"You're either part of the solution or part of the problem." - Eldridge Cleaver, 1968. Last month, in a breathtaking display of what's wrong with health care in America, Senate Republicans on July 15 defeated the Democratic-sponsored, labor-backed "Patient's Bill of Rights." Below is a column by the Wall Street Journal's Albert Hunt, which explains how political ideology has moved many Republicans way out of the mainstream when it comes to the problem of regulating HMOs. The best way to explain what happened with the 53-47 defeat of the Senate bill is to tell you about some of the practices that will be allowed to continue in the health care industry, thanks to the GOP vote:

• Patients still can almost never sue their HMOs for malpractice.
• A patient's doctor still cannot make the final decision over what procedures are medically necessary. Republicans instead passed a provision that leaves the final decision for medical procedures to a doctor in the insurance company.
• Republicans let HMOs impose "gag rules" on doctors, preventing them from discussing all treatments with their patients.
• Republicans defeated a provision to let patients keep their same doctors for a few months if they are forced to switch health plans.
• Women cannot choose their obstetrician-gynecologists as their primary care doctor. Under the Republican legislation, women cannot see Ob-Gyns without their primary doctor's permission.

"Most Americans would be shocked to know that HMOs are immune from responsibility for their actions," said Sen. Edward Kennedy, D-Mass. "No other industry in America enjoys this immunity…This immunity is literally a license to kill." Republicans countered that widening the limited circumstances in which patients can sue HMOs would result in an avalanche of lawsuits that would send health care costs through the roof. Kennedy responded by citing Congressional Budget Office estimates the Democratic bill would only increase health costs by 4.8 percent over five years. Democrats have vowed to make patients' rights a campaign battleground in 2000. Republicans, who control both the U.S. Senate and House, have had the say over far-reaching Democratic proposals to give 161 million Americans greater control over their health insurers. "How can a law which excludes 100 million Americans, allows insurance companies to make critical medical decisions, exposes health care workers to retaliation when they speak out on behalf of a patient and denies patients access to specialists be labeled patient protection?" asked AFL-CIO President John Sweeney. President Clinton called the Republican defeat of the bill "a sad day for health care in America." Clinton called their managed care legislation "merely toothless and half-hearted protections,'' adding, "The people deserve a bill that protects them, not the insurance companies." Vice President Al Gore called the Republican version of the legislation a "fraud" and said that Clinton "will veto it in a minute." The AFL-CIO supported the Patients' Bill of Rights sponsored by Sen. Edward Kennedy (D-Mass.) and Senate Minority Leader Tom Daschle (D-S.D.). "When Washington politicians bow to the pressure of well-heeled insurance company lobbyists, working families lose out,'' federation President John J. Sweeney said. The AFL-CIO states more than 90 percent of Americans believe that a patient protection act is needed. Today, some 80 percent of people with private insurance are in managed care, which tries to control costs by eliminating unnecessary care and coordinating treatments.