U.S. Senator John Edwards: The Patients' Bill of Rights

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FRANCISCO KJOLSETH/THE CHARLOTTE OBSERVER/AP

Sen. John Edwards tapes the Democrats' weekend address at a radio station

The Democrats’ plan, sponsored by Senators Edward Kennedy, John Edwards and Republican John McCain, would allow mistreated, misdiagnosed or neglected patients to sue their health plans in both state and federal court, because, the sponsors argue, patients should be able to skirt the long waiting times and bureaucracy plaguing the federal judicial system. The bill also allows wronged patients to receive unlimited punitive damages in state court (unless state law dictates otherwise) and awards in federal court of up to $5 million.

Below, Edwards makes the case:

TIME.com: What is the most important difference between the bill you support and the GOP-sponsored version?

Senator Edwards:When you stack up the two bills side by side, the McCain-Edwards-Kennedy bill favors patients and doctors and the Frist-Breaux bill is tilted toward the HMOs. The most important thing is that our bill gives patients and doctors the right to get a second opinion if an HMO or insurance company denies coverage for care that a doctor orders.

Our bill provides for a quick, independent review. Their bill has what they call a review process, but it lets HMOs and insurance companies control who does the review. That's like letting them pick the judge and jury. Our bill also covers more Americans and ensures better care for patients. It also gives patients a way to enforce their rights through strong HMO accountability. We have a bill of rights; they have a bill of suggestions.

It is important to understand that we designed our bill to avoid lawsuits, but in rare cases when someone has been injured or killed and the dispute winds up in court, we think cases involving medical decisions should go to state courts. State courts have experience in these kinds of cases, they're faster, and they're closer to where patients live. The Frist-Breaux bill sends all cases to federal court, which are already backlogged. That's one reason the US Supreme Court and the United States Judicial Conference, headed by Chief Justice William Rehnquist, favor our approach.

Our plan also protects businesses. We make sure that employers cannot be sued unless they actually make a decision to deny an employee health care, which rarely happens.

How do you respond to Senator Frist's contention that the Democrats' bill would raise the price of insurance to the point that as many as 1.2 million would lose their coverage?

The truth is that Senator Frist's bill and John McCain and my bill are almost identical in cost. According to the Congressional Budget Office report, the Frist-Breaux plan would raise insurance premiums about 3 percent. Our plan, the McCain-Edwards plan, would increase premiums by about 4 percent. So there's only a one percent difference between the two plans. The truth is, our bill gives people a better product--better health care. For that marginal kind of cost, we think the American people, employers and employees, will think this is a good buy.

Recent HMO industry reports indicate that higher-priced coverage could eliminate coverage for as many as 18 million of America's working poor. How can we prevent this from happening?

The HMO industry is trying to scare the American people, and it just won't work. The cost difference between the Frist bill and the McCain-Edwards bill is something like 37 cents a month per employee. The cost is negligible, so I really don't think employers are going to drop health care coverage for their employees.

Why is it so critical to the Democrats' plan to allow suits to be filed in both state and federal courts?

The truth is, most of these cases will never go to court, period. Most patients do get the care they need, and those who don't can go through an appeals process. Patients will go to court only if they've gone through both internal and external appeals and still haven't gotten the care they need and have been injured or killed as a result. Our plan is based on Texas state law, and in Texas, only a handful of patients have actually had to go to court.

Under our plan, most cases will go to state court and be covered by state law. Certain cases, cases involving contract disputes, would go to Federal court. Despite our opponents' claims, our plan does prohibit someone filing cases simultaneously in both state and federal courts.

Is the $5 million ceiling on damages designed to send a message to HMOs? Or do you expect it to be tested in real-life cases?

We want to treat HMOs the same way everybody else is treated in this country. Right now, they are about the only business in America to have special status. They want to keep their privileged status. We should be able to hold HMOs accountable, the same way we treat doctors and nurses and others, in order to help patients get the health care they deserve. Strong accountability will deter HMO abuse and make sure that all patients get high quality care.

Senator Trent Lott has hinted at his willingness to filibuster the Democrats' bill. Do you think that will happen — or will Democrats and Republicans will reach a compromise on this issue?

The McCain-Edwards bill is a consensus bill. It's supported by a majority of the House and a majority of the Senate. It's supported by over 600 health care and consumer groups across the country. This is a very strong bill and I think we'll see it pass and I think we'll see the President sign it into law. President Bush, during his campaign, said he supported a real patients' bill of rights. Our bill meets this standard and we're confident that the President will agree with us and sign the bill.