[Congressional Record Volume 140, Number 79 (Tuesday, June 21, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: June 21, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                         WE NEED HEALTH REFORM

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Washington [Mr. McDermott] is recognized for 30 minutes.
  Mr. McDERMOTT. Mr. Speaker, the question that has been raised very 
frequently over the last few months has been the question, why do we 
need health care reform?
  There has certainly been those in this House who have said we do not 
need health care reform, that everything is just fine, that if one has 
health care insurance now, do not worry, they are taken care of, there 
is nothing to worry about.
  Mr. Speaker, I want to take this time to talk to the Members about an 
issue that affects me very much personally because I know the people 
involved. This is not some theoretical story, this is an actual human 
beings story who have what is called good health insurance. Many times 
people say, ``Are you in the Congress going to give us the same kind of 
health care that you have?''
  I would suggest to people who say that that they want better than we 
have in the U.S. Congress.
  All the Members of the U.S. Congress belong to the Federal Employees 
Health Benefit Program. All other Federal employees are in that same 
program. I want to talk about what that program really does and how it 
affects individuals.
  Many times as people talk about the whole area of health insurance, 
they say that the problem is the patients. The patients, they are using 
the system too much, it is costing too much because the patients are 
the ones at fault in the health care system. The theory, then, is that 
we ought to have managed care, we ought to force everybody into managed 
care and give people a bunch of booklets to look through so that they 
can shop smart, like buying health insurance was like buying a new 
automobile, or was like buying a new refrigerator.
  If you are going to buy a new refrigerator, you know exactly the size 
of your kitchen, you know the space it is going to go, you know whether 
you want a de-icer or what kind of attachments you might want on it.
  If you are buying an automobile, you know whether you are going to be 
driving long distances or short distances or over rough terrain or what 
kind of use you will put that vehicle to.
  The problem with health care for all Americans is none of us know 
what we will need tomorrow. We hope that we will never have to use our 
health insurance. There is not anybody out there sort of slathering 
after using their health insurance. People have health insurance 
policies, hopeful that when the time comes and a problem comes to them, 
that health insurance will cover them for the things that they need.
  Mr. Speaker, I was a physician in the State Department living in 
Zaire a long time ago, in 1987, and as a member of the State 
Department, I got to know the director of medical affairs of the U.S. 
Department of State. He has allowed me to use his name and I am going 
to tell his story and his wife's story because I think it is 
instructive about what all Americans face no matter who you are or in 
what level you are why we need health reform in this country.

                              {time}  1900

  Dr. Goff is an oncologist. That is somebody whose primary specialty 
is in the treatment of cancer. So if there is anybody in this society 
who ought to know how to buy a smart insurance policy related to 
cancer, it should be Dr. Goff. But here is what happened to the Goff 
family.
  Mrs. Goff, who is 53 years old, got cancer of the uterus, and she had 
the diagnosis made at a fairly late stage. She has had now two 
operations and several sets of chemotherapy, and they recently did what 
they call an operation to look back and see if the cancer has cleared 
up.
  There is a reoccurrence, and the recommendation made by the 
Hutchinson Cancer Center in Seattle and the doctors in Bellingham, WA, 
where she lives, is she ought to have high dose chemotherapy plus a 
bone marrow transplant to support that high dose chemotherapy.
  They went to their Federal Employees Health Benefit Plan and they 
looked in it and they said, well, it says it covers bone marrow 
transplants. We will go and get the assurance of the Federal plan that 
we are covered by.
  Now, the Federal plan is administered by Blue Cross of Washington, 
DC., here in the city of Washington, in the capital city. Even though 
they live out in Washington State, their insurance plan is administered 
by Blue Cross of Washington, DC.
  Blue Cross of Washington, DC., said our plan does not cover your 
treatment, the high dose chemotherapy or the bone marrow transplant.
  So here is a family, Dr. Goff is now retired from the State 
Department, he has been in the Government for 25 years, paid into a 
plan that he every year thought would cover whatever is necessary for 
his family's well-being, and suddenly he finds that he has a plan that 
does not cover his particular problems.
  Now, he began to do some research because he is an oncologist, and he 
went through the literature and found that things that are covered by 
that plan, there is no more basis for their being covered than for the 
procedures that his wife was trying to get payment for, and, in fact, 
in many instances the things that are covered have less scientific 
basis than what they produce.
  He talked to people at the Washington State Blue Cross. Blue Cross of 
Washington and Alaska is in Seattle. He talked to the medical director 
there and I talked to him. The doctor said yes, the Federal plan does 
not cover this kind of treatment. But if you happen to be in Blue Cross 
of Washington State, if you are covered by the Washington State Blue 
Cross, this treatment would be covered.
  Now, I ask you, and I ask any Member of Congress, how we can possibly 
in this body put out the belief to people that we are going to make it 
possible for them to shop smart? You cannot shop smart when you do not 
know what is going to happen to you, when you cannot read your Blue 
Cross plan, when you do not know what the scientific changes are across 
the medical field. And yet, here we are hurdling toward going after, 
presenting to the American people, a plan which gives more power to 
insurance companies.
  What is happening to Dr. Goff and what is happening to lots of 
Americans is that their health care is being rationed. Right now all 
the rationing that is going on in this country is being done by 
insurance companies. It is being decided by actuaries, it is being 
decided by accountants, people who decide well, this only gives 
somebody 10 percent greater chance. We are not going to worry about it. 
We will not give that kind of treatment. We will only give treatment to 
somebody, maybe 50 percent or 60 percent or whatever.
  The decisions that are being made in health care today are being made 
by insurance companies. And for the Congress to say that we want to get 
everybody into managed care, and therefore we will be able to save 
money, is simply handing control of the health care of all our 
constituents into the hands of about six or eight large insurance 
companies in this country.
  Now, Dr. Goff has a fall-back position. Since his insurance does not 
pay for it, if you want to get a bone marrow transplant, I don't care 
what center it is in the United States, they will either take you, if 
your insurance plan covers it, or if you can take out of your pocket 
$60 or $80 or $100 thousand and put it on the table before you come in.
  Now, this is a doctor, he has got a practice, he is making a decent 
living. He has a pension and so forth. But they will not accept from 
him oh, just come in and have the treatment and pay us when you get the 
money. They wanted the money up front. This is in the Hutchinson Cancer 
Center in Seattle and every other cancer center. They do not do bone 
marrow transplants without advance payment or assurance of it from an 
insurance plan.

  Now, Dr. Goff is lucky. He may be able to take a loan out on his 
house, take the equity out of his house, for $60,000 or $80,000, and 
put that money down and get that kind of treatment for his wife. He is 
lucky.
  Not everybody in this country is not lucky enough to be able to come 
up with $80,000 at the exact time that their loved one, whether it is a 
wife or a child or whomever, needs that kind of treatment. And what the 
President has said is that we need health care that can never be taken 
away, and that covers the things that Americans are worried about.
  Everyone who has insurance right now says, why should I be worried? 
Well, let me tell you, the reason why every American, including Members 
of Congress, should be worried, is that none of us know whether the 
policy we have been paying on will cover the kinds of things that may 
face us. And there is no way we can ever be that knowledgeable.
  I am a physician. I could not be that knowledgeable. Nobody can. And 
it is nonsense to say that he American people suddenly, we are going to 
hand them booklets and they are going to then be knowledgeable to buy 
health insurance.
  Any time anybody comes on the floor of this House and says that we 
will hand around a bunch of booklets and people will know how to buy 
good health care simply is talking nonsense. If Dr. Goff did not know 
how to do it, it is sure that Jim McDermott will not know how to do it, 
and every Member of Congress and all the American people are going to 
be in the same bind.
  Now, I support the single payer system because I think it is the best 
way to give every one the opportunity to see the physician of their 
choice, to have the biggest benefit package, to have it paid for in the 
most efficient way. We can save $100 billion a year. The Congressional 
Budget Office has said by eliminating insurance companies from the 
process and letting the doctor and the patient make this decision about 
what ought to be done, we can save $100 billion a year, which will 
cover all the benefits which our society presently does not have.
  All of us hope, all of us hope, desperately hope, that we will never 
use our health insurance. We do not want to use it. It is not something 
people lie around at night saying, gee, I wonder how I can get some 
benefits out of my insurance policy. That would be like saying you 
would want to have some benefits out of your fire insurance policy. 
Maybe if we had a fire in the house, we could finally get some benefits 
out of that.
  Nobody want that. And the fact is that the single payer system is the 
only way you can guarantee to the American people that you provide a 
benefit package that covers the things that people need with an 
affordable cost. And I hope that this Congress will consider the case 
of Dr. Goff and all the other people.
  He is not alone. There was a case in California of a woman who had 
breast cancer, and the doctors recommended a bone marrow transplant for 
her. And, she did not have the money. So she had to go around and try 
and raise the money. Finally she got it, but too late. She died.
  But the case was settled in the California courts for $84 million, 
very simply because the contract that she had from the managed care 
operation said they did bone marrow transplants. What it didn't say was 
we don't do bone marrow transplants if you have breast cancer.

                              {time}  1910

  So she thought she was covered. And in fact, that same case was 
settled really in large measure because they found a provision in the 
internal memos of the company which said to the doctors, ``If you don't 
make referrals for bone marrow transplants, you will get paid more.'' 
That is what managed competition is all about. That is what managed 
care under insurance companies is all about. It is not directed at what 
is in the best interest of the patient. It is directed at what is in 
the best interest of the stockholders.
  You have to remember that managed care from insurance companies 
simply is designed in a corporation to take in as much money as 
possible, spend as little on benefits as possible so at the end of the 
quarter you can give the biggest dividends to the stockholders. And a 
health insurance plan run by insurance companies with managed care by 
insurance companies is not going to be good for the American people.
  That is why I support the American Health Security Act, which is the 
single-payer plan, H.R. 1200. I hope every Member of this Congress will 
read that bill and consider it the best for all their constituents.

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