibuster-proof majority in the Senate: "We really feel comfortable we're there at the 60 [vote] mark," he said. Tuesday, Stone was uncharacteristically not returning reporters' phone calls.
Norwood had said in June, "Anything less than full protection for all patients cannot be taken seriously." Apparently he's now a bit more interested in protecting something else.
Norwood was not taking appointments Tuesday, even though his lobbying for the bill was one of the main reasons several Republican senators, including McCain, signed on to the bill last year.
Here is the diplomatic Ganske's take on the meeting, as he described it in a press conference on Tuesday: "The meeting was cordial. We are friends. I look forward to further discussions with them." More than that he will not say.
Ganske even defends the Bush White House. In an interview Tuesday afternoon, Ganske alluded to "very powerful, influential and wealthy organizations" -- the HMOs and big businesses that run their own health insurance plans -- that oppose the bill, ones that had already started moving against this bill.
When Salon asked, "So you're not just facing opposition from the White House, you're also being challenged by big special interests?" Ganske carefully replied, "I never said we were facing opposition from the White House."
In an aside, the Iowa surgeon, whose medical career was spent fixing up more than a few farmers' hand injuries, expresses amazement at how Gore mishandled this issue against Bush in the election. During the third "town meeting" debate, when a member of the audience lobbed Gore a softball -- "Why are the HMOs and insurance companies not held accountable for their decisions?" -- Gore whiffed, yapping annoyingly about the "Dingell-Norwood bill" (getting the names backward; the congressman from the majority party is the one who gets top billing). "Gore could have said, 'Governor Bush, two Republicans, Greg Ganske and Charlie Norwood, wrote that bill!'" Ganske said. "'Why don't you support your fellow Republicans?' But there he was, Mr. Partisan, Al Gore."
Despite Norwood's capitulation, there are some Republicans, like Ganske, who will not give in on this no matter how much they admire and support Bush. And politically, it's never a bad idea to be anti-HMOs, which have matured into full-fledged American black hats. (John Grisham's thriller "The Rainmaker," one of the first demonizations of HMOs, celebrates its fifth anniversary this month.)
On March 16, 1999, Ganske spoke on the House floor about an HMO claims reviewer named Linda Peeno who admitted that by denying a client a heart operation she "caused the death of a man" and "was rewarded for this" by her former employer. "It brought me an improved reputation in my job and contributed to my advancement afterwards."
Ganske also told the tale of 6-month-old James Adams, whose HMO sent him to an emergency room more than 70 miles away after he suffered a cardiac arrest in the middle of the night. "Due to a delay in treatment," Ganske said, "the doctors had to amputate both of his hands and both his feet because of the gangrene that resulted."
"Under federal law, that HMO which made that medical decision is liable for nothing," Ganske said.
Bush is a charming man with cute and funny nicknames for members of Congress. But surely he's concerned about his ability to counteract stories from Linda Penno and about James Adams. Which is why it was Rove's job to squash the bill. The only question is: Aside from Norwood, how many other members of Congress can Rove persuade to turn their heads and cough out their consciences?