[Congressional Record Volume 143, Number 128 (Tuesday, September 23, 1997)]
[Extensions of Remarks]
[Page E1820]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


   PEOPLE HAVE TROUBLE SEEING DOCTORS BECAUSE THEY DON'T HAVE ENOUGH 
          MONEY--NOT BECAUSE MEDICARE PAYS DOCTORS TOO LITTLE

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                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                      Tuesday, September 23, 1997

  Mr. STARK. Mr. Speaker, the just-enacted Balanced Budget Act includes 
a provision that allows doctors not to participate in Medicare for 2 
years at a time, but instead to private contract with patients so that 
they can charge these patients much more than the Medicare fee 
schedule.
  There is now a move underway to strike the 2-year requirement and let 
doctors do wallet biopsies--decide on a patient-by-patient basis 
whether they are going to ask patients to give up their Medicare rights 
and insurance and pay the extra in an individual private contract.
  I can think of nothing that will encourage patients to move into 
HMO's faster, so that they are protected against the fear of this type 
of doctor extortion. The American Medical Association supports the 
proposal, but it is an idea that must have been deviously planted in 
their association by a mole from the HMO lobby--the American 
Association of Health Plans.
  The proposal is pure greed wrapped in the flag of freedom.
  Before the Congress is drowned in the rhetoric of this issue, we 
should note the facts. To the extent that Medicare beneficiaries have 
trouble seeing doctors, it is almost totally due to the fact that the 
cost is too much for the beneficiaries--not that Medicare doesn't pay 
the doctor enough to allow the doctor to see patients.
  The latest data from the independent congressional advisory panel--
the Physician Payment Assessment Commission--shows that only 4 percent 
of all Medicare beneficiaries reported having trouble getting health 
care in the last year. About 11 percent had a medical problem, but 
failed to see a physician, while 12 percent did not have a physician's 
office as a usual source of care. Roughly 10 percent of Medicare 
beneficiaries delayed care due to cost. Considering all four access 
measures, about 26 percent of Medicare beneficiaries cited experiencing 
at least one of these problems.
  PhysPRC reports that from their surveys of those who failed to see a 
physician for their serious medical problem, 43 cited cost as the 
reason. About 8 percent of those who failed to see a physician could 
not get an appointment or find an available physician. For another 8 
percent, transportation was the problem, 13 percent felt there was 
nothing a doctor could do, and 11 percent were afraid of finding out 
what was wrong.
  In another words, Congress is preparing to let doctors charge 
patients infinitely higher fees because less than 1 percent of all 
Medicare beneficiaries had trouble finding a doctor--perhaps they lived 
in a rural area, etc. Yet over 5 percent of Medicare's nearly 40 
million beneficiaries could not get to a doctor because they didn't 
have enough money--and Congress is silent.
  Mr. Speaker, a humane Congress, a compassionate Congress, a logical, 
rational Congress would put five times as much effort into addressing 
the problem of doctors costing too much as it would in addressing what 
may be a 1-percent problem of a few doctors wanting to get paid more.
  Where are our priorities, Mr. Speaker? A vote to let doctors, the 
richest 1-percent income group in our Nation, charge the sky's the 
limit, while ignoring the needs nearly 2 million seniors who find 
doctors already too expensive is a shameful vote.

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