[Congressional Record Volume 140, Number 91 (Thursday, July 14, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: July 14, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                      THE IMPORTANCE OF MEDICARE C

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
February 11, 1994 and June 10, 1994, the gentleman from Washington [Mr. 
McDermott] is recognized for 60 minutes as the majority leader's 
designee.
  Mr. McDERMOTT. Mr. Speaker, as part of my effort to talk to my 
colleagues each week about how health care reform issues affect the 
American people personally, I would like to talk tonight about a part 
of the new proposal in the health care reform debate.
  It is found in the Ways and Means Committee bill for health care 
reform. that proposal is to create Medicare part C to provide insurance 
to the non-senior population the way Medicare provides insurance for 
senior citizens.
  Medicare C is a voluntary program. It will provide insurance to 
people who cannot afford to purchase their own and it would enable 
individuals and small business to buy insurance at a price they can 
afford.
  It is simple, it is affordable and it is easy to access. Health 
insurance through Medicare C is purchased through a payroll deduction. 
Anyone who does not have insurance is automatically enrolled.
  If you prefer to have private insurance, you don't have to be 
enrolled in Medicare C. It is purely voluntary. But more importantly, 
enrolling in Medicare C guarantees you free choice of provider. It 
enables Americans to have a nonprofit, national nonmanaged care health 
insurance option.
  But there is a problem with the way Medicare C is structured in the 
Ways and Means bill. It is not open to everyone. Only people who are 
unemployed or employees of small businesses can enroll in Medicare C.
  Everyone else is required to enroll in insurance company plans.
  Well, Mr. Speaker, I don't think we should lock people into insurance 
company health plans which increasingly means insurance company 
interference in patient treatment decisions, even in fee for service 
plans.
  I want to talk to my colleagues tonight about the American people's 
relationships with their doctors, and about who should make medical 
treatment decisions.
  Because a Medicare C open to anyone who wants to join may be more 
important to you and your health care and your relationship with your 
doctor than you would ever imagine.
  What Americans are experiencing now in the health care marketplace is 
a new trend called ``managed care.''
  This change is happening today as the ``market'' is left to its own 
devices to solve the health care cost crisis.
  And that means that insurance companies interfere more and more 
aggressively in the treatment decisions of doctors. And they do this 
not to protect the patients quality of care, but to protect the profit 
margins for their stockholders. This is happening not only in HMO's. 
All patients are experiencing the reality that it is their insurance 
company, not their doctor, who determines whether or not they get 
admitted to a hospital. It is their insurance company who decides if a 
child can stay in the hospital overnight after a bad reaction to 
surgery. It is their insurance company who is deciding that women 
should be discharged from the hospital on the same day as childbirth or 
that newborns should be sent home before their first feeding.
  These decisions are not being made by the physicians or nurses or 
other practitioners who actually care for the patient and bear the 
responsibility for their well-being.
  They are being made by company employees who have never seen the 
patient and are sitting at a 1-800 number just to approve or disapprove 
care. The American people know in their hearts, in their guts, and in 
their minds that something is terribly wrong with this arrangement. 
They know that this cost-control approach by the insurance companies 
ultimately will ruin the quality of American health care. And I want to 
be clear. It is not the Government that is doing this. It is the free 
market approach to health care that is giving the insurance companies 
unprecedented control over the doctor-patient relationship.
  If health care reform fails, this trend is simply going to get worse. 
There will simply be no restraint on insurance companies' ability to 
control the medical care you receive.
  Without health care reform, insurance companies will completely 
consolidate their control over the delivery system. Mr. Speaker, I 
oppose that trend.
  One of the most ominous recent developments was the recent 
announcement that Travelers Insurance Co. and Metropolitan Life agreed 
to merge their health care operations to create a more efficient 
managed care entity.
  Where are the patients and providers in this merger?
  Insurance companies have discovered that the real money in insurance 
is not processing claims but in denying claims and controlling access 
to care. They have created a private health insurance trap.
  But Medicare C is your escape from that trap. Medicare C is your 
protection against managed care.
  I am a physician as well as a Congressman. I practiced medicine for 
25 years. To me, just as the family is the building block of 
civilization, so is the physician-patient relationship the building 
block of good medical care.
  When the American College of Surgeons endorsed a single-payer 
approach to health care reform--a system where Americans pay a public 
premium in the form of a payroll tax and the Government provides health 
insurance to all Americans the way it does in Medicare for senior 
citizens--the College of Surgeons stated that physicians could not 
continue to tolerate the amount of interference by insurance companies 
in treatment decisions.
  Dr. Murray, the chairman of the board of the college, specifically 
noted that free choice of provider was preserved in Medicare and that 
clinical interference was not a problem in Medicare.
  Patients and physicians in Medicare are much more in control of 
treatment decisions.
  Americans are entitled to have a choice about how they receive their 
medical care. A nonprofit, nonmanaged care option for insurance that is 
guaranteed by the Government protects that choice as nothing else will.
  But there is another reason to open Medicare C to anyone who wants to 
join. It will work to keep the insurance companies honest.
  Medicare currently administers its entire program for 2.1 percent of 
its budget. U.S. Health, one of the Nation's largest managed care 
companies, administers its plan with 28 percent of its budget.
  In other words, Medicare pays 98 cents on the premium dollar for 
actual health care delivered to people, while U.S. Health spends only 
72 cents on the premium dollar on actual health care.
  Now which system is going to give you more care? The one that pays 98 
cents on the dollar or the one that pays 72 cents on the dollar? We all 
know the answer, and the answer is that Medicare is giving Americans 
more bang for their buck.
  If the insurance companies have to compete with Medicare--if 
Americans can vote with their feet--then insurance companies might have 
to bring down their administrative expenses and provide more medical 
care instead.
  So why isn't Medicare open to everyone? Why are most Americans being 
denied that choice?
  Because insurance companies do not want to compete with the 
advantages of medicare. Insurance companies are working nonstop on 
Capitol Hill to keep Americans from having that choice. Insurance 
companies are afraid that people will like Medicare more.
  Well, the purpose of health reform is not to protect the insurance 
companies. The purpose of health reform is to make health care and 
health insurance better for ordinary people.
  Mr. Speaker, the American people should demand that Medicare C be 
open to everyone who wants to join, that they have the right to choose 
what's best for them,
  That their health insurance choices and health care choices not be 
dictated by special interests in Washington.
  Americans need Medicare C to be open to those who choose it. Medicare 
C will help protect their health care futures. Mr. Speaker, I hope they 
get it.

                          ____________________