[Congressional Record Volume 141, Number 24 (Tuesday, February 7, 1995)]
[Senate]
[Pages S2275-S2276]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


                          CRUELTY TO PATIENTS

 Mr. SIMON. Mr. President, one of the more thoughtful writers 
on our scene today is Joan Beck with the Chicago Tribune.
  Recently, she had a column on our national health care system that 
takes a slightly different perspective on where we are and some of our 
problems.
  I believe her comments merit serious consideration.
  We are talking about some modification of the health care system this 
year.
  On the floor of the Senate, several of us on both sides of the aisle 
have talked about the need for bipartisan cooperation.
  I hope we can go ahead.
  In the meantime, I urge my colleagues to read the Joan Beck column, 
and I ask to insert it into the Record at this point.
  The column follows:

 Cruelty to Patients--Nation's Health Care System Needs an Examination

                             (By Joan Beck)

       Even without new federal legislation, health care in 
     America is changing rapidly. Many of these changes are 
     worrisome. Some are deadly scary.
       Increasingly, the focus of medical care is becoming to 
     reduce costs, to do only the minimum possible for patients, 
     to wring money out of the system for a new set of corporate 
     providers.
       Fewer people are now allowed by HMOs and insurance company 
     rules to see specialists. Far more surgery--more than half in 
     many hospitals--is being done on an outpatient basis, often 
     with assembly-line rules. Hospital stays after childbirth are 
     often numbered in hours, not days.
       Hospitals are cutting nursing staffs, lowering the level of 
     patient care and substituting other caregivers with less 
     training and lower pay. Teaching hospitals, with their higher 
     costs and heavy load of patients needing specialized 
     treatment, are getting squeezed.
       Many doctors, like Ma and Pa stores swallowed up when a 
     Wal-Mart comes to town, are losing their independence to a 
     whole new world of corporate-managed health care.
       Physicians, in fact, don't really seem to be major players 
     in the health-care business these days. Politicians, 
     administrators, employers, insurance companies, even the 
     financial markets, are shaping the future of health care to 
     an extent that makes many people highly uncomfortable--and 
     may endanger their health.
       There is a new emphasis on efficiency, not on 
     humanitarianism and healing. Hospitals are competing for 
     contracts from insurance companies, HMOs and big employers to 
     care for large groups of people, often for a fixed, per-
     person fee. Then they must try to push down their costs 
     however they can--by eliminating unnecessary tests and 
     treatments, by being more efficient, by avoiding as many 
     high-cost procedures as possible, perhaps even by taking 
     risks with patients' health.
       Federal efforts to pass national health-care legislation 
     seem to be in hiatus for now, although Illinois Sen. Paul 
     Simon has been trying to talk up the issue again. There are 
     new threats to make drastic cuts and changes in Medicare and 
     Medicaid. Congress may do some tinkering with insurance 
     regulations.
       But in the immediate future, changes in health care will 
     not come from Washington. There will be more efforts by 
     hospitals to trim costs. More efforts from HMOs, insurers and 
     employers to get discount prices. More pressures on 
     physicians to follow HMO and insurance company rules. More 
     attempts at 
     [[Page S2276]] change by the states, particularly California, 
     Minnesota, Washington, Hawaii and Pennsylvania. And more 
     lamenting that while the increase in costs is slowing down, 
     health care still takes 14 percent of the gross national 
     product.
       It is difficult to measure the impact of all of these 
     changes on the nation's well-being. But a useful yardstick is 
     to evaluate how these changes affect the way physicians can 
     do their job and how well they safeguard patient choice in 
     their doctors.
       Doctors should be the ones to decide the future of health 
     care in the United States--not Hillary Rodham Clinton or Ira 
     Magaziner or Newt Gingrich or Bob Dole or the Republicans or 
     the Democrats or Prudential or Humana or General Motors or 
     Exxon.
       It's disappointing to see how little impact doctors have 
     actually had on the health-care debate and on the future of 
     health care and how quietly most of them have gone along with 
     restrictions on how they care for patients.
       Medical societies, of course, have issued proposals and 
     lobbied legislators. The American Medical Association has a 
     big lobbying arm in Washington and in 1990 proposed its own 
     Health Access America plan. The Journal of the American 
     Medical Association has published hundreds of articles and 
     proposals, as have other medical journals. But these efforts 
     have not had major impact on the future of health care.
       It is taken for granted among health-care reformers that a 
     major factor in high costs has been overtreating by 
     physicians who stand to make a buck by doing so. Yet these 
     same reformers assume that the same physicians can be trusted 
     not to undertreat patients when the economic incentives are 
     reversed.
       Undertreatment is hard to define and, often, to detect. 
     It's difficult to measure outcomes; the data is subject to 
     interpretation, not only for individuals, but for HMO 
     populations, communities and states. Monitoring and 
     evaluation protocols are not well developed. Clinical 
     guidelines need further development if they are to be used as 
     protection against undertreatment. Databases that will permit 
     comparisons are still far from adequate.
       People must rely on their physicians to withstand pressures 
     to undertreat, to do what's best for patients regardless of 
     new and increasing incentives to do less than that.
       If the kinds of changes now happening in health care really 
     reflect advances in medicine and commendable efforts to 
     reduce unnecessary expenses and unneeded treatment, we should 
     all be cheering. But how can we be sure that pressures from 
     insurers and employers and HMOs won't push doctors and 
     hospitals to cut even more corners that will risk patients' 
     health?
       There is still an enormous reservoir of trust in physicians 
     in this country. But it will be increasingly hard for doctors 
     to keep that trust and to deserve it in the new regimes of 
     red tape and cost controls. They will have to figure out how 
     to control the health-care system, not be controlled by 
     others. And they will have to stand up for patients against 
     the cost-cutters and the administrators when they interfere 
     with optimum treatment if we are to be comfortable and safe 
     with our health care in the future.
     

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