- The Washington Times - Sunday, March 10, 2002

The critics hated "John Q.," but it's still a gripping movie, and one that should have more influence on a Congress that may pass little or no significant health legislation this year.
Academy Award winner Denzel Washington plays a father driven to take over a hospital emergency room at gunpoint to secure his son a heart transplant that has been denied because he lacks adequate health insurance coverage. "John Q." is a cinematic argument both for patients' rights legislation and for better insurance protection for low-income workers.
Patients' rights legislation has a chance of passing this year; insurance coverage for the uninsured has virtually none, even though about 40 million people lack coverage.
Movie critics panned "John Q." as "propagandistic" and overly simplistic, but I know of a real-life case that is also a compelling argument for patients' rights.
The central character in this drama is a 61-year-old woman I'll call Amy S., who was diagnosed two years ago with a rare form of lymphoma, a cancer of the blood and immune system. Her insurance company has paid for seven rounds of heavy chemotherapy, but the cancer has returned, and now she needs a bone marrow transplant or she'll die.
Basically, there are two kinds of transplants available, both costing in the range of $300,000 to $400,000. For persons her age, one procedure, involving more toxic chemotherapy, has a fatality rate of 40 percent to 50 percent.
The insurance company will pay for that but not for the less-toxic procedure that the company considers "experimental" even though it's been in use since 1994. This procedure has a fatality rate of 20 percent to 25 percent.
Two cancer doctors I consulted about Amy's case believe it's inappropriate and shortsighted for the insurance company to decide what form of therapy she may have shortsighted because if the transplant fails, the company will have to make expensive outlays for intensive care at the end of her life.
One of the doctors, who practices at the M.D. Anderson Cancer Center in Houston, said declaring procedures "experimental" is "one of the many ploys insurance companies use to avoid paying for transplants. We fight them all the time."
Amy's case is a particularly compelling argument for patients' rights legislation because if either the House- or Senate-passed version of the bill were law, insurance companies would be required to pay for cancer clinical trials, including the less-toxic marrow transplant recommended for her.
Negotiations are under way between the White House and Sen. Edward Kennedy, Massachusetts Democrat, to resolve differences between the bills on what cap to place on damages plaintiffs could win if they sued their HMOs or insurance companies for denying coverage.
The House bill favored by the Bush administration calls for a $1.5 million cap. The Senate bill originally sponsored by Mr. Kennedy and Sen. John McCain, Arizona Republican, allows for damage awards of up to $5 million.
The two sides ought to be able to come together and produce a bill Mr. Bush can sign unless Republicans and their allies in the insurance industry balk at too-high caps, or Democrats and their allies in the trial lawyers' lobby reject caps that are too low.
Democrats will also be tempted to block a less-than-ideal bill to make patients' rights an issue in the fall Congressional campaigns.
If the two sides can't or won't come to terms on the liability issue, at the end of the day they ought to agree to pass a bill that includes agreed-upon items, such as mandates for clinical trial coverage and emergency services.
It's a shame that "John Q." hasn't created more buzz this year to put pressure on Congress to pass a patients' rights bill, the way the movie "As Good As It Gets" (1997) did to boost the patients' rights cause to the top of the political agenda.
In that film, a brief disparagement of HMOs by star Helen Hunt caused audiences to erupt with cheers, giving patients' rights advocates a chance to rally support.
When "John Q." came out this year, the American Association of Health Plans, the insurance-HMO lobby, pre-emptively took out ads adopting the film as an argument in favor of expanding health coverage for uninsured workers.
That cause also is being championed with an expensive advertising campaign conducted by the Robert Wood Johnson Foundation and a consortium of groups ranging from the U.S. Chamber of Commerce to the AFL-CIO.
It's a worthy effort, considering that 39 million people lacked health insurance in 2000 and 2 million more may have lost it amid the 2001 economic downturn.
However, Congress is nowhere near even considering a plan to cover the uninsured, and groups helping finance the ad campaign likely would disagree violently on how to do it.
As with the patients' rights issue, if Congress can't agree on a comprehensive approach to the problem of the uninsured, it ought to resolve to simply expand coverage to more people each year to do something even if it can't do everything. Lives can be saved in the process.

Morton Kondracke is a nationally syndicated columnist.


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