This column is about U.S. Sens. Olympia Snowe and Susan Collins, and you.

Growing up barely big enough to pound chalk erasers together, I had to pick my fights carefully. There were some kids in my school you never fought with because they were bigger than the school bus. There were other kids no bigger than I, however, that you never picked a fight with because they came across as crazy enough to hit you with a chair. You thought twice before you crossed them.

Having health insurance is a bit like that; compared to the health maintenance organizations and the businesses that employ them, most of us are playground runts. We need something that makes them think twice about taking advantage of us, and that something is a patients’ bill of rights with the right to sue an HMO when its decision to deny payment for a specific element of medical care results in injury to the patient.

The U.S. Senate is currently the scene of a playground brawl over the proposed McCain-Edwards-Kennedy patients’ bill of rights because that bill would allow patients the right to sue HMOs in state courts for damages up to $5 million. That would make anyone think twice about picking on you at recess.

The McCain-Kennedy bill is opposed by a coalition of HMOs, business interests and conservative Republicans. It is seeing the light of day only because the Democrats have assumed control of the Senate, and because more moderate Republicans such as Sen. John McCain have put forth a bipartisan bill.

President Bush has threatened to veto the bill, supporting instead another bill that allows for a right to sue for a lot less money, only in federal court, and only after an independent appeals process has been concluded. That is a bit like offering a bug the right to sue the driver if it can get through the car windshield it hits at 60 mph. It is nothing that would keep you out of trouble with the big kids.

Those who oppose the McCain-Kennedy version of a patients’ bill of rights do so in part because they fear many suits against HMOs will result, and that will add to the cost of health insurance. The national experience thus far with the right to sue HMOs is that few lawsuits result. Both Texas and California have laws that allow HMOs to be sued, and there have been few suits in either state.

All patients’ rights bills include appeal and review processes that will settle most disputes before the courtroom. The idea that the right to sue will increase health insurance premiums is being hyped by opponents of the bill because the only thing scarier to most of us than an HMO that is not accountable for its actions is no health insurance at all.

Among the delicious features of the great patients’ bill of rights debate is that it pits the patient David against the HMO Goliath, and in this case too, David has a real chance to win in the Senate. In addition, Maine voters may have a great deal of influence in Washington on this issue.

The Senate is currently controlled by Democrats, but crucial votes belong to moderate Republicans, including Maine’s own Sens. Snowe and Collins. Their votes will be necessary to override a veto of the McCain-Kennedy bill by President Bush, and will also be necessary to prevent the weaker alternative from becoming the predominant patient’s rights bill. Neither Maine senator wants to run in their next election against an opponent who will be able to gain lots of political mileage pointing out that a good patient’s bill of rights failed on their accounts. Both might support a weaker bill than McCain-Kennedy if they are not convinced that doing so would be get them in trouble at recess.

This is where you and Sens. Snowe and Collins come in. The good senators need to be convinced that Maine voters, Maine patients, want them to support the McCain-Kennedy patients’ bill of rights because the patient is not going to be pushed around on the playground anymore. That can only be done by generating enough noise from the public that its voice can be heard over the din of HMOs spending millions for the bill’s defeat.

Sen. Snowe can be reached at 800-432-1599 or you can e-mail olympia@snowe.senate.gov.

Sen. Collins can be reached at 202-224-2523, or 207-945-0417, or e-mail senator@collins.senate.gov.

Will there be chocolate milk for snack today?

Erik Steele, D.O. is the administrator for emergency services at Eastern Maine Medical Center and is on the staff for emergency department coverage at six hospitals in the Bangor Daily News coverage area.