Not long after Sen. Tom Daschle, D-S.D., became the new majority leader, he announced that the Senate would take up patients bill of rights legislation as soon as it finished hashing out an education bill, which could happen as soon as Thursday.
In the process, Daschle breathed new life into HMO reform, an issue wildly popular with voters and eagerly supported by both presidential campaigns last year, but one that, in recent months, seemed all but dead. The patients bill of rights -- which features the right to sue HMOs as its cornerstone -- has been the primary vehicle for healthcare reform in recent years, but no bill has been able to get through Congress. This year, Sens. Ted Kennedy, D-Mass., John Edwards, D-N.C., and John McCain, R-Ariz., sponsored and introduced a patients bill of rights law, but even that bipartisan effort has to be taken seriously in the bitterly divided Senate. Daschle said that after the education bill was completed, the Kennedy-Edwards-McCain bill would be priority No. 1.
Within hours of Daschle's announcement, positions were staked out and lines were drawn in the sand. And now, with House Republicans crafting their own alternative and the White House gearing up to oppose the Democrats as well as Bush-nemesis McCain, the patients bill of rights could prove to be the first true battle between the Bush administration and a newly aligned Congress.
By Friday, Daschle told reporters "we've compromised about as much as I think we possibly can" when it came to Republicans' chief concerns. On Sunday, White House Chief of Staff Andy Card returned the volley, appearing on the Fox News Channel to deride the bipartisan bill as "a trial lawyers' bill" that "should be changed" lest it receive President Bush's veto.
But Bush got bad news when Rep. Charlie Norwood, R-Ga., a chief Bush ally in the House, announced he would now shift his support back to the bipartisan Kennedy-Edwards-McCain bill, which is favored by most moderate Republicans and almost all Democrats.
Since February, Norwood had been meeting with Bush's healthcare advisors, including deputy chief of staff for domestic policy Josh Bolten, senior advisor Karl Rove and Ann Phelps, a former legislative aide to Sen. Bill Frist, R-Tenn.
Week after week the group met, ever since a February huddle with Rove and crew prompted Norwood to take his name off his own bill, which had been the House version of the Kennedy-Edwards-McCain legislation. Instead, Norwood sought to work with the White House on a bill the president wouldn't veto.
His Republican House colleague, and bill co-sponsor, plastic surgeon Rep. Greg Ganske of Iowa, had been summoned to the meeting as well. But Ganske rejected the White House's suggestion, soon introducing the bill with Rep. John Dingell, D-Mich.
But Norwood kept going, even though Bush had fought tooth and nail against a similar law when he was Texas governor, vetoing it in 1995 and then eventually letting it pass without his signature when he was faced with a veto-proof majority in 1997.
Then, as first reported in Salon, Frist, acting as Bush's liaison, told Edwards and Kennedy that he would be willing to negotiate with them on a bill, but not with McCain, their GOP partner.
But still, Norwood pursued his self-appointed role, trying to heal the breach between himself and the president who had once vetoed a patients bill of rights as governor.
"Charlie has taken a fair amount of criticism for this for simply working with the Bush folks," says Norwood aide John Stone. "He knew it was a long shot goal to try to negotiate this to begin with. But his concern was that we finally have support in the House and Senate for the bill and then it gets vetoed by President Bush and then we get no law." Having to wait until 2003 for a new Senate or until 2005 for a new president wasn't good enough, Stone says. "How many people will get hurt in the meantime by HMOs?"
But Bush and his advisors want the cap for punitive damages against HMOs to be $500,000. (The Kennedy-McCain version caps such damages at $5 million; Ganske's House bill has no cap.) Anything more they consider a gift to the trial lawyers, a Democrat-leaning niche Bush loathes even more than reporters. Norwood thinks the $500,000 figure is insulting, not to mention ineffective if the goal is to make HMOs value saving lives over saving pennies. Norwood also opposed the White House's insistence that the administration-backed bill supersede any state laws. But the White House wouldn't budge.
So Norwood gave up.
As for the White House, Stone says he didn't know "what their motive was," but that Bush envoys were unwilling to make the same type of concessions Norwood was prepared to make.
So last week, Stone sent out a memo on his boss's behalf to three dozen or so other members of Congress, as first reported in Roll Call, tartly announcing that Norwood had thrown his support back to the original bipartisan bill.
One of the reasons behind his memo, Stone says, is that the House Republican leadership has moved to propose an alternative bill, one more closely resembling the Bush-favored version -- complete with price caps -- introduced in the Senate.
With the anticipated support of the entire Senate Democratic caucus (with the exception of Sen. John Breaux, D-La.), along with the support of McCain and a few moderate Republicans, the Kennedy-Edwards-McCain team has more than enough votes to pass the more progressive bill, but they currently lack the 60 votes necessary to prevent a filibuster.
In the House, the prognosis for the patients bill of rights is questionable. The Norwood-Dingell bill passed by a vote of 275-151 in October 1999, with the support of 68 Republicans. However, with the House GOP leadership crafting its own bill, that support will likely diminish.
Asked for a prediction about the bill Friday, Daschle said: "I use this phrase too often, but I really believe it's true: Only the paranoid survive. And, you know, I'm adequately paranoid about our political future, I'm adequately paranoid about our current circumstances legislatively, and I'm certainly paranoid about the patients bill of rights."
But one Republican strategist sees a possible political reason for Daschle's pessimism. "It's unclear if it's in the interests of the Democrats to get something signed into law," says the strategist, who's directly involved with the issue and thinks there's room for compromise between the two camps. "The Republicans' blocking HMO reform is a good issue for Democrats to run on" for the midterm elections in 2002, not to mention Bush's reelection two years after that. In this scenario, a Bush veto might, for the Democrats, be just what the doctor ordered.