[Congressional Record Volume 140, Number 89 (Tuesday, July 12, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: July 12, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
       WALL STREET JOURNAL ARTICLE ``PRESCRIPTION FOR DISASTER''

                                 ______


                           HON. NEWT GINGRICH

                               of georgia

                    in the house of representatives

                         Tuesday, July 12, 1994

  Mr. GINGRICH. Mr. Speaker, I would like to bring to the attention of 
my colleagues the June 6, 1994, Wall Street Journal article 
``Prescription for Disaster,'' by Michael E. DeBakey. This article 
portrays the dangers of cost-containment methods that restrict freedom 
of choice and stifle new medical research and development.

                       Prescription for Disaster

                        (By Michael E. DeBakey)

       When I think of HMOs and other health care plans with an 
     emphasis on cost-containment, I am reminded of a woman from 
     California who flew out to see me in Texas several years ago.
       This patient, active and in her 50s, had a dissecting 
     aneurysm of the aorta, a type of heart disease that is 
     rapidly fatal when not treated by the corrective operation 
     that I developed and first used successfully in 1954. The 
     woman, who belonged to an HMO-type of ``managed care'' plan, 
     had been told by her physicians at home that surgical 
     treatment would not be approved. A doctor relative of hers 
     put her into contact with me, and although I was willing to 
     perform the operation without charge, she couldn't afford the 
     hospital costs. Only after another family member--a lawyer 
     this time--kicked up a fuss did the HMO grant the woman the 
     chance to live by approving her hospitalization costs.
       This is a lucid example of how patients become victims of 
     cost-containment through restriction of their freedom of 
     choice. Most HMO-type managed-care organizations use 
     stringent methods of cost control, as exemplified by the 
     ``withhold'' practice, which may punish physicians 
     financially who provide the care their patients need.


                              medical r&d

       A more subtle, but equally pernicious, attack on patients 
     is the government's curtailment of medical research, which 
     has been accelerating unabated for the past several years and 
     is slated to worsen under the Clinton health plan and other 
     ``reform'' proposals. During the past 20 years, federal 
     support for health research and development as a percentage 
     of national health care expenditures has dropped by more than 
     one-half. The U.S. now expends more than $800 billion 
     annually on health care, but less than 8% of that is 
     reinvested in medical research.
       As a percentage of the gross national product, our 
     expenditures on medical research and development have been 
     falling until their present level is about 1.8%, considerably 
     below that of Germany (2.67%) and Japan (3.04%). 
     Concomitantly, the number of U.S. patents for drugs and 
     medicine being awarded to foreign inventors has been rising. 
     Funding of approved National Institutes of Health grant 
     applications has declined from more than 30% in the 1980s to 
     below 25% in many categories and even 15% in some categories. 
     Thus, a serious negative effect of the cost-containment 
     hysteria associated with reduction of the budget deficit is 
     the creation of an unstable environment within the research 
     community.
       Physicians and scientists with inquiring minds and an 
     investigative bent naturally gravitate to America's Medical 
     Centers of Excellence, a term that was first used in the 
     Report of President Johnson's Commission on Heart Disease, 
     Cancer and Stroke, which I chaired in 1965. These centers 
     comprise university medical schools, their affiliated 
     teaching hospitals, and other related health and research 
     institutions. At such centers, the environment is hospitable 
     to new and fertile ideas, and cross-fertilization thrives 
     among diverse biomedical disciplines.
       Any proposal for ``reform'' that shunts funds from these 
     medical centers to less advanced or productive facilities 
     simply because they offer bargain goods at bargain prices 
     will be catastrophic. It will stultify medical knowledge; 
     repress future advances in diagnosis, prevention and 
     treatment; and ultimately decimate the general quality of 
     health care delivery.
       The integrated function of our medical centers has already 
     been almost ravaged by the financial constraints imposed by 
     Medicare, which now pays only about 70% of the cost of the 
     patient's care; in most states Medicaid provides even less. 
     The medical centers are heavily reliant on revenue from 
     Medicare, Medicaid and private insurers: A November 1992 
     report of the Association of American Medical Colleges found 
     that revenues generated by the clinical practice of the full-
     time faculty represent 45% of total medical school revenues. 
     This money must be stretched far beyond capacity. For in 
     addition to carrying out most of the research and the 
     advanced education of health professionals, the medical 
     centers provide half the uncompensated health care in the 
     U.S.--that is, health care for the underprivileged.
       In the Clinton health bill, the financial cross-subsidies 
     of medical schools are not addressed. With fees from the 
     faculty's medical practice representing almost half the 
     medical school revenues in support of their expenses, this 
     deficiency becomes a critical factor in the viability of 
     these Centers of Excellence.
       The continuing movement toward managed care, with its 
     stringent policy of cost-containment and restrictions on 
     patient referral, has already significantly slowed the flow 
     of patients of these Centers of Excellence, with a 
     progressive decline in their clinical practice revenues. 
     Under the Clinton health plan, managed care would become the 
     law of the land, the flow of patient referrals would 
     virtually disappear, and patients would thus be deprived of 
     desperately needed specialized treatment. In addition to the 
     severe financial burden this would impose on the Medical 
     Centers of Excellence, an equally dangerous impact is the 
     severely restricted patient population that would be 
     available for teaching and research.
       What role should the Medical Centers of Excellence play in 
     health care ``reform''?
       The efficiency and quality of medical care can be greatly 
     enhanced, with considerable savings, if a large proportion of 
     patients requiring highly specialized and costly diagnostic 
     and therapeutic procedures--such as cardiac catheterization, 
     open-heart surgery, organ transplantation and specialized 
     cancer therapy--were channeled to the Medical Centers of 
     Excellence instead of being scattered in hospitals with 
     wasteful duplication of equipment and inadequately trained or 
     underexperienced personnel. This would, of course, require 
     adequate cost reimbursement.
       Most large cities have hospitals and outpatient clinics 
     whose primary responsibility is to provide medical care to 
     the indigent. Medical emergencies, and especially trauma 
     cases, are treated largely in these institutions. Integrating 
     these former charity hospitals into regional Medical Centers 
     of Excellence would greatly reduce costs while elevating the 
     quality of patient care.
       Our medical centers, which have set the highest standards 
     of health care, can also ensure the rapid and widespread 
     application and implementation of these standards through 
     telemedicine. By their linkage to small clinics in rural 
     areas with a primary care physician, or perhaps only a nurse 
     practitioner or physician's assistant, all the expertise and 
     clinical resources of the medical centers will become 
     accessible to these rural areas.


                          Shortsighted Answers

       If by ``health reform'' the folks in Washington mean 
     ``health improvement,'' that is commendable. But any 
     ``reform'' that focuses on access at the expense of medical 
     research, education and training will not advance diagnosis 
     or treatment beyond the status quo. Patients still suffer 
     from many diseases for which medical science has not yet 
     found a cure or prevention. The easy answers may be 
     politically seductive and superficially appealing, but they 
     will prove shortsighted and, ultimately, self-defeating.
       Already, as the health industry anticipates far-reaching 
     but uncertain changes and sweeping government control, 
     patients are feeling the adverse effects: denial of physician 
     selection; brief, assembly-line encounters with a succession 
     of unfamiliar physicians; and general dissatisfaction with 
     the impersonality and reduced quality of health care 
     received. The handwriting is on the wall. Will Americans heed 
     it?

                          ____________________