By Robert Jordan, Globe Columnist, 10/10/99

erhaps the one group in the nation most in need of health care is the Republican leadership in Congress.

After suffering setbacks from a series of self-inflicted political wounds during their stubborn opposition to a proposed patients bill of rights, the GOP leadership and other Republican extremists in the House of Representatives were virtually trampled last week by the Democratic-led vote of 275 to 151 to approve the measure.

The margin of victory for the patient protection bill, which includes a patient's right to sue a health plan in state courts, underscores the growing public support for this grass-roots movement to protect patients from health maintenance organizations and other managed care plans.

Supporters of this strong measure are optimistic that a patients' rights bill will pass the Senate and, when all is done, will remain strong enough for President Clinton, a staunch backer of the House bill, to sign into law.

As Edward M. Kennedy, who sponsored a patient protection bill in the Senate that was the basis for the House-passed version, said, ''The Senate flunked the test in July, but the House has given us a new chance to do the right thing.'' And the right thing is for the House-Senate conference to adopt the House bill but without the costly tax breaks that Republican extremists managed to tack on in an apparent effort to kill the legislation.

Republicans who backed the House bill no doubt are aware that many voters will view Republicans who fought the bill as on the side of the medical/insurance establishment, and lawmakers who backed the bill as on the side of consumers.

Among the list of protections the House bill provides is the right to see specialists, the right to independent review of health plan denials, guaranteed payment for emergency care, and, of course, the right to sue a health plan.

The much-weaker Senate bill - passed in July with the backing of the managed care industry - provides protections only to the 48 million Americans in plans regulated by federal law. The House-passed bill covers all Americans, more than 161 million, with private health insurance.

The right-to-sue issue appears to be at the crux of the Republican opposition to the House-passed measure. The House bill allows patients to sue in state courts, and it lifts the federal ban on lawsuits for patients in health plans that fall under federal regulation.

Foes of the House bill argue that giving patients the right to sue will produce more lawsuits that in turn will force up the cost of health premiums - a hardship on working families.

But the argument rings hollow, given how little interest HMOs and other managed care companies have shown in protecting working families. They are out to protect the interests, and the profits, of the health insurance industry.

The right to sue is essential because so many patients have been seriously injured - or have died - because of badly managed HMOs, and they or their families have had virtually no legal recourse.

And there is little reason to believe GOP arguments that waves of frivolous lawsuits will result from the House-passed bill. Texas two years ago passed legislation that is a model for the House-approved bill. Since enacted, according to backers of the House bill, the Texas law has resulted in five lawsuits, with the possibility that two of them might be withdrawn. The one that went forward involved a pyschiatric patient who didn't want to leave the hospital, fearing he would kill himself. The health plan nonetheless discharged him even earlier than his scheduled date. When he committed suicide by drinking anti-freeze, his widow sued.

Similar laws have been passed in California and Missouri, reflecting the growing movement for state and federal protections for patients.

Many other patients harmed while under HMO care did not get any help because they either had no right to appeal, or were not informed that they did. Both the state law in Texas and the House-passed bill spell out those rights.

Given the lack of evidence that a flood of lawsuits will flow from the right to sue, the GOP's scare tactic about higher costs can be dismissed. In fact, one insurance company executive recently acknowledged that his plan would not charge higher premiums to patients if legislation gave patients the right to sue. And an examination of costs in right-to-sue venues showed only a 3-cent monthly increase in premiums.

In addition, most supporters, as well as some enlightened insurers, see the right-to-sue clause as a deterrent against HMOs mistreating patients.

Now it's up to the House-Senate conference committee to agree on a measure close to the House bill. It is something most Americans want and need. Once it passes Congress, some GOP extremists may finally realize that embracing the patients' rights bill could have saved their own political lives - but for them it will be too late.

Robert A. Jordan is a Globe columnist.