Molly Ivins July 13

AUSTIN, Texas — The Congressional Follies offer another merry skit this week, a tug-o'-war over something called the Patients' Bill of Rights.

In this era of corporatized medicine — with the insurance companies making the decisions about what kind of medical care we get — all the politicians are theoretically in favor of this legislation, which will give patients some recourse when they are denied treatment by their HMOs. What with the HMO Horror Story of the Week now a staple, the time, you might think, has come.

But we are watching a classic political shell game: There's the Patients' Bill of Rights that actually gives the patients some rights, and there's the Patients' Bill of Rights that doesn't. It's one of those pay-close-attention moments: It would help if the truth-in-labeling law were extended to legislation.

The most astonishing development in this does-so, does-not tussle is a series of TV ads so blindingly misleading they're sort of impressive We're not talking the Big Lie technique here, we're talking the Monumental Lie. In these charming ads, we are told should this legislation pass — identified as "Ted Kennedy's bill" in tones normally reserved for "repellent venereal disease" — the cost of health insurance will soar, people won't be able to afford it, what will they do if the kids get sick, don't the politicians have any mercy, get off our backs you lousy scum ... and so forth. The key fact here is the ads are sponsored by the insurance companies.

The reason we know this is pure hooey is because the very bill they are opposing has already been in effect in Texas for over two years, and none of the heinous consequences they predict has occurred here.

It's so rare for Texas to be ahead of the curve, for us to have actual progressive legislation before anyone else — kind of the political equivalent of having your century plant bloom — that we ought to stop and savor the moment.

As you know, we sometimes consider applying for federal funds on the grounds that we serve as the National Laboratory for Bad Government, but this time we are out in front and proud of it. Furthermore, it was a Republican deal. Are you listening, Washington?

The Patients' Bill of Rights passed by the Texas Legislature in 1997 was primarily the work of state Sen. David Sibley, R-Waco, who has the singular distinction of being both a lawyer and a doctor (oral surgeon). He's looked at life from both sides now. Sibley was also a major player in the tort deform effort of 1995 and in a excellent position to see how that played out.

The Patients' Bill of Rights was relatively uncontroversial here — Gov. George W. Bush signed it without protest, and no one has ever claimed he's a friend of the trial lawyers.

The bill set up a mediation procedure so that when a patient has a complaint about an HMO, it goes first to a review board — and only if it cannot be resolved there can a patient sue. In two years, one lawsuit has been filed. It is expected that more will come along, but I wrote the same thing at the end of the first year the law was in effect, and we're still waiting for this famous "flood of lawsuits" to appear.

The Senate Republicans who oppose the Kennedy bill might want to explain to Sibley and Bush just what they think is wrong with a plan that has already proven to work extremely well in a very conservative state without upsetting anyone. And we have a militant anti-trial-lawyer lobby here.

The bill of rights has not driven up the cost of anyone's health insurance, no employer has been sued for offering health insurance (what a ridiculous argument), no children are going without because of it. True, lots of people in Texas don't have health insurance, but that's because we have an unusually high proportion of working poor people in the state and a generally crummy social safety net at all levels. It has nothing to do with the Patients' Bill of Rights.

There are already HMOs mandating the least costly — rather than the most effective — treatment of illness, and we are not talking about using the generic drug rather than the brand-name drug. We are talking about some truly outrageous and sickening cheap-skate tricks. One incident involved a woman with a serious skull fracture who was denied coverage because she did not get permission in advance from her HMO before doctors went to work to save her life. Of course, she was unconscious at the time, but there it is.

I have yet to see any way to limit corporate greed except through either government regulation or fear of lawsuit. "Sue the bastards!" is an ancient American right in danger of extinction these days because corporations have so much political stroke through their enormous campaign contributions. At the same time, and for the same reason, deregulation is the political fashion of the day, leaving consumers with no protection at all.

Enough people have been hurt by enough HMOs so there is a real backlash and demand for a patients' bill of right with teeth in it. But if the Republicans and the insurance industry have their way, the old shell game will run right through the Senate and we'll get something called a bill of rights that has no remedies in it. Then the insurance companies will have carte blanche to find the "least costly treatment."

Leeches are really cheap.

Molly Ivins is a columnist for the Fort Worth Star-Telegram. To find out more about Molly Ivins and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate web page at www.creators.com.

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