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If you were a foreigner eavesdropping on the bruising battle in the Senate, you would assume that the most important health care issue in America is the right to sue an HMO. You would believe we all sit around waiting for an appendix to burst or a malignancy to spread, hoping that we will be denied a specialist or an experimental treatment so we -- or our heirs -- could sue the bejesus out of our insurer.

This is what it has come down to. For five years, we've been wrangling our way to a national Patients' Bill of Rights. Those who regard insurers as an enemy to fight, hassle or 'game' in order to get a test are close to getting a handful of weapons for self-defense.

Both sides of the Senate seem ready to guarantee access to specialists, to emergency rooms, to clinical trials of experimental drugs and to independent review of medical claims. But they still disagree over when and where we can sue and how much we get if the HMO improperly denies a claim.

This has produced a battle of the Capitol Titans. Republicans and Democrats are fighting for control of the Senate agenda. Lobbyists are fighting for a piece of the action. The president is threatening a veto. All over damages.

Well, I have no doubt that there are too many lawyers in the U.S. Senate. But the senators who want to make it easier to sue are not really chasing ambulances. They see the threat of liability as a way to scare the HMOs straight.

Ron Pollack of the health-care advocacy group Families USA calls it a deterrence plan or "litigation prevention." After all, California has had the right to sue for unlimited damages since January. Not a case has been filed, and HMOs are referring more patients for swifter treatment.

Nevertheless, as I watch the heat and light -- and money -- being expended over the question "to sue or not to sue," I'm beginning to long for a little perspective. This isn't a Patients' Bill of Rights. It's a Bill of Rights for People Who Have Insurance.

It's a bill of rights without the right to health care.

"To listen to the rhetoric on Capitol Hill," says Jack Meyer of the Economic and Social Research Institute, "you would think everyone had coverage and we're just arguing over access to certain doctors. I wish we would spend a fraction of the energy that's been spent on this Patients' Bill of Rights on assuring basic coverage.

"I have insurance, and at times I get very frustrated," he adds, "But if you don't have a health plan at all, it's a very academic issue."

Let's run the numbers. More than 43 million Americans are in this "academic" state. That's about 15 percent of the population. They don't have an insurance company to get frustrated at. The United States is -- may I repeat? -- the only industrialized country that doesn't guarantee the right to health care.

Conservatives, including the president, couch their opposition to the new bill with concern for consumers. The party line is that lawsuits would drive up the cost of health care and drive out consumers.

Have you seen the ad featuring the mother of a toddler saying, "I'll lose my coverage if costs go up!" Well, many of the HMOs claiming that they'll go broke from frivolous lawsuits are paying their own CEOs very nicely, thank you. As Families USA reported last week, the 25 highest-paid executives of for-profit health plans made a collective $201 million last year. And that's not counting the unexercised stock options.

Yes, health care coverage is expensive. Most HMOs are not making a bundle, even if their top CEOs are. It's expensive, as Meyer says, "because every day we are discovering new things and we want it all." But so far, we're just nibbling around the edges of our problems. What's expected in many countries is considered pie in the American sky. Even under the current crazy-quilt system, we could begin expanding from the coverage of elders and children to parents and single adults.

It's time to pass this Bill of Rights for the Insured. Those of us with health care deserve some tools to deal with the diffident HMO clerk on the other end of the line.

But there's a waitress out there who can't afford a mammogram and a maintenance worker who can't afford prostate screening, and neither of them has an insurer, let alone a lobbyist. Their great American dream is not, I promise you, finding someone to sue.

Boston Globe Newspaper Co.

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