[Congressional Record Volume 144, Number 33 (Monday, March 23, 1998)]
[Senate]
[Page S2430]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. FAIRCLOTH:
  S. 1811. A bill to prohibit the Secretary of Health and Human 
Services from promulgating any regulation, rule, or other order if the 
effect of such regulation, rule, or order is to eliminate or modify any 
requirement under the medicare program under title XVIII of the Social 
Security Act for physician supervision of anesthesia services, as such 
requirement was in effect on December 31, 1997; to the Committee on 
Finance.


               The Safe Seniors Medical Care Act of 1998

  Mr. FAIRCLOTH. Mr. President, I come before you today to introduce 
legislation that should be of interest to all senior citizens in the 
U.S.
  Mr. President, I must share with you my shock and outrage when I 
learned of a recently proposed rule by the Clinton Administration that 
eliminates the requirement of a real anesthesiologist during surgery 
for Medicare and Medicaid patients.
  The legislation I am introducing today would stop the Administration 
from imposing such on rule on our nation's senior population.
  At a time when President Clinton is seeking to expand Medicare 
coverage for more Americans, why is he quietly moving to lessen the 
standard of care for our senior citizens? This Administration is 
proposing a change that will permit non-physicians to evaluate patient 
health and administer anesthesia to a population at the greatest risk 
for complications.
  Not long ago, the President stood before Congress and stated that 
``Medical decisions should be made by medical doctors'' and that 
``every American deserves quality care.'' I totally agree with the 
President on these important points.
  But it's not good enough to simply say this--actions have to speak 
louder than words. This is one of the reasons I am introducing this 
bill.
  Mr. President, our elderly are our most vulnerable population. We 
established Medicare because of the cost of health care for the 
elderly. But Medicare doesn't have to be second class care. I think it 
is sinful to lower the quality of care for our seniors.
  Furthermore, this Administration won't even allow seniors that want 
to pay for their own health costs to do so--without forcing the doctor 
out of Medicare. So our seniors have little choice, but to be treated 
under the guidelines of Medicare.
  Now I am 70 years old, but to other Senators this will involve their 
mothers and fathers. To the younger generation, this will involve the 
treatment of their grandparents.
  I have to ask, do you really want to send your mother or father, or 
grandparents in for a critical operation and have the anesthesia 
administered by a non-doctor?
  Does the same standard apply to senior government officials? I would 
assume the President had a doctor administer his anesthesia. When I 
asked HHS Secretary Shalala whether she would choose a nurse or doctor 
to administer the anesthesia, when pressed she said she would ask her 
doctor!
  Here we go again, one standard for Washington officials--another for 
everyone else. I think that is wrong.
  Mr. President, I want to make an important point. This is not about 
diminishing the important role that nurses play an important role in 
the health care system. They play a valuable, great role. But on this 
one issue, I feel that the practice of Anesthesiology is simply too 
important to the any medical procedure to be left to those that are not 
trained extensively in this field. Anesthesia is the most important 
part of any operation, particularly for the elderly.
  Nurse anesthetists are non-physician providers who normally complete 
a two or three-year training technique-oriented training program after 
nursing school. Anesthesiologists are physicians who, after taking a 
pre-med curriculum in college, complete four years of medical school 
and a four-year anesthesiology residency program.
  We value the need for greater education in society, and here we are 
ignoring the importance of extensive education. All the rhetoric in 
Washington these days is about the importance of education. But if the 
Administration has its way, further education in the field will be 
deemed worthless.
  Mr. President, for three decades, Medicare and Medicaid patients have 
benefitted from an attending anesthesiologist. To my knowledge, there 
is no clinical study that can provide justification for eliminating the 
physician supervision requirement. 81% of senior citizens oppose the 
President's rule. And you can count me in that group.
  It is my understanding that there is no difference in cost if this 
rule is implemented. The reimbursement is the same to the doctor or the 
nurse. Furthermore, the number of patient deaths involving anesthesia 
has dramatically declined since the 1950's because we have a greater 
number of anesthesiologists in practice. We have made great strides in 
this field. Why would it make sense to radically change the rules at a 
time when we are so successful? It just doesn't make any sense.
  Mr. President, the bottom line is that senior citizens don't want 
this rule, there is no difference in cost and there is no evidence that 
warrants such a change. I simply cannot stand by and watch the 
President put the lives of senior citizens all across this country in a 
potentially dangerous situation. Thank you, Mr. President. I urge all 
the members to support this legislation.
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