THE MAJORITY leadership of both houses of Congress increasingly find themselves in the anomalous position of trying to suppress majority will. The House last week passed by 75 votes a campaign finance reform bill that the Republican leadership opposed and agreed to bring up only when a majority threatened to seize control of the floor through a discharge petition. Friday the leadership acquiesced and announced it will likewise permit debate next month on a bill it opposes regulating managed care.
In the Senate, the leadership was able to fend off a strong managed care bill only by passing a shell. It will likely take part in a filibuster next month to head off a campaign finance bill that it agreed to schedule only under duress. And it may well be forced before the year is up to permit a vote on a minimum wage increase, which it opposes but which is thought likely to pass. In each case, the outline is the same. The causes are popular, and enough Republicans have joined most Democrats in support that the Republican leaders are having to struggle to maintain control.
Speaker Dennis Hastert has promised a House vote the week of Oct. 4 on a managed care bill that he has been trying to deflect for months. The administration and most House Democrats support it. If that were all, Mr. Hastert would have no problem, but at least 21 Republicans have signed on as supporters as well. That's about 15 more than he can afford to lose if he picks up no Democrats in turn.
For all the claims made for and against, this is actually rather modest legislation. The country wants quality health care at minimal cost; the managed care industry sits astride that tension. The bill seeks to make sure it doesn't tilt too far toward cost containment at quality's expense. The goal is not so much to weaken cost containment as to legitimize it, lest even more people be priced out of the market entirely. Most of the bill consists of fairly orthodox consumer protection -- full disclosure, no deception, sufficient resources to provide the promised care, the right of appeal to an independent panel if care is denied. The debate is inflated in both directions. The industry claims that it already does most of these things, but that the bill will nonetheless be costly. Proponents say that the cost will be trifling even though the need is great.
The major fight is over liability -- whether to expand the right of patients to sue insurers for damages when harm has been done because care has been denied. Lest medicine be consumed even more by law, we would rather try a strong appeals process first. If a right to sue is granted, as the majority seems bent on doing in the House, it ought to be heavily qualified. But there ought to be a serious bill, not token legislation such as passed the Senate. If there is such a bill, the Republican dissenters will be owed a debt of gratitude by their party that the party is unlikely to pay. It is they who may force what would otherwise be a do-nothing Congress to do something.