news analysis:
One for the patients

The patients' rights bill would empower people to better deal with their health insurance providers. One provision would make it easier to see a specialist, such as the one examining this ultrasound scan.

By Eileen O'Connor CNN Health Correspondent Special to CNN Interactive

(CNN) -- Call it the year patients found their voice. Despite tens of millions of dollars spent in ads and lobbying by the insurance industry, the U.S. House of Representatives in October passed a far-reaching patients' bill of rights.

For many in Congress the message from home was clear. According to estimates by those speaking for the Congressional leadership of both parties, at least half their members reported that problems with managed care providers was the No. 1 topic in town meetings in their districts.

Among the bill's provisions:

• Doctors would have the right to decide what is medically necessary for patients.
  
  
• Patients would have the right to sue an HMO or insurance company if injured through the denial of care.

The next step is to reconcile the bill with one passed by the Senate that granted neither right. The Republican majority delayed sending the bill to a House-Senate conference committee until next year, and in an election year, compromise may be difficult.

The bill may have acquired an unlikely ally in November when UnitedHealthcare, the country's second largest medical insurer (after Aetna), announced it would no longer review doctors' decisions and would automatically approve treatments doctors think necessary.

A United official said it was costing the company more to review procedures it approved "99 percent of the time" than whatever was saved from the treatments it denied. The company said it will cut 20 percent of its review staff. The public relations benefits of the policy change, of course, cannot be measured.

It is too soon to know whether other insurers will follow, but United's action undermined the industry's argument that such reviews are necessary to "control costs."

Other victories for patients

The elderly and their families joined forces with the nursing home industry to lobby against therapy caps in Medicare -- spending limits on various therapies imposed by Congress in 1997 to help balance the budget.

The caps, which took effect in 1999, went too far, say patients and nursing home industry leaders, saving $750 million more than the $1.3 billion Congress envisioned. And therapy options for some stroke victims, for example, were limited so severely that patients were forced to choose between physical and speech therapy -- or whether they "could walk or talk," as one industry spokesperson put it.

The tens of millions of dollars the nursing home industry spent on its ad campaign got the message across. In November, as part of a deal that restored $11 billion in Medicare cuts, Congress agreed to a two-year moratorium on some therapy caps until lawmakers can make a more extensive review.

Consumers also battled higher prescription drug costs, especially among those most often dispensed to the elderly, and demanded prescription drug benefits be included in an overhaul of the Medicare system.

The proposal to overhaul Medicare made by the Clinton administration in June would include payments for prescription drugs, which would help people such as 73-year-old Eunis Martin, who pays $320 a month for medicine

The American Association of Retired Persons led the charge, arguing elderly patients would not be able to afford the new "wonder drugs" being developed for their benefit. Congress is expected to take another look at the issue next year.

Health care clearly has become a central issue in American politics. A common theme of floor speeches in Congress this year: People are tired of hearing the United States has the best medical system in the world when many are unable to access it.

As if to reinforce the point, government figures show the ranks of the uninsured rose slightly in 1998 to 44.3 million, the highest since Medicare and Medicaid began three decades ago.

And surveys by the Kaiser Family Foundation indicate more families than ever are concerned about the cost of medical insurance.

Medical advances to come

According to Health Magazine, we can look forward to some major medical advances in the next decade.

One that may be available in three to five years, the magazine says, is an insulin inhaler that could allow those affected by diabetes to get their daily doses of insulin without needles. At least two companies are testing powdered insulin delivered through such a device.

Other advances, according to Health Magazine, include clothes that actually kill germs made from a new line of cotton fabrics that have HaloShield, a rechargeable chlorine-based treatment. Hospitals are particularly interested because the fabrics kill salmonella and E. coli bacteria, among other germs, without promoting antibiotic resistance.

Aided by new discoveries in genetics, scientists at the National Institutes of Health and other private companies, continue to find success, at least in mice, with several new drugs to combat diseases from cancer to Alzheimer's.

Amgen, a California biotech company, identified an enzyme critical in the formation of the protein plaques that damage neurons in the brains of Alzheimer's patients. The race is on to find a drug that will inhibit this enzyme and its role in forming these destructive plaques.

If the drugs work in people, they may slow or even halt the confusion and memory loss associated with this devastating disease.

Researchers caution, however, it will take years of safety and efficacy trials to determine whether such drugs really can make a difference. An 18-year-old boy in Arizona died in 1999 from a gene therapy experiment for a treatment of a certain liver disease, a sober reminder that the science of medicine holds no guarantees.

Testing a cancer 'vaccine'

Another hopeful avenue scientists are exploring involves the development of vaccines. One actually uses cancer cells from patients recently diagnosed with lymphoma. The cells are later re-injected into the patient along with cells the immune system recognizes and fights.

The idea is to teach the patient's own immune system to recognize the cancerous cells as "bad" and fight them, should they grow back after surgery and chemotherapy. A second clinical trial, conducted by the National Cancer Institute in Washington, will start as early as next year.

All these vaccines are linked to the advances made from our knowledge of the human gene. This spring scientists working at labs throughout the country will complete the first draft of the human genome, a blueprint of the genetic code.

Genes have already been identified that help explain why certain people are more prone to heart disease, certain cancers and other conditions. The next step will be to use that knowledge to prevent disease almost from conception.

Eileen O'Connor has been reporting from Washington on medical and health issues for CNN since November 1998. She previously was a White House correspondent and chief of CNN's Moscow bureau.