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 treat you."
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 deserve.
COPYRIGHT 1998 CREATORS SYNDICATE, INC.
ALL RIGHTS RESERVED
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