The Senate last night voted to grant patients a wide array of limited new protections devised by Republicans to help people cope with the managed-care plans that have come to dominate the nation's health care system.
The legislation, forged amid a biting four-day debate and furious lobbying, calls for the federal government to guarantee some people easier access to emergency rooms and medical specialists, help women stay in the hospital longer after breast cancer surgery and expand patients' ability to appeal if health plans won't pay for care.
But before taking final action on the bill, the Senate voted 53 to 47 yesterday to smash a cornerstone of Democrats' efforts to empower patients -- giving people the right to sue HMOs for malpractice. And most of the protections that the Senate adopted would be available to fewer than one-third of Americans with private health insurance.
With the issue's fate uncertain in the House and the White House vowing to veto the approach the Senate embraced last night, the final, largely party-line vote of 53 to 47 represented, as much as anything, an important political success for the Senate's Republican majority.
"It is the right thing to do, and this is the right time to do it," Majority Leader Trent Lott (R-Miss.) said last night.
"This is a victory for patients with improved access to health care for Americans," declared Sen. Bill Frist (R-Tenn.), the Senate's only physician, who helped formulate the GOP approach. "It achieves a balance [for] doctors and patients . . . with a cost that does not hurt access to care."
Through the week, the GOP prevailed on each of about a dozen amendments to both Republican and Democratic bills, giving GOP leaders a clean win on an issue of prime importance to the American public. That win has particular significance, coming on top of the Senate's meager record of accomplishments so far this year and -- in particular -- the GOP's prominent display of disunity in late May over a Democratic proposal to strengthen gun control laws.
While the GOP handily won this week's legislative showdown, Democrats were quick to contend yesterday that they ultimately will emerge as victors in the court of public opinion. They predicted that voters will be dissatisfied with Republicans' more modest steps to tilt power away from insurers and toward patients and health professionals.
"I think it's a step back," said Sen. Edward M. Kennedy (D-Mass.), who co-sponsored the Democratic legislation and managed the party's floor debate. "It gives false security."
Vice President Gore, standing in a display of solidarity yesterday afternoon with Democratic senators just outside the Senate chamber, issued the administration's strongest veto threat on the issue to date. "Nobody should be under any illusion: If the Republican leadership insists on going through a charade in passing that `bill of goods' they've been trying to promote, President Clinton will veto it in a minute. It has zero chance of going across his desk because it is a fraud."
Immediately after the final vote, Clinton weighed in, saying that he would not sign what he called "an empty promise to the American people."
"This should be about protecting patients, not insurance companies," the president added.
Regardless of which party proves able to wield the issue to greater advantage in next year's election campaigns, the Senate's action this week reflects a marked failure of compromise. The parties sought to outmaneuver one another even on those proposals -- such as ones to allow women greater freedom to remain hospitalized after having a mastectomy -- on which they essentially were in agreement.
In such an acrimonious, partisan climate, a bipartisan group of moderates was unable to force a vote on its own attempt to find a middle ground that would have, for instance, given patients a limited right to sue -- but not one as broad as many Democrats sought. The group, led by Sens. John H. Chafee (R-R.I.), Bob Graham (D-Fla.) and Joseph I. Lieberman (D-Conn.), began a last-minute drive Wednesday to muster at least five GOP supporters -- enough to prevail as long as all 45 Democrats went along. But in the end they managed to attract only two Republican votes.
At a morning news conference, called in a futile attempt to drum up broader support, the moderates said the Senate's polarization ultimately would doom its legislation. "The track we are now on is, a GOP bill will pass, the president will veto it, the veto will be sustained, and the American people won't be one bit better off than before this exercise started," Chafee lamented.
Chafee and Sen. Peter Fitzgerald (Ill.) were the only Republicans who voted against the bill.
The intense sparring inside the Senate chamber this week was matched by an equally vigorous lobbying effort by well-organized constituencies with big stakes on both sides of the debate -- essentially pitting insurers and employers against patients, doctors and other providers of medical care.
The Health Benefits Coalition, a consortium of insurance and business interests, has been running radio and television advertisements this week in the districts of senators facing election next year, and many top business leaders have placed calls to Capitol Hill. The Health Insurance Association of America has coordinated tens of thousands of letters and calls.
On the debate's other side, meanwhile, the American Medical Association ran radio ads around the country, flew dozens of doctors from several states to Washington for a lobbying blitz on Tuesday and set up a toll-free number that allowed doctors and patients to be connected directly to their senator's office.
Despite those efforts, aides to several Republicans, targeted by lobbyists because they are up for election next year, said they did not feel deluged and were not swayed. A spokesman for Sen. Mike DeWine (R-Ohio) said the senator got about 100 calls on patients' rights in both his Ohio and Washington offices -- one-fifth the number during the gun debate.
Before last night's vote, the Senate finished off the remaining Democratic proposals. One would have prohibited HMOs from imposing "gag rules" that prevent doctors from discussing expensive treatments with their patients. Another would have guaranteed that patients could, under certain conditions, keep the same doctor for a few months even if they are forced to switch health plans.
In contrast with Democratic efforts to protect all 161 million Americans with private insurance, most aspects of the final legislation apply only to 48 million people who get coverage through big companies that insure themselves and legally cannot be regulated by states. Republicans said the states are already doing a good job regulating health plans.
The expanded ability for an outside appeals hearing when HMOs deny care would be available to a somewhat larger group of 123 million people with private insurance.
On the other hand, all women and children with private insurance would be helped by a provision allowing them to visit obstetrician-gynecologists and pediatricians without permission of their primary doctor. All Americans also would be eligible for tax changes allowing self-employed people to deduct the entire cost of insurance premiums, expanding the availability of savings accounts to let people set aside money for medical expenses tax-free and creating new tax breaks to help individuals buy insurance against long-term care.
CAPTION: Senators who tried to forge patient bill compromise were, from left, Graham (D-Fla.), Bayh (D-Ind.), Chafee (R-R.I.), Baucus (D-Mont.) and Robb (D-Va.).