[Congressional Record Volume 140, Number 6 (Tuesday, February 1, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]
[Congressional Record: February 1, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]
DO WE NEED HEALTH CARE REFORM?
(Mr. DUNCAN asked and was given permission to address the House for 1
minute and to revise and extend his remarks and include extraneous
matter.)
Mr. DUNCAN. Mr. Speaker, if the President's health care plan is so
great, why not try it out in some city or county first.
Why do we have to force it on the whole country before we even know
if or how it will work?
Columnist Paul Craig Roberts said in his most recent syndicated
column:
If Americans think their health-care system is in crisis
now, just wait until Clinton's health plan becomes law.
All of us would make some changes if we could, but before we rush
into some radical and extremely expensive new system, I hope we will
consider these words from yesterday's column by George Melloan:
If you ask Europeans how they feel about `free' health care
many will say it's nice, unless they have been in an Italian
hospital lately or been put on a six-months waiting list for
surgery in England.
If you ask them how they feel about high taxes and
insolvent governments, they say its terrible. Yet the two
things are inextricably linked.
For example national health care swallows some 40% of
Italy's direct taxation, even though half the country now
resorts to private care part of the time.
Europe's politicians know that national health care isn't
`free'. Every Western European government is trying to cut
its costs, courting unpopularity in the process. Sweden is
trying to totally overhaul the welfare state to stave off
national bankruptcy.
Our system is not perfect, but it is far better than what is found
any place else in the world.
Mr. Speaker, I include for the Record the article to which I
referred:
[From the Knoxville News-Sentinel, Jan. 30, 1994]
Clinton Plan Not Good for What Ails Us
(By Paul Craig Roberts)
If Americans think their health-care system is in crisis
now, just wait until Clinton's health plan becomes law. The
plan is based on ``managed care,'' an approach sold by health
maintenance organizations, including Kaiser Permanente.
These systems employ ``gatekeepers'' to pressure
participating doctors to hold down costs in order to meet
budgetary targets. The savings are passed on to employers in
the form of lower health insurance premiums and to
participating doctors in year-end bonuses.
There is nothing wrong with saving money, but often it is
at the expense of patients whose illnesses fall outside
normal parameters. Once doctors have to be advocates for HMO
budgets, physician behavior and medical culture change.
Guidelines force doctors to defer to statistics and
probabilities when making decisions to use expensive
diagnostic tools and treatments.
A person whose illness, for example, falls outside the
normal age range for a disease can go undetected and
untreated until it is too late. There have been celebrated
cases of women denied mammograms by their HMOs because they
were younger than the ``at risk'' age. In Clinton's health
plan, only women older than 50 would be eligible for
mammography. Similar cutoff points apply to prostate and
colon cancer tests and any number of procedures.
Budgetary pressures will cause some operations to be
rationed by age. Cutoff points are likely for hip
replacements and organ transplants, regardless of the
patients' energy, zest for life and general viability.
Various treatments that don't have high success rates will be
curtailed--at the expense of the minority that would have
benefited. In the name of ``eliminating wastefulness,''
budgets will prevail over health care.
Doctors who are advocates for their patients will find
themselves over-budget, penalized and even dropped from the
HMO.
For about a decade, doctors have been under cost pressures
that make them less effective advocates for their patients.
``Utilization review'' is used by hospitals to pressure
doctors to discharge their patients by the date set by the
employer's insurance company. No doubt this practice prevents
unnecessary and prolonged hospitalizations. It works for the
person whose postoperative recovery fits the normal pattern.
Every patient is not typical, and borderline cases no longer
get the benefit of the doubt.
In our present system, the rationing that is imposed by HMO
gatekeepers and utilization review is kept in check by the
availability of a variety of health-care arrangements, such
as fee-for-service care. However, once Clinton turns the
whole system into an HMO, budgetary considerations will
prevail over patient care.
The proof that Clinton's plan is going to impose massive
rationing of health care is the stiff penalty it imposes on
anyone who resorts to bribery. Bribes are not a feature of
our present system, and we should be forewarned by Clinton's
expectation that bribery will be a feature of his.
Health-care reformers claim that a system of ``report
cards'' will force doctors to provide quality care despite
budgetary pressures. These report cards will be
counterproductive. Heart surgeons, for example, can get good
grades by having high rates of patient survival--a result
that can be insured by not operating on risky patients. Thus,
report cards will reinforce rationing.
In Clinton's system, the people with the worst odds are
going to be written off. The greatest fault of Clinton's plan
is that it is designed to benefit a minority at great expense
to the majority. It is cruel to make most people worse off in
order to meet the needs of the homeless, the unemployed and
those with uninsurable preconditions.
A better alternative is to design a health-care safety net
for the uninsured. Indeed, Clinton's plan is unlikely to help
even the poor. Often illiterate and inarticulate, the poor
lack the skills and persistence to squeeze health care out of
a bureaucratized system. To get anywhere in Clinton's system,
the poor would need a support service of special advocates,
which would put them in conflict with the plan's prohibition
against using influence to obtain health care.
Sometimes even rationing imposed by guidelines and budget-
conscious gatekeepers cannot keep a plan within budget. When
that happens, as it did recently in Canada, the government
closes down the system and reneges on its contracts. For two
weeks in December, Ontario shut its hospitals. It had run out
of money.
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