A Step Forward for Patients’ Bill

WASHINGTON â€”  The pitched battle over patients’ rights legislation increasingly hinges on negotiations between President Bush and a former dentist from Georgia who has made reforming health care insurance his signature issue in Congress.

Rep. Charlie Norwood (R-Ga.), a leading sponsor of the bill Bush is trying to derail, moved the two sides closer to a compromise Thursday after talks with the president on contentious provisions that would make it easier for patients to sue their health plans.

Though disputes remain, members of both parties expressed optimism that progress was being made to resolve the deadlock. House and Senate sponsors of the legislation emerged from a meeting late Thursday saying that they were still far from completing a deal with the White House but that they were encouraged by new proposals from Bush.

The president gave ground on a key front, proposing that suits against health plans be allowed in both state and federal court. Until now, the White House and GOP leaders have insisted that such suits generally be allowed only in federal courts, which are considered less favorable to plaintiffs.

But a long list of obstacles remains, including disagreements over how much patients should be able to collect in damages. The developments point toward intense negotiations in the coming days--if not weeks--and a pivotal role for Norwood.

The four-term House member, who turns 60 today, has championed the patients’ bill for the last five years, motivated largely by his own frustrations in dealing with managed care as a dentist for 25 years in Augusta, Ga.

“Time after time,� Norwood said, “I could see very clearly that [the insurers] were trying to have me treat the patient as inexpensively as possible,� with little regard for what would represent the best care.

Norwood’s bill, co-sponsored by Reps. Greg Ganske (R-Iowa) and John D. Dingell (D-Mich.), would create sweeping new protections for health plan members. It would guarantee access to certain specialists, require unquestioned coverage of emergency room visits and give patients new rights to participate in clinical trials.

The issue poses a difficult dilemma for Norwood, a staunchly loyal Republican whose bill relies on Democrats for the vast majority of its support.

Indeed, Democrats appear poised to capitalize on the patients’ rights issue no matter the outcome. If it becomes law, they can claim victory on legislation that they made their priority after taking control of the Senate this spring. If it fails, they can blame Republicans and Bush for blocking a measure that has strong public support.

With that in mind, Norwood faces a difficult balancing act of advancing his cause without hurting his party. “It’s hard. I’m Republican to the core.�

Norwood came to Congress as an eager foot soldier in the Newt Gingrich-led Republican revolution of 1994.

Born in rural Valdosta, Ga., he has deep roots in the South. Four of his ancestors died fighting for the South in the Civil War. On his 40-acre spread north of Augusta, he still flies the old Georgia flag with the Confederate battle emblem.

Asked once when he would take it down, he replied, “When it rots.�

Norwood is an avid hunter and a staunch ally of the National Rifle Assn., although an accident with a gun led to the most tragic incident in his life.

As a teenager, Norwood accidentally killed a close high school friend when the two were playing “draw� with a .22-caliber pistol they assumed was unloaded. Norwood still refuses to discuss the incident, saying it continues to cause him pain.

Norwood earned a dental degree at Washington’s Georgetown University and served in a field hospital in Vietnam. Before running for Congress, he had never held elective office other than a stint as president of Georgia’s dental association.

Norwood’s conservative credentials, and his credibility with patients’ rights advocates, make him well positioned to broker a deal.

“This is his bill,� said Rep. Bob Barr (R-Ga.), part of a critical bloc of House Republicans following Norwood’s lead on the issue.

Discussing the efforts between Norwood and Bush to reach an agreement, Barr said, “If Charlie tells me this is a good compromise that has what we need, then the chances are that’s the way it’s going to be.�

Even Senate Majority Leader Tom Daschle (D-S.D.), who guided the patients’ rights bill through the Senate last month, said he would respect Norwood’s judgment.

“My preference would be not to have any more compromises,� Daschle said. “But obviously, if Dr. Norwood . . . feels that some of these proposals are acceptable, I would certainly entertain them.�

The talks between Norwood and Bush center on liability provisions that would greatly expand patients’ ability to sue health maintenance organizations. A 1974 law essentially shields HMOs from liability. Patients can sue but are generally barred from collecting anything beyond the cost of treatment.

Critics argue that exposing HMOs to significant damages is the only way to give patients leverage against companies often accused of putting financial considerations ahead of medicine.

The latest proposal from the White House would allow patients to sue in state or federal court over denials or delays of treatment, but only if a single federal standard--not a patchwork of state laws--applies.

Norwood said he supports the White House proposal because it achieves the key goal of allowing patients to sue and would create a uniform national standard.

But his colleagues, particularly Senate co-sponsors, said they remain skeptical, partly because so many daunting details need to be worked out. The all-encompassing federal law, for example, still needs to be written.

There is still a gulf between the two sides on the issue of capping damage awards. The Democrats’ bill would allow patients to collect unlimited economic and pain-and-suffering damages and punitive awards up to $5 million.

Bush has vowed to veto the measure over that provision, saying it will encourage frivolous lawsuits and drive up the cost of health care premiums. Instead, he is clinging to a proposal that would cap pain-and-suffering awards at $500,000 and ban punitive damages.

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Times staff writer Janet Hook contributed to this story.