July 22, 1998
Let me share three stories with you -- stories my husband heard at a
recent roundtable on health care. They help explain why he wants
Congress to pass the Patients' Bill of Rights.
Mary Kuhl described the night she and her husband Buddy celebrated their
25th wedding anniversary the same night Buddy suffered a massive heart
attack. His doctor diagnosed ventricular tachycardia, but assured the
Kuhls that surgery could correct the problem.
Buddy's doctor recommended immediate surgery, but his HMO canceled the
procedure, demanding a second opinion. The second doctor concurred with
the first and immediately called the HMO with his opinion.
But by the time Buddy checked in for surgery, his condition had
deteriorated to the point where the doctors could no longer perform the
procedure. Buddy died waiting for a heart transplant. He was 45.
Barbara Garvey's husband, David, remembered the call he received from
Hawaii, where his wife was vacationing. She had noticed some unusual
bleeding and, after undergoing blood work at a local clinic, doctors
discovered aplastic anemia and recommended a bone marrow transplant.
Unfortunately, her HMO demanded that she return to Chicago for the
procedure, even though her doctors argued that she was in no condition to
fly. En route, she suffered a stroke and died nine days later. The mother
of seven children, Barbara was 55.
Shortly after giving birth at age 38, Rhonda Bast discovered a lump in
her breast. Her brother Mick explained that, after a mastectomy and
chemotherapy, the cancer had spread to her lungs. Doctors recommended a
bone marrow transplant, but her insurance carrier said they did not cover
this kind of treatment.
After doggedly pursuing the issue, Rhonda's family discovered that her
policy did cover bone marrow transplants. By then, tragically, Rhonda's
cancer had spread to her brain, and she was no longer a suitable
candidate. She died 10 months later.
It is not easy for family members to tell these stories or for us to hear
them. But they help explain why 60 percent of all Americans say they are
worried that if they become sick, their health plan will be more
concerned with saving money than with giving them the best care.
In this country, 160 million people are covered by managed care health
plans, an increase of 75 percent since 1990. Managed care plans can make
health insurance more affordable and more accessible. But there is
something wrong with a system in which a doctor can spend countless hours
on the phone arguing for a lifesaving procedure, can spend more time with
bookkeepers than with patients and can spend more time filling out forms
than making rounds. And there is something wrong with a system where a
clerk with a checklist makes decisions about what medical treatment a
patient will receive.
Imagine how Carol Anderson feels. She works as the billing manager in an
oncologist's office and says the hardest part of her job is "facing a
patient and telling them your insurance plan has told us that you're
denied coverage ... Just like that. If you don't have cash, we can't
This is why, for the last nine months, the President has been urging
Congress to pass legislation that would protect the relationship between
Americans and their doctors. And, this is why the American Medical
Association has made the Patients' Bill of Rights their top priority.
The Patients' Bill of Rights would guarantee access to needed health care
specialists and emergency room services. It would promise continuity of
care, a timely and independent appeals process and limits on financial
incentives that encourage doctors to limit care. It would ensure full
disclosure of treatment options, direct access for women to OB-GYNs and
an enforcement mechanism that would hold a health plan accountable if a
patient is maimed or dies as a result of its actions.
Now, with fewer than 40 days left in this Congressional session,
Republicans have outlined their own "Bill of Rights." Unfortunately,
their plan would not guarantee access to specialists, such as oncologists
and cardiologists, require disclosure of financial incentives to doctors
who limit treatment or adequately compensate those who suffer serious
harm. And, the Senate Republican plan leaves out 100 million Americans
who need these protections.
The health of our citizens should not be a partisan issue. Whether it's
traditional care or managed care, Americans deserve quality care. Buddy
Kuhl deserved quality care. Barbara Garvey deserved quality care. And,
Rhonda Bast deserved quality care.
This country is capable of providing the highest-quality health care in
the world. Congress should put politics aside and pass a strong,
enforceable and bipartisan Patients' Bill or Rights to give all Americans
confidence in their health care system and patients the protections they
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