[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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