[Congressional Record Volume 142, Number 49 (Wednesday, April 17, 1996)]
[Extensions of Remarks]
[Pages E562-E563]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




INTRODUCTION OF THE HIPPOCRATIC OATH AND PATIENT PROTECTION ACT OF 1996

                                 ______


                          HON. BERNARD SANDERS

                               of vermont

                    in the house of representatives

                       Wednesday, April 17, 1996

  Mr. SANDERS. Mr. Speaker, I would like to say a few words about 
disturbing trends in contemporary health care, and to discuss H.R. 
3222, The Hippocratic Oath and Patient Protection Act of 1996, which I 
introduced to halt those trends and protect strong doctor-patient 
relationships.
  Mr. Speaker, more and more doctors and patients are enrolled with 
managed care and HMO's. The Wall Street Journal reports on the 
financial success of HMO's by stating it has left them ``so awash in 
cash they don't know what to do with it all.''
  U.S. Healthcare, for example, is a major, corporate HMO with 2.4 
million members. It makes $1 million a day in profits. Is CEO, Leonard 
Abramson, walked away from his company's recent merger with Aetna with 
a personal profit of nearly $1 billion.
  Clearly, there is a built-in conflict between a for-profit HMO and 
the needs of a patient. The less money spent on providing care for the 
patient, the more money the company makes. It's that simple.
  Obviously, Mr. Speaker, we must all work to control health care 
costs. However, we must also ensure that health care decisions are made 
by doctors using medical rationale with their patients' interests at 
heart, not insurance administrators using financial spreadsheets with 
their own economic interests at heart. And most importantly, we must 
preserve the fundamental core of successful health care--the strong 
doctor-patient relationship.
  Unfortunately, with the growth of managed care and the power of large 
insurance companies, serious problems are developing which, in my view, 
threaten the doctor-patient relationship.
  Many HMO's use what are essentially ``free-for-denying-service'' 
systems, which pay doctors for denying care and penalize them for 
providing it. Doctors under some plans lose up to 50 cents of 
compensation for every dollar they order spent on emergency care. And 
according to a Mathematica Policy Research study, 60 percent of managed 
care plans in this country currently place their providers at some 
financial risk for the cost of patient care. This places doctors in 
very difficult situations, as they are asked to base their decisions on 
criteria that is contrary to what they were taught and swore to uphold.
  You would have to be patently insane to sign on with an HMO you know 
is going to pay your doctor not to treat you. So some insurance 
companies are taking steps to make sure you don't know what they are 
doing. They keep their incentive plans secret from their customers, and 
in many cases keep both patients and doctors in the dark about the 
formulas used to approve or deny coverage. Therefore, doctors and 
consumers signing on do not know what they are getting themselves into, 
and insurers are free to make arbitrary decisions without outside 
scrutiny.

  Further, many HMO contracts contain blatant gag rules that tell 
doctors what they can and cannot say to their patients. Last year, for 
example, Kaiser Permanente of Ohio told its doctors not to discuss any 
possible treatments with patients before checking with the company's 
consultants.
  These outrageous clauses strike at the heart of informed consent and 
health care ethics--someone considering an operation should have all 
the relevant information to make their decision, and doctors must be 
able to provide that information.
  These problems are serious enough that Massachusetts has already 
passed a law banning gag rules, while New York and several other State 
legislatures are considering bills to deal with these issues. Before 
recess, I introduced legislation that will take three steps to preserve 
strong doctor-patient relationships. My bill has already been endorsed 
by Consumers Union, the American Nurses Association, the Vermont 
Psychological Association, the American Psychological Association, the 
National Medical Association, and the Gray Panthers.
  First, my legislation will ban outright incentives to deny 
appropriate care, and ensure safeguards are installed so doctors are 
not placed at substantial financial risk for patient care.
  Second, my bill prohibits gag rules and other interference in 
doctors' communications regarding patient care. It is the only 
legislation that safeguards doctors' communications with their 
colleagues and the public as well as their patients.
  Third, to ensure neither doctors nor patients are kept in the dark 
about what their insurer is doing, my legislation provides for open, 
honest discussion of practices key to patient care

[[Page E563]]

by requiring disclosure of utilization review procedures, financial 
incentives for providers, and all services and benefits offered under 
the health plan.
  That disclosure may be half the battle, because I think no insurance 
executive will be willing to stand up and defend these outrageous 
practices once they are out in the open.

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