[Congressional Record Volume 140, Number 105 (Wednesday, August 3, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: August 3, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                   LET'S REPAIR THE HOUSE HEALTH BILL

                                 ______


                        HON. MICHAEL A. ANDREWS

                                of texas

                    in the house of representatives

                       Wednesday, August 3, 1994

  Mr. ANDREWS of Texas. Mr. Speaker, our goals for health care reform 
are in serious danger. It seems that our true objectives for 
controlling cost and providing coverage to those in need have been 
subverted by the desire to produce a massive new, Government-run 
program.
  I commend the majority leader, Richard A. Gephardt, for bringing 
together the many interests in this crucial bill. While this bill 
offers many improvements over the current system, it fails to provide a 
method to control cost and maintain the quality care our public 
expects. Under a Government-run program, the goals of quality care and 
cost control are usually at odds with each other. No other program 
illustrates this inefficiency better than the Medicare program.
  For example, the House bill creates a new entitlement program that 
includes up to 59 percent of the population under Medicare Part C, 
essentially leading the country toward a single payer system. While 
Medicare can place a cap on cost, the cap also causes a decline in 
quality. Due to the large increase in the number of patients in the 
Medicare program, a much larger share of cost will be ``shifted'' onto 
the private sector. Compared to payments from the private sector, the 
current Medicare program pays only 59 percent of cost for physicians' 
services, and 68 percent of cost for hospital services. Therefore, 
instead of providing all citizens with health care, patients will find 
more and more physicians who refuse to treat them due to the low 
Medicare payments.
  I believe that Congress can act to remedy these problems, and to 
ultimately produce a bill that can insure health security, and reduce 
overall health spending.

              [From the Dallas Morning News, Aug. 2, 1994]

             Health Care--Medicare Expansion Is Ill Advised

       The most eye-catching element of the health plan Rep. Dick 
     Gephardt introduced Friday is the creation of a so-called 
     Medicare Part C option. The Gephardt creation, which grew out 
     of a House Ways and Means Committee recommendation, is an odd 
     political beast.
       In essence, the Part C provision says that any small 
     employers who do not provide health coverage can enroll their 
     employees in a government-managed health plan. Likewise, 
     unemployed, self-employed and part-time workers can enroll in 
     the new government program, which could eventually deliver 
     health services to 60 million people.
       What's politically odd is that Mr. Gephardt is proposing a 
     new government program just as others within Washington are 
     trying to rein in government's growth. Indeed, Medicare Part 
     C would not be solely publicly financed. Small employers 
     would still have to pay an extensive share of their 
     employee's Part C expense, just as self-employed workers 
     would have to make a hefty contribution.
       But why create a new bureaucracy, which is unlikely to hold 
     down overall medical prices? By contrast, private insurers, 
     through such ``managed care'' options as health maintenance 
     organizations, help control costs through negotiating fees 
     with doctors and hospitals. A government-managed program has 
     little ability to do that, since it does not enter the 
     marketplace to bargain for lower health prices.
       In fact, the Medicare Part C option would greatly expand 
     fee-for-service medicine, where you go to any doctor and pay 
     whatever fee he or she charges. That kind of service has been 
     a significant force behind the explosive growth in medical 
     costs.
       Mr. Gephardt will surely argue that the Medicare Part C 
     option would control expenditures through placing a ceiling 
     on prices doctors and hospitals charge. But as health experts 
     will inform you, those ceilings, which are often artificially 
     low, only add to overall health costs. As medical providers 
     receive low reimbursements for their Medicare clients, which 
     often fail to meet their costs, they make up their loss by 
     charging other clients higher prices.
       Perhaps Mr. Gephardt is making a political pitch to House 
     liberals who want a government-run health system for all 
     Americans. But his Medicare Part C option is ill advised and 
     deserves a defeat by the full House.
                                  ____


                [From the New York Times, July 30, 1994]

                      The Failed House Health Bill

       The health-care bill that the Democratics leadership will 
     take to the full House for debate early next month would do 
     more harm than good. Though it starts off correctly--
     achieving universal coverage by requiring employers to pay 
     for most of the cost of insuring their workers--it proposes 
     insurance ``reforms'' that would bury the most innovative 
     cost-effective plans that many Americans routinely choose 
     today.
       The bill would be a victory for highly paid physicians and 
     would reward those in Congress who want to control the huge 
     health-care industry. But it would be a defeat for patients 
     who expect high-quality care at a reasonable price.
       The leadership bill, announced yesterday, would create 
     Medicare C, a public, fee-for-service plan, to enroll the 
     poor and otherwise uninsured. That might sound like a 
     sensible way to provide failsafe insurance to relatively few 
     families because it would build upon Medicare, the existing 
     plan for the elderly. But Medicare C, unlike the program 
     limited to the elderly, threatens to trigger an inevitable 
     roll toward government-run medicine for most Americans.
       The Government cannot supervise treatment provided under 
     Medicare. The only way it can control costs is clamp down on 
     prices it pays providers. Medicare pays doctors and hospitals 
     less than their costs; that forces providers to make up the 
     loss by jacking up prices to private patients. This ``cost 
     shift'' is already widespread. But the leadership bill would 
     add to Medicare the poor, who are now covered by Medicaid, as 
     well as the unemployed and other uninsured people; that would 
     bring 50 percent of the population under Medicare, according 
     to Congressional staff estimates. The cost shift to the 
     remaining patients would become devastating. Fees to private 
     patients would skyrocket, driving premiums up and private 
     insurers out of business through no fault of their own.
       Other detrimental features of the leadership bill are 
     provisions that render illegal the approach used by most 
     existing managed-care plans--which charge enrollees a fixed 
     annual fee regardless of medical need in exchange for 
     limiting care to a fixed panel of doctors and hospitals. The 
     leadership bill would, for example, require most plans to 
     hire any qualified doctors who apply--thereby eliminating the 
     plans' ability to control the quality and cost of treatment 
     by closely supervising a small panel of doctors. Most 
     managed-care plans would have to hire specialists, like 
     chiropractors, that they believe are unnecessary.
       But the special interests were too powerful for the 
     leadership to resist. The effect of the bill's anti-managed-
     care provisions is to lock in fee-for-service medicine that 
     lies at the core of the existing system's penchant for 
     wasteful and often inappropriate care.
       The leadership did not have the gall to forthrightly 
     propose a government takeover. But it has proposed a bill 
     that would achieve the same end through stealth. When it 
     comes to the floor, the bill's provision for universal 
     coverage through an employer mandate is worth fighting for. 
     Much of the rest deserves to be scrapped.

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