Diagnosis: Confusion

The Patients' Bill of Rights is a sure thing, but no one seems to know what it will do


Anyone who tells you that Republicans and Democrats are worlds apart on health care reform is obviously misinformed. On Tuesday morning, the warring factions staged simultaneous and nearby outdoor press conferences on Washington's topic du jour: the Patients' Bill of Rights. This legislation is supposed to guarantee great health care for the sad sacks stuck in HMOs which, you may remember, were touted only a few years ago as the solution to all the nation's health care woes. As with all things in Washington, by the time dueling press conferences have been arranged, it's all over but the shouting.

The Democrats set up on the steps of the Capitol, while the GOPers staked out a patch grass about 100 yards north known as the Senate Swamp. As the factions screeched their familiar tunes, two messages emerged, and neither was particularly illuminating: 1) liberals are better at holding rallies than conservatives, and; 2) at least one side of the aisle hasn't bothered to actually read the Patients' Bill of Rights. But then, the point of such spectacles is not to clarify basic principles, much less raise substantive issues. Rather, it is to signal to the other side that you're ready to sign a truce.

Heavy hitters Sens. Tom Daschle (D-S.D.), Hillary Clinton (D-N.Y.), Edward Kennedy (D-Mass.), John Edwards (D-N.C.), and Tom Harkin (D-Iowa) joined a smattering of influential congressmen for a confident display of legislative resolve. A few hundred enthusiastic interns and union representatives waived signs and shouted frantically, oblivious to the rising late-morning heat. Republican presidential candidate and Arizona Sen. John McCain was part of the main display. He was there to bask in accolades, having crafted the proposed legislation in "maverick" bipartisan fashion with Ted Kennedy. The crush of onlookers was so unwieldy that congressional security had to continually shepherd strays off the adjoining road and back into a cordoned gallery.

Senate Majority Leader Daschle wowed the crowd with his best impersonation of a diligent hallway monitor, threatening naughty senators with in-school suspension if they don't finish their work on time. "There will be no July 4th recess," he said, sending a shiver down the spine of every senator and their staffs. "There will be no break until this bill is passed in the United States Senate." McCain averred that giving people the right to sue over wrongfully denied coverage was the only path to better care: "This is the doctors and nurses and patients of America vs. the HMOs." That particular line in the sand drew high praise from the faithful.

With all the commotion, it was hard to notice the more sedate Republican gathering being led by Sen. Don Nickles (R-Okla.) at the Senate Swamp. There was no horde of supporters and there was no maverick legislator from the Grand Canyon State. In fact, the microphones didn't even work. Still, a dedicated corps of reporters and cameramen was on hand, struggling to hear the other side of the story.

Nickles, accompanied by Sens. Phil Gramm (R-Texas), Bill Frist (R-Tenn.), Judd Gregg (R-N.H.), and Rick Santorum (R-Pa.), paraded a host of small-business owners who feared that lawsuits spurred by McCain-Kennedy would bust their balance sheets and force them to drop coverage for their employees. "This is a disaster," Santorum moaned. Nickles followed suit: "[Employers] are going to be liable. This is an open invitation to litigation." While nobody seemed to be able to put a price tag on the purported debacle, they all agreed that over a million poor suckers like you and me would be added to the rolls of the uninsured, as skittish employers backed out of offering insurance altogether.

But hold on a minute: Is everyone talking about the same bill? Maybe not. Ten minutes earlier, Daschle told his crowd that the measure would add only $1.20 to typical monthly insurance premiums. McCain emphatically added that "our bill protects employers from liability." He then repeated the sentence, in signature maverick fashion. For his part, Nickles read a passage from the sprawling piece of legislation that he said proved otherwise. Then he complained that hardly anyone really knew what the bill said because the other side kept issuing amendments. To prove it, he said the version he was looking at had been amended already.

So for now, no one knows for sure who will be exposed to lawsuits under the bill. Or how much it will all cost. It all depends on whose close-reading skills you trust more. But don't let such vagueness get you down. The Senate is going to pass someone's version of a Patients' Bill of Rights. Indeed, Nickles shrugged off Daschle's threat to keep the self-anointed "World's Greatest Deliberative Body" from enjoying its summer vacation. He said he would be more than willing to sacrifice his summer to hammer out a better bill than the one on the table now. The cool winds of compromise are already beginning to blow.

That was the deep message of Tuesday's tribal warfare. Republicans were previously married to the notion that any litigation—even lawsuits against HMOs—would be far too costly for the system to bear and was thus a deal-breaker. At the Tuesday rally, they only mentioned lawsuits against employers as "non-starters" for the legislation. On the other side, the Democrats seem willing to cap damages in some cases to put a brake on the cost of litigation. Senators might be in town to hash out the details over the Fourth of July, but it's becoming clear that they'll manage to cram something through before long.

Maybe at that point, a real debate–over whether we need a Patients' Bill of Rights in the first place, or whether more arcane regulations will encourage more employers to offer more coverage–will begin.