George W. needs an HMO to fix his growing nose

AUSTIN, Texas -- 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 drafted 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 versus "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. ...

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George W. needs an HMO to fix his growing nose