Everybody wants a "patients’ bill of rights," or so it seems. The president wants one, the Congress wants one, and the patients certainly want one. The question is, exactly what rights should patients be guaranteed?

President George W. Bush has told Congress that he wants such a bill before the end of the year, but he has vowed to veto legislation that would drive up the cost of health care and health insurance by encouraging litigation. "The idea is to serve more patients, not to create more lawsuits," said Bush, and other Republican leaders said that health care should be accomplished in physicians’ offices and hospitals , not in attorney’s offices and courtrooms.

The Democratic plan would rewrite 27 years of rules that now protect HMOs and insurers from patient complaints and lawsuits. That plan would provide a list of guarantees for patients, including emergency care, access to obstetricians and gynecologists, and payment for costs associated with clinical trials, and would let patients sue insurers in either federal or state court for a wide range of damages, including punitive ones. Currently, the 1974 Employee Retirement Income Security Act prohibits patients from suing in state courts over health-care or other employee benefits. While a suit may be filed in federal courts, the benefits covered are extremely limited.

Patients and employers have been hit with drastic increases in health-insurance costs over recent years, and no one wants to drive those costs up further. In an even broader sense, no one wants to take any action that will render health care less affordable and so, ultimately, less accessible. Those concerns are justified and the GOP is acting reasonably to insist that they must be addressed.

But Congress must provide a mechanism by which patients’ appeals of denials of coverage can be heard and decided in a timely manner. Lengthy processes that involve shuffling papers from one bureaucrat to the next effectively serve to deny care to patients who cannot afford it unless it’s covered by their insurers. Few of us are hard-hearted enough to believe that justice is served if a patient dies while appealing their HMO’s decision not to cover a procedure.

In addition, not all of the disallowed services are controversial. Some of them are expensive but cost-effective; some are effective but problematic from a political or religious standpoint (a recent example has been the challenge to insurance companies who pay for Viagra but not for contraception), and some simply have been denied because of clerical errors. Mistakes happen, even in life-and-death decisions.

It’s possible that the Republicans can craft a plan that will expedite the appeals process and preserve patients’ rights. The more safeguards that are built in, the better. At the end of that process, though, patients must have the right to use the judicial system to protect their right to adequate health care.