Bush Vows to Veto Patients’ Rights Bill

President Bush, demanding “a new approach,” vowed Wednesday to veto any patients’ bill of rights legislation unless it strictly limits the ability of consumers to sue insurers or health maintenance organizations.

Bush’s uncompromising stance on liability was clearly meant as a direct veto threat to the bipartisan legislation sponsored by Sen. John McCain (R-Ariz.), Sen. Edward M. Kennedy (D-Mass.) and Rep. John D. Dingell (D-Mich.). It is the strongest patient protection legislation in Congress and the only one currently that has a strong liability provision.

Addressing a convention of cardiologists here, Bush said he finds all the current proposals objectionable but focused the brunt of his criticism on the bipartisan legislation that has won majority support in the House and has the support of all Senate Democrats and a handful of Republicans. He described it as lacking what he considers sufficient deterrence against “excess and frivolous litigation.” And the resulting lawsuits, he predicted, would further drive up health care costs.

“To make sure health care coverage remains affordable, I will insist any federal bill have reasonable caps on damage awards. The caps in the proposed legislation before Congress are too high,” the president said during a morning address at the 50th scientific session of the American College of Cardiology.

“Some proposals now before Congress fail to adequately address this problem and would even make it worse.”

Although Bush made most of these points in a letter to Congress last month, this was the first time that he highlighted both the issue and his views in a public address. Indeed, the president and his staff considered his speech here so important that Bush delivered it with the help of a TelePrompTer, something he rarely uses.

Although there is strong support in Congress for the general concept of granting patients more rights in dealing with their HMOs, there has been a tremendous lobbying effort by both employer groups and HMOs to block any plans that broaden consumer rights to recover damages if they are injured or killed by a plan’s negligence. Most consumer and physician groups have said that without a strong right to recover damages there would be no hammer to force HMOs to pay attention to consumer needs.

Bush Looks to Curb Health Care Litigation

Bush has tried to find a middle ground that is far from what HMOs wanted but also would make it unlikely that there would be many lawsuits. The latter would be because of tight caps on awards and a requirement that people go to federal rather than state court, giving trial lawyers little incentive to take the cases.

Even as Bush made known here his desire to curb health care litigation, he insisted that he does not want to block access to the courthouse to those who were denied proper medical care.

But first, he said, such consumers must have their cases heard by “an independent, impartial review panel of medical doctors.”

“After independent review, if you have been harmed by your HMO’s refusal to provide care, you have a legitimate complaint and you should have recourse in court,” Bush said.

“Our federal legislation must allow the review process to work, not short-circuit it by inviting unnecessary lawsuits.”

A senior administration official, speaking under the condition that he not be identified, said after the president’s remarks that a bill being drafted by Sens. Bill Frist (R-Tenn.) and John B. Breaux (D-La.) “moves in the right direction” in meeting the president’s concerns.

That bill, however, has yet to win the support of conservatives in the Senate who question whether it is necessary to broaden consumer access to the courts at all. And it also is having trouble attracting the support of Democrats, who worry about the limits on litigation and that it allows the states considerable leeway to write their own versions of many of the patient protections, such as guaranteed access to specialists.

Aboard Air Force One, while en route from Washington to Orlando, Fla., White House Press Secretary Ari Fleischer told reporters that Bush wants any lawsuits against HMOs that deal with denial of benefits to be filed in federal court rather than state court, where he claimed trial lawyers have more influence.

Medical malpractice suits could still be filed in state courts, under the Bush proposal.

Fleischer said Bush will not sign the Kennedy-McCain bill, which caps punitive damage awards in federal court at $5 million. Under that bill, an injured patient also could get economic and non-economic damages. Fleischer said that the $5-million cap was too high, but he did not say what limit was acceptable to Bush.

President Pushes for Independent Review

In his remarks to the heart doctors, Bush also reiterated his own principles that he said must be embraced by any bill that he would sign. These include consumer protection for everyone in a private insurance plan, the right to emergency treatment and medical specialists and, above all, an independent review process to deter litigation.

Perhaps to bolster his veto threat, Bush recalled that as governor of Texas he had vetoed “a bad” patients’ bill of rights before signing “some good ones.”

“I don’t want that to happen again. This time, I hope we can get it right the first time,” he said. “I want to sign a patients’ bill of rights this year. But I will not sign a bad one and cannot sign any one that is now before Congress. So enacting a patients’ bill of rights this year is going to require some different thinking, a new approach based on sound principles.”