Bush's take on patient protection goes beyond Texas bragging
AUSTIN -- Oh, come now, Gov. Bush. None of us minds a little
exaggeration, a little polishing of the positive when it comes to
your record here in Texas. But now it's "liar, liar, pants on fire."
Your nose is growing, Governor.
George W. Bush is now running a TV ad around the country that
claims: "While Washington was deadlocked, he passed a patients'
bill of rights. Under Gov. Bush, Texas enacted some of the most
comprehensive patient protection laws in the nation."
Excuse me, but if anyone is interested in the truth, George Dubya
vetoed the patients' bill of rights in Texas when it was first
passed by the legislators in 1995; and when they passed it again,
over his opposition, by a veto-proof majority in 1997, he
threatened to veto it again and then let it become law without his
signature because a veto wouldn't hold.
He never even signed the patients' bill of rights, and you can look
it up. Claiming that "he passed" or "delivered" the patients' bill of
rights is turning the truth on its head.
Let us return to those thrilling days of yesteryear in the 74th and
75th sessions of the Texas Lege.
As you recall, Bush's sole legitimate claim to be a "reformer with
results" rests entirely on "tort reform," if you happen to consider
that reform.
The package of bills called "tort reform," passed in 1995 with
Bush's strong support, makes it much, much more difficult to sue
corporations for almost any variety of misfeasance, malfeasance
or nonfeasance. Of course Bush was opposed to letting patients
sue HMOs. As he said repeatedly, he wanted "to make sure we
don't create more reasons for lawsuits."
The first version of the patients' bill of rights passed in 1995 for
the following quaint reason: In Texas, the doctors' lobby has more
clout than the health insurance lobby.
The doctors were unhappy with HMOs, both on their own behalf
and on behalf of their patients. Two weeks after his maiden
session of the Lege was over, Bush vetoed a bill by Sen. David
Sibley, R-Waco. Bush vetoed the Patient Protection Act that
would have allowed patients greater freedom in choosing
health-care providers and allowed doctors more latitude in
prescribing treatment.
In 1997, there was a happy harmonic convergence of political
forces. Lt. Gov. Bob Bullock (remember, in Texas the lite guv has
more power than the guv) had appointed a special interim
committee to study the growing problem of patients being
extremely unhappy with their HMOs.
Bullock named Sibley -- the only member of the Lege who
happens to be both a doctor (oral surgeon) and a lawyer -- as
chairman of the interim committee. The R's on the committee,
most notably Sibley and Sen. Chris Harris of Arlington, led the
charge on patient protection.
They took the ball that Bullock handed them and ran with it. They
listened to all the witnesses who came to complain about lousy
treatment from their HMOs and were outraged.
The interim committee came up with six pieces of legislation that
came to be called the patients' bill of rights. The most
controversial was holding HMOs legally responsible for injuries
caused if they deny or delay payment for needed medical
treatment.
The other parts of the package were:
* A report card allowing consumers to compare health-care plans.
* Repeal of the "gag rules" so that doctors can freely inform
patients of treatment options without fear of reprisals from the
HMOs.
* More stringent protection for the confidentiality of patient
records.
* Requiring that managed-care officials who decide what care
would be covered must be licensed physicians, nurses or
physician assistants.
* Prohibition of retaliation against patients or doctors who file
reasonable complaints.
* Calls for a "prudent layperson" definition of emergency care.
* Terms stating that patients could not be forced to pay for
services that are covered under a plan, even if the HMO fails to
pay.
Of course, the HMOs all screamed and yelled and claimed that
costs would go through the ceiling and that floods of lawsuits
would result.
They were particularly frantic about the possibility of legal
liability, and they proposed instead that there be an "independent
review" of denials of care. Except, naturally, in the HMO version,
the review would not have been independent -- the HMOs would
choose who did the review.
Instead of getting into a bloody battle over legal liability vs.
"independent review," the reformers said calmly: "Why not do
both? We'll take it." And so they did. They put a truly
independent review in place to deal with patient complaints, and
that has solved almost all the problems, and they put in the
option to sue, too. Last time I checked, exactly two lawsuits had
been filed in the three years since.
From state newspapers during that battle:
* `The Dallas Morning News,' Feb. 19, 1997: "Steve Montgomery,
manager of government affairs for Harris Methodist (HMO) said
HMOs still have Gov. George Bush in their corner but are not
counting on his support since he has not taken an official stance
on the issue."
* `Austin American Statesman,' May 11: "A battle over lawsuits
against managed care organizations for treatment decisions that
harm patients has prompted two Republican lawmakers [Sibley
and Harris] to take on GOP Gov. George W. Bush's office. . . .
Bush has supported the idea of an independent review of the
insurers' decisions. But a proposal to establish such a procedure
was voted down 120-21 in the House. . . .
"Republican Sens. David Sibley of Waco and Chris Harris of
Arlington accused a Bush staffer of working against the bill when
an effort to win final approval for it was sidetracked Saturday. `I
can't make some staff member in the governor's office happy, and
I can't make them happy no matter what I do, unless I completely
gut the bill,' said Sibley. . . .
"Vance McMahon, Bush's policy director, has been dealing with
lawmakers on the issue and represents Bush's wishes, said Bush
spokeswoman Karen Hughes. `The governor is concerned about
opening a Pandora's box of new lawsuits,' Hughes said. . . .
Hughes said Bush hasn't decided whether he would sign or veto
the bill if it reaches his desk."
And this is the guy now claiming he "passed" the patients' bill of
rights?
Molly Ivins is a columnist for the `Star-Telegram.' You can reach
her at 1005 Congress Ave., Suite 920, Austin, TX 78701; (512)
476-8908; or send comments to mollyivins@star-telegram.com