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A Bill of Rights for Patients, But Not for Women
The Bill of Rights
The Senates "Patients Bill of Rights" was meant to provide
Federal protection for patients covered by HMOs and other private
insurance companies. The original Democratic legislation would
have been a broad bill protecting the rights of nearly 161 million
Americans. The watered down Republican bill that passed by a
narrow margin only protects the rights of the 48 million Americans
who are members of HMOs.
The Democratic Version
The Democratic version of the "Patients Bill of Rights" would have
contained many benefits for all patients, although some of the
measures were specifically aimed at women. Democrats wanted
to give patients access to specialists even if those specialists
were outside the healthcare network. Democrats also wanted to
require health insurance plans to pay for overnight hospital stays
after a mastectomy, lumpectomy, or a lymph node dissection for
the treatment of breast cancer, if it was deemed appropriate by the
doctor and patient. Previously, these procedures were commonly
performed on an outpatient basis. Democrats wanted patients to
be able to have easier access to experimental treatments through
their healthcare network. Another part of the Democrat plan would
have given patients the ability to get care at any emergency room,
even if it was outside their healthcare network. Democrats also
sought to allow women to designate an Ob/Gyn as their primary
care physician. The Democratic contingent also wanted to allow
patients to sue their HMOs. All of these measures would have
benefited the 161 million people on private healthcare or managed
care plans.
The Republican Version
The Republicans, in an effort to protect HMOs and to stem rising
premium costs, watered down many of the Democratic
components to the bill. Republicans defeated the Democratic
effort to allow patients to sue their HMOs. Republicans also
defeated the Democratic attempt to allow patients to go to
specialists outside their healthcare network. Women were given
the right to stay in the hospital overnight after undergoing a
mastectomy, lumpectomy, or lymph node dissection, but this was
limited to members of HMOs and does not apply to members of
other private insurance companies. GOP members voted to allow
women to see an obstetrician when pregnant without prior
approval from their HMO. However, they still are not allowed to
designate an Ob/Gyn as their primary care physician, thus setting
the stage for denial of access.
What it Means for Women
A mastectomy is major surgery. A woman often has a drain
embedded under the skin that funnels infection to the outside. She
has virtually no use of her arm on the affected side initially.
Bleeding and infections are most likely in the greatest need of
immediate attention in the first day after surgery. If women are not
allowed to stay in the hospital overnight after surgery when a
doctor feels it is necessary, they may be put at risk for serious
problems. The same is true for other breast cancer treatments
such as a lymph node dissection or lumpectomy.
Studies have shown that doctors who are more experienced with
performing pap smears tend to end up with less false negative
results and produce better quality pap samples. The situation is
similar for birth control selection and implementation and
diagnosis of gynecological diseases. Basically, practice makes
perfect. Although family practitioners officially can cover routine
gynecological care, they actually have limited specific training in
gynecological matters and this makes up only a small part of their
practices. Womens Health Specialists do basic gynecological
care more often than Ob/Gyns do. Going to a Womens Health
Specialist should be viewed as a viable alternative to an Ob/Gyn.
Obstetricians are practically the only doctors who ever deliver
babies. Many Ob/Gyns drop the Ob part of their practice after
years in practice. It is nearly impossible to find enough
non-obstetricians to deliver babies, so the Republican legislation
to allow pregnant women to visit an obstetrician is meaningless.
President Clinton has indicated that he will veto the bill when it
reaches his desk due to the Republican "watering down." Of
course, this does not mean that another Patients Bill of Rights will
be passed with the kind of protections for women that are truly
necessary.
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