Under the radar.

Though the decade-long debate on a patients' bill of rights continues, a medical malpractice "reform" debate will probably unfold soon. But bubbling beneath these two issues is an interesting, much less visible, federal initiative. It now becomes part of the larger, ongoing debate over improving the quality of patient care and allowing doctors, rather than insurance companies, to make health care decisions.

H.R. 3897, the Health Care Antitrust Improvements Act of 2002, would give physician alliances a quasi-union status and enable doctors to negotiate with health plans without fear of violating federal antitrust laws. The hope, as expressed in a letter by House co-sponsors Bob Barr (R-Ga.) and John Conyers (D-Mich.), is for "physicians and other health care professionals to provide their patients with high-quality care," which they say "has been compromised as a result of the economic clout wielded by large insurers."

One of the most unusual aspects of the bill may be its cosponsorship. Barr (in his 4th term) and Conyers (in his 19th) are political opposites. As such, they are rated in many congressional "who's who" handbooks by conservative and liberal interest groups such as the Americans for Democratic Action, the American Conservative Union, the AFL-CIO, the League of Conservation Voters, and the U.S. Chamber of Commerce.

In The Original U.S. Congress Handbook guide to the current Congress, for instance, Barr has approval ratings of 100 percent from the American Conservative Union and 10 percent from Americans for Democratic Action. Conyers, on the other hand, has approval ratings of zero from the American Conservative Union and 95 percent from the Americans for Democratic Action.

Despite Barr and Conyers' political proclivities, their cosponsorship of this bill is not as strange as it might seem. During the patients' rights debate in 1999, Barr actually voted against an amendment that would have weakened the strongest patient protection bill introduced in the House. That amendment would have capped noneconomic damages and limited medical injury and death cases to federal court.

One of the reasons Barr stood strong on patients' rights was probably because he is politically and geographically close to Rep. Charlie Norwood (R-Ga.), who cosponsored the 1999 patients' rights legislation with Rep. John Dingell (D-Mich.). Norwood shifted his stance on patients' rights last year and introduced an amendment to weaken the House version. Barr followed his lead and voted to dilute the protections in the bill.

Conyers has always supported strong patient protections, and he opposed the Norwood amendment when it was offered. On issues of medical malpractice tort "reform," Conyers and Barr have always been on opposite ends of the spectrum, with Conyers firmly against.

Joint effort

Now the two are coming together on an issue that is being promoted partly as a means of improving patient services and care.

The representatives wrote in a letter to their colleagues on the House Judiciary Committee, "In many parts of the country, the health insurance market has become dominated by a few large health plans.... When physicians attempt to negotiate patient care issues with these large health plans, they are at a severe disadvantage. In fact, actual `negotiations' are rare due to the `take-it-or-leave-it' contracts forced upon health care providers.... [This legislation] will help physicians advocate for their patients when negotiating with large insurers."

This legislation is notable not only for the alliance of its cosponsors, but also for the shifting alliances of its supporters and opponents. H.R. 3897 is supported wholeheartedly by the American Medical Association (AMA), which states on its Web site, "The sheer size of these insurers, who often put profits over patients, allows them to use strong-arm tactics on health providers. These tactics mean that HMOs, not doctors, are dictating health care."

One of the AMA's recent studies of the health care marketplace found that in a "significant number" of markets, insurers have "substantial leverage" over patients and physicians in determining the scope, coverage, and quality of care.

Insurer opposition

Meanwhile, the Health Insurance Association of America (HIAA), on the day the bill was introduced, issued a press release stating, "The American public should be concerned with legislation that would provide physicians with unprecedented authority to essentially form cartels that would reduce competition, increase costs to both public and private health care programs, and force consumers to pay more for their health care." The HIAA and AMA typically align on the topic of medical malpractice insurance issues and then diverge again on the topic of patients' rights.

One thing remains abundantly clear, whether the topic is antitrust reform for physicians, patients' rights legislation, or medical malpractice: The insurance companies are always on the same side--against patients.

Kristin Loiacono is media relations coordinator for Atla.