FIRST TOBACCO, NOW PATIENTS' RIGHTS

Armies Of The Left, Right Maneuver For Political Advantage On Hot Topic

THE tobacco wars are far from over in Congress, but already the next big
partisan fight of this election year is being teed up over patients' rights
health-care reform.

The political dynamics are startlingly similar to those on tobacco:
Democrats think they are pushing a popular cause. They are targeting a
distrusted industry as their bogeyman. And they expect to win politically
whether they pass their favorite bill or not, since they can blame the
Republicans for killing it.

As on tobacco, Republicans think the public can be persuaded -- by them or
the HMO industry's ads -- to oppose the Democrats' proposals as too
government-intrusive and costly, and that they can get away with passing a
``light'' bill.

Some of the personality dynamics are even similar. A key player on the same
side of the issue as the Democrats is a renegade conservative Republican,
though on patients' rights, Rep. Charles Norwood (Ga.) has had an even more
instrumental role than Sen. John McCain (Ariz.) played on tobacco.

A House GOP task force headed by Rep. Dennis Hastert (Ill.) will soon
unveil ``principles'' for health care reform almost certainly including
rights of patients to full information from providers, guaranteed access to
obstetricians and pediatricians, reasonable guarantees of service in
emergency rooms and accelerated reviews when service is denied.

The task force, being Republican, almost certainly will reject proposals by
Norwood and Democrats that patients be permitted to sue their HMOs and/or
employers when services are denied; mandates that all insurance plans allow
patients to seek outside service; and the creation of a federal bureaucracy
to regulate health care providers.

However, as directed by House Speaker Newt Gingrich, R-Ga., the task force
is likely to recommend some ``21st century initiatives'' to expand consumer
choice, including tax-exempt medical savings accounts, employer
insurance-purchasing co-operatives and ``health marts,'' where individuals
can buy insurance as part of a state-managed pool.

And, as a politically clever add-on, the Hastert task force may include a
set of caps on medical malpractice awards when patients sue doctors, though
they still won't be able to sue HMOs. The idea is to open up Democrats to
the charge of being ``tools of the trial lawyers'' when they oppose the
liability caps.

An actual bill embodying the Hastert proposals will be introduced after the
Fourth of July recess.

Senate Majority Leader Trent Lott, R-Miss., last week proposed a procedure
to Minority Leader Tom Daschle, D-S.D., for handling the debate, but
Daschle rejected it as too restrictive. If no agreement is reached, the
Democratic bill will be brought up as an amendment to some other pending
legislation.

Sen. Don Nickles (Okla.), head of a Senate GOP task force, had been
pursuing a strategy designed simply to kill the Democratic bill,
co-sponsored by Daschle and Sen. Edward Kennedy (Mass.) and Reps. John
Dingell (Mich.) and Dick Gephardt (Mo.). But he abruptly began considering
alternatives about the time he led the Senate shoot-down of the McCain
tobacco bill.

As in the tobacco fight, Democrats are armed with polls showing that big
majorities of citizens want controls on HMOs, which are about as unpopular
as tobacco companies. Even better for Democrats, instead of endlessly
repeating statistics as they did about teenage smoking, they can cite
real-life horror stories of patients denied care by money-hungry HMOs.

But HMO lobbyists and Republicans say that, as on tobacco, this is an issue
whose technical details are not well understood by the public, so an
advertising blitz could well convince voters that too regulatory an
approach would raise premium costs and force some small employers to drop
coverage.

There ought to be a middle ground here that allows patients to sue their
health plans, as the Democrats and Norwood propose, but caps the amount of
damages they can get for ``pain and suffering.'' Major special interests
involved in this fight won't like such a compromise. HMOs and large
corporations that insure their employees themselves -- who contribute most
of their campaign money to Republicans -- won't like it. Neither will trial
lawyers, who overwhelmingly contribute to Democrats. For this reason, don't
expect a deal. Expect a brawl.

Checked-by: Richard Lake