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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Copyright © 1999 GenneX Healthcare Technologies,Inc.


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