Patients' patron saint, or devil?

Published June 27, 2001 10:59PM (EDT)

Wordplay: Did Bush sign or not?

President Bush has always tried to give the impression that he supported an HMO patients' bill of rights while Texas governor. The truth is somewhat more complex that that, but Bush has always been careful to couch his language. He has always been factually correct -- if a tad wormy -- when discussing the right-to-sue bill that he vetoed in 1995 and then allowed to become law without his signature when presented with a veto-proof majority in 1997.

The language he uses, however, is frequently subject to parsing, as exemplified at a press availability Wednesday afternoon in the Cabinet Room. There Bush sat with members of the House who support a more conservative patients' bill of rights that Bush favors, a rival to the one offered by Reps. Greg Ganske, R-Iowa, and John Dingell, D-Mich.

"I realize there are some complaints with HMOs," Bush said. "I signed legislation in Texas that dealt with those complaints. I look forward to signing legislation here that does just that. And the bill we discussed around this table is a piece of legislation that I will sign."

In actuality, Bush signed legislation in Texas that dealt with some complaints about HMOs. But the sticking point on this issue has long been whether or not a patient has the right to sue an HMO for medical coverage that was denied and ended up adversely affecting the patient's life or health.

Advocates for a patients' bill of rights -- like Ganske and Dingell -- have long argued that there is no reason why HMOs should be exempt from lawsuits when doctors receive no such benefit. Moreover, they argue, HMOs only understand bottom-line considerations, so the threat of financial penalty is necessary in order for them to value life over pennies. Detractors like President Bush as well as Reps. Ernie Fletcher, R-Ky., and Colin Peterson, D-Minn., are concerned that such a law -- if not containing significant caps on punitive damages -- would create an even more litigation-slutty atmosphere, driving health care costs up astronomically.

So, bearing that in mind, was Bush being honest in his statement about having "signed" a Texas bill on HMO reform when he notably refused to sign the key HMO reform bill?

Maybe, says Ken Ortolon of the Texas Medical Association.

Ortolon clarifies: "It is true that, in 1997, the patient protections enacted in this state were enacted in a series of bills, and he signed all but one," Ortolon says. "The one he did not sign was whether or not Texans would have the right to sue their HMO. He did sign four or five other bills that contained other managed care reform provisions."

One Texas Senate bill that Bush did sign codified some Texas Department of Insurance consumer protection rules that, immediately after the 1995 veto, Bush had instructed his insurance commissioner to begin drafting. Another bill brought HMOs under the state Utilization Review Act. A third required the Office of Public Insurance Counsel to start making consumer report cards about HMOs.

But then, of course, there was the sticking point, Texas Senate bill 386, which holds HMOs and similar entities responsible for harm caused to patients when necessary and appropriate care is denied to them. So as to safeguard against the barrage of frivolous lawsuits Bush threatened would flood the state, an independent review board was established as the first step before an insurance company or HMO would be taken to court. But even with this safeguard added, Bush's legislative lobbyist -- Vance McMahan -- did everything he could to sabotage the bill, to the point that conservative Republican senators were complaining on the senate floor about being "stymied by the governor's staff ... at every juncture on this bill."

So was Bush being truthful?

"If he's saying he signed managed care reform legislation, that's true," Ortolon says. "If he's saying that he signed a bill that gave patients the right to sue their HMO, that's not true."

Democrats were quick to judge. "It's no wonder weekend polls show that the American people can't take Bush at his word and think the country's being run by special interests," said Jenny Backus, communications director for the Democratic Congressional Campaign Committee. "His use of half-truths and coy phraseology is designed to hide the fact that the HMOs and the insurance companies are making the calls in this administration."

-- Jake Tapper

Rant: We don't know Dick

Vice President Dick Cheney has gotten pretty far by simply seeming adult compared to the chronically impish boy president. He's been the blandly reassuring face of experience in the new administration, and his testy ticker and lesbian daughter have only helped to humanize him.

But Cheney's comparative free ride from the media may come to a screeching halt thanks to his refusal to turn over the list of people who met with his super-secret Energy Task Force, which is widely reported to include oil, nuclear and gas executives. Maybe he fears the list, which we already know is light on environmentalists, will simply fortify the idea that this administration is too industry-friendly. Maybe he thinks it's none of our business.

Cheney is right to be worried about growing concerns by the public, tracked by opinion polls, that the administration is too close to fatcats. And pro-business regulatory roll-backs, together with the investment hijinks of senior advisor Karl Rove and Treasury Secretary Paul O'Neill, haven't helped reassure people.

But does Cheney think forcing the General Accounting Office to file a civil action against the White House, which it says it will do if Cheney continues to stonewall, will be some kind of P.R. coup?

This week's controversy over disclosing the Energy Task Force meeting list comes on the heels of a disturbing report by the Washington Post that shows how Cheney hasn't told the full truth about whether the oil-field supply company he ran, Halliburton, did any business with Iraq despite a U.S. embargo. He denied it during the campaign, but the Post cites "oil industry executives and confidential United Nations records" which say that "Halliburton held stakes in two firms that signed contracts to sell more than $73 million in oil production equipment and spare parts to Iraq while Cheney was chairman and chief executive officer of the Dallas-based company."

Cheney's advisor, Mary Matalin, told the Post that "In a joint venture, he would not have reviewed all their existing contracts," and that "the nature of those joint ventures was that they had a separate governing structure, so he had no control over them."

But not having control over them is not a strong defense of his denial that they ever existed. Especially when Cheney -- who was Secretary of Defense during the Gulf War, and helped devise the anti-Iraq embargo --promised to maintain a hard line against Iraq when he went to Halliburton in 1995.

Whether Cheney is the real commander in chief or not, he surely is the most important partner to a president since a first-term Hillary Clinton. And he ought to know, even better than the first lady did, that the only response that works, in the face of an increasingly skeptical public, is transparency. If he doesn't, he should learn from the travails of Hillary's closed-door healthcare sessions, not to mention Clinton White House stonewalling on Travelgate and Whitewater. His image could turn from kindly elder statesman to the No. 1 threat to democracy faster than you can say Ira Magaziner.

-- Kerry Lauerman

Daily line

"I think it's fair to say that this week you will see the president step up his efforts in a variety of ways, including phone calls to the Hill, meetings that will take place here at the White House and in several other ways. The president is very concerned because he wants to have a bill that he can sign into law that gives patients those protections."
-- White House Press Secretary Ari Fleischer, describing the president's efforts to reach a compromise on the patients' bill of rights

Bush buzz

The president is sounding a lot more conciliatory on the patients' bill of rights, asking key Republican moderates who have been supportive of the bill to work for a compromise with Democrats on the legislation's thornier issues. Bush has also told House Republicans that he supports their version of the bill, which would allow patients to sue healthcare providers in state court, an element in the Senate version that Bush last week said would guarantee his veto.

This apparent change of heart came on a day when GOP opponents of the legislation failed to pass two amendments to the bill that would have exempted employers from lawsuits and sent the package back to committees for additional work. Democrats won significant crossover support in defeating both amendments, with six Republicans joining all the Democrats and lone independent Sen. Jim Jeffords of Vermont to kill the employer exemption amendment, and 12 Republicans, 48 Democrats and Jeffords standing against the other one. But questions about whether the bill ultimately helps patients or trial lawyers continue to divide the leadership of the parties.

Although the House is expected to be more consistent in its support of the Bush agenda, it embarrassed the boss on Tuesday with a vote to delay American compliance with a provision of the North American Free Trade Agreement. In a move that directly contradicts the president's position on the treaty, 82 Republicans joined 201 Democrats to block authorization for Mexican truckers to have unrestricted access to America's highways.

Bush is having better luck with his faith-based charity initiative. House Republicans support the president's revision of the plan that would force religious groups that receive federal funding to allow needy citizens to opt out of worship-related activity. The president hopes that this change will quiet critics who see the plan as compromising the division between church and state.

The president is also dealing with a division in the antiabortion community over funding of fetal stem cell research. Bush has leaned against federal support of research that uses human embryos, but some self-identified pro-life Republicans have joined many Democrats in affirming scientists' assertions that such research will speed development of cures for ailments like Parkinson' disease, cancer and spinal cord injuries. White House advisor Karl Rove has apparently warned Bush that allowing such research to go forward would jeopardize his standing among diehard abortion opponents and Catholic voters.

In other administration news, Senate Democrats have vowed to cooperate with the GOP to pass a $6.5 billion stopgap spending bill for the American military. This comes as Defense Secretary Donald Rumsfeld plans to ask for a cutback in the production of B-1 bombers. The move is not popular with lawmakers from either party whose constituents would lose jobs as a consequence of the cutback. The struggle is part of Rumsfeld's efforts to make the military a more effective fighting force, an objective that some critics believe conflicts with Bush's desire to limit federal spending.

The spending limits are an effort to pay for Bush's $1.35 trillion tax cut without chewing up the nation's budget surplus. But the Congressional Budget Office now reports that the tax cut has taken a big bite out of that money.

And don't miss the battle brewing between Senate Republicans and the former first lady over office space. Sen. Hillary Rodham Clinton, D-N.Y., was the only senator to get new offices after the Senate switched hands at the beginning of June. Connecticut Sen. Chris Dodd, a Democrat, is in charge of allocating offices, and says that Clinton's new digs are her due as a senator from a state the size of New York. Republicans charge that the office move is an indication of Clinton's hunger for power.

Wednesday schedule: Bush holds an afternoon meeting with Republican House leaders to discuss the patients' bill of rights. In the evening, he speaks at a dinner at the Washington Convention Center, a Republican fundraiser expected to net more than $15 million.

-- Alicia Montgomery

This day in Bush history

June 27, 1994: Two out-of-state newspapers took an interest in a tussle between Texas Gov. Ann Richards and her Republican challenger, George W. Bush. The Times of Albany and the Washington Times blasted Richards for warning girls in her state to work for a living instead of waiting for "Prince Charming" to support them. Columnists in both papers opined that Richards' statement was bigoted male bashing, agreeing with Bush's assertions that the remark didn't reflect Texas family values. "Our leaders should be building up the family, not tearing it down," Bush said. "We want our sons and daughters to look upon marriage as an equal partnership where -- contrary to the governor's assertion -- husbands and wives help and love each other.

Burning Bush

Links to the Web's best sites for hardcore Bush watchers.

Send scoops to bushed@salon.com.

Bushed! contributors: Eric Boehlert, Karen Croft, Gary Kamiya, Kerry Lauerman, Daryl Lindsey, Alicia Montgomery, Fiona Morgan, Scott Rosenberg, Jake Tapper, Joan Walsh, Anthony York

Take a look at the previous edition of Bushed!

By Salon Staff

MORE FROM Salon Staff

Related Topics ------------------------------------------

George W. Bush