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Where today is legislative ingenuity lavished more bountiully than on the titles of statutes? And where has that ingenuity been better exercised than in the name "patients' bill of rights"? Do not our dearest liberties flow from the Bill of Rights? And who more deserves similar protection than patients in the hands of an angry Managed Care Organization? And behold, both Democrats and Republicans, both President Clinton and President Bush, have summoned us to arms. The patients' bill of rights is an idea whose time has seemed to have come for several years, and only conflicts among the numerous proposals and 11 September have postponed the apparently inevitable. The impetus for legislation is irresistible. Its name is managed care. American medicine has moved from cottage industry to bureaucratic behemoth with imposing and implacable speed. Ought not combinations of great size-malefactors of great wealth-be regulated, especially when their services can literally be vital? What is more, cost containment with bite, once a fantasy, is becoming a reality. When medical bureaucracies are commanded to conserve resources, they in turn drive physicians into an ethically tense position-serving both the god of patients' welfare and the Mammon of MCO profits. Ought not government police that conflict of interest?


Reprinted with the permission of the Hastings Center Report and Wiley-Blackwell.