[Congressional Record Volume 140, Number 24 (Tuesday, March 8, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: March 8, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                 A DIFFERENT PERSPECTIVE ON HEALTH CARE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
February 11, 1994, the gentleman from Ohio [Mr. Hoke] is recognized 
during morning business for 5 minutes.
  Mr. HOKE. Madam Speaker, I would like to speak this morning, just 
briefly, with a different perspective on health care and some of the 
implications of the President's plan, some of the implications that 
have come about as a result of what has been a fundamental shift in the 
way that health care gets paid for in our country over the past 40 or 
so years. To illustrate that, Madam Speaker, I would like to point out 
first of all that in 1950 approximately 20 percent of all health care 
was paid for by third parties, and in 1950 ``third parties'' meant 
insurance companies for the most part. And 80 percent of health care 
was paid for by individuals. In 1994, Madam Speaker, that number gets 
flipped around, where 20 percent of health care gets paid for by 
individuals and 80 percent gets paid for by third parties; that is, 
insurance companies or the Government, and I want to share with my 
colleagues what I believe is probably the most profound ethical 
implication of that because it is, in fact, the issue of quality as 
opposed to cost which will ultimately be the issue that every single 
one of us as consumers of health care, as patients, as people who get 
into trouble with either diseases or accidents, that we will be 
concerned with because it is, in fact, the quality issue that will 
ultimately become the most important issue.
  Madam Speaker, I want to share with my colleagues a quotation from a 
Swiss medical philosopher whose name is Ernest Truffer, admittedly not 
a household name, but he brings out this point in a way that is much 
better than I could.

       The increasing intrusion of third parties on the doctor-
     patient relationship amounts to a rejection of the medical 
     ethic, the medical ethic which is to care for a patient 
     according to that patient's specific medical requirements as 
     opposed to the veterinary ethic which consists of caring for 
     the sick animal, not in accordance with its specific medical 
     needs, but according to the requirements of its master and 
     owner; that is, the person who is responsible for paying the 
     fee.

                              {time}  1120

  Herein is the rub with respect to managed care, with respect to 
Government-funded and Government-paid-for health care programs. That is 
that instead of having that relationship between the doctor and the 
patient upon which quality health care is built, upon which the entire 
Western medical model is built, instead we are building this model that 
is based not necessarily on what the doctor wants or what the patient 
wants but what the person who is paying for it is willing to pay, and 
that is the Government or the insurance company in the models we have 
created in the 1990's in the United States.
  I commend to the attention of the Members two things: First, I would 
commend to their attention the book that was recently published, 
written by Robin Cook called ``Fatal Cure.'' It describes very well how 
this works to a patient's detriment in managed care situations.
  I would also commend to their attention a very, very careful 
consideration of the implications that third party payers have with 
respect to the actual quality of care that we receive as patients. It 
is, in fact, necessary to empower patients as consumers, patients as 
the ones making the decisions, putting the patients and the doctors 
back in the driver's seat, which will restore and insure quality care 
in the United States going into the 21st century.

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