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Bush marches to own beat as patient-rights initiative takes off in US
CMAJ 2001;164(11):1611 [PDF]

Patient-rights bills have been before both the House of Representatives and Senate recently, but early this spring President George Bush was vowing to reject both versions and come up with his own plan to protect American patients who belong to health maintenance organizations (HMOs).

"I want to sign a patients' bill of rights this year but I will not sign a bad one," Bush told the recent annual meeting of the American College of Cardiology. "And I cannot sign any bill that is now before Congress."

Bush envisions a bill of rights that would cover all Americans, guarantee emergency treatment at the nearest emergency room, provide for an immediate appeals process if an insurance plan denies care, allow the right to sue (but not "frivolously"), and provide access to affordable health care coverage.

"To make sure health care coverage remains affordable, I will insist any federal bill have reasonable caps on damage awards," said Bush. "The caps in proposed legislation before Congress are too high and will drive up the costs of health care."

However, proponents of the bill before the Senate, the Bipartisan Patient Protection Act, disagree with Bush's stand. "President Bush has to decide whose side he is on — patients and doctors or the HMOs," said cosponsor John Edwards. "This debate shouldn't be about personalities. It's not about who gets the credit — it's about protecting patients."

The American Medical Association, which favours the bipartisan bill, has been careful not to alienate Bush. "The president is right — we can enact a patients' bill of rights this year," said Dr. Thomas Reardon, the AMA's immediate past president. "And we agree that the legislation must hold health plans accountable when things go terribly wrong."

The US is not the only country to grapple with these charters. The Patient's Charter initiative in the United Kingdom was first discussed in 1991, and in 1995 it resulted in a document setting out the rights and standards of service patients can expect from the National Health Service. Scotland, Wales and Northern Ireland now have their own charters. — Steve Wharry, CMAJ



Copyright 2001 Canadian Medical Association or its licensors