[Congressional Record Volume 144, Number 39 (Tuesday, March 31, 1998)]
[House]
[Pages H1846-H1850]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                         HMO CRISIS IN AMERICA

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 7, 1997, the gentleman from Iowa (Mr. Ganske) is recognized for 
60 minutes.
  Mr. GANSKE. Mr. Speaker, 2 years ago I met a woman who killed a man. 
I did not meet her in prison; she was not on parole. She had never even 
been investigated by the police. In fact, for causing the death of a 
man she received congratulations from her colleagues and moved up the 
corporate ladder.
  The woman, Dr. Linda Peeno, was working as a medical reviewer at an 
HMO. In testimony before the Committee on Commerce on May 30, 1996, she 
confessed that her decision as an HMO reviewer to deny payment for a 
lifesaving operation led to the preventable death of a man she had 
never met.
  Since then Dr. Peeno has regretted her HMO deeds every day of her 
life. In contrition she has blown the whistle on the ways that HMOs 
deny payment for health services. She showed how plans draft contract 
language to restrict access to benefits. She showed how HMOs cherry-
pick healthy patients, and she showed how HMOs use technicalities to 
deny necessary care.

                              {time}  2000

  Dr. Peeno also told Congress about the most powerful weapon in an 
HMO's arsenal; to hold down costs. HMOs generally agree to cover all 
services that are deemed ``medically necessary.'' But because that 
decision is made by HMO bureaucrats, not by the treating physician, Dr. 
Peeno called it ``the smart bomb of cost containment.''
  Hailed initially as a great breakthrough in holding down health 
costs, the painful consequences of the managed care revolution are 
being revealed. Stories from the inside, like those told by Dr. Peeno, 
are shaking the public's confidence in managed care. You can now read 
about some of Dr. Peeno's experiences in the March 9 edition of U.S. 
News & World Report.
  The HMO revelations have gotten so bad that the health plans 
themselves are running ads touting the fact that they are different 
from the bad HMOs that don't allow their subscribers their choice of 
doctors, or who interfere with their doctors practicing good medicine.
  Here in Washington one add says, ``We don't put unreasonable 
restrictions on our doctors. We don't tell them that they can't send 
you to a specialist.''
  In Chicago, Blue Cross ads proclaim, ``We want to be your health 
plan, not your doctor.''
  In Baltimore, the Preferred Health Network ad states, ``As your 
average health plan, cost controls are regulated by administrators. At 
PHN, doctors are responsible for controlling costs.''
  This goes to prove that even HMOs know that there are more than a few 
rotten apples in the barrel. The HMO industry has earned a reputation 
with the public that is so bad that only tobacco companies are held in 
lower esteem.
  Let me cite a few statistics. A national survey shows that far more 
Americans have a negative view of managed care than a positive view. By 
more than 2 to 1, Americans support more government regulation of HMOs.
  The survey shows that only 44 percent of Americans think that managed 
care is a good thing. Do you want proof? Well, recently I saw the 
movie, ``As Good As It Gets.'' When Academy Award winner Helen Hunt 
expressed an expletive about the lack of care her asthmatic son gets 
from her HMO, people in the audience clapped and cheered. It was by far 
the biggest applause line of the movie.
  No doubt the audience's reaction was fueled by dozens of articles and 
news stories highly critical of managed care, and also fueled by real 
live experiences.
  In September 1997, the Des Moines Register ran an op-ed piece 
entitled ``The Chilly Bedside Manner of HMOs'' by Robert Reno, a 
Newsweek writer.
  Citing a study on end-of-life care, he wrote, ``This would seem to 
prove the popular suspicion that HMO operators are heartless swine.''
  The New York Post ran a week-long series on managed care. Headlines 
included, ``HMOs' cruel rules leave her dying for the doc she needs.''
  Another headline blared out, ``Ex-New Yorker is told get castrated so 
we can save.''
  Or this one, ``What his parent didn't know about HMOs may have killed 
this baby.''
  Or how about the 29-year-old cancer patient whose HMO would not pay 
for his treatments. Instead, the HMO case manager told him to hold a 
``fund-raiser.'' A fund-raiser.
  Mr. Speaker, I certainly hope that campaign finance reform will not 
stymie this man's chance to get his cancer treatment.
  To save money, some HMOs have erected increasingly steep barriers to 
proper medical care. These include complex utilization review 
procedures, computer programs that are stingy about approving care, 
medical directors willing to play fast and loose with the term 
``medically necessary.''
  Consumers who disagree with these decisions are forced to work their 
way through Byzantine appeals processes which usually excel at 
complexity, but generally fall short in terms of fairness, and these 
appeals, unfortunately, Mr. Speaker, sometimes last longer than the 
patient.
  The public understands the kind of barriers they face in getting 
needed care. Republican pollster, Frank Luntz, recently held a focus 
group in Maryland, and this is what consumers said. One participant 
complained, I have a new doctor every year. Another said she is afraid 
that ``if something major happened, I won't be covered.'' A third 
attendee griped that he had to take off work twice because the plan 
required people to see the primary care doctor before seeing his 
specialist.
  Those fears are vividly reflected in editorial page cartoons. Here is 
one that reflects what that focus group was talking about. It shows a 
woman working in a cubicle in the claims department of an HMO. In 
talking to a customer she remarks, no, we don't authorize that 
specialist. No, we don't cover that operation. No, we don't pay for 
that medication. She is then surprised, no, we don't consider this 
assisted suicide.
  These HMO rules create ethical dilemmas. A California internist had a 
patient who needed emergency treatment because of fluid buildup in her 
lungs. Under the rules of the patient's plan, the service would come at 
a hefty cost. She told the doctor she couldn't have the treatment 
because she didn't have the money. However, if she was admitted to the 
hospital, she would have no charges. So the internist bent the rules. 
He admitted her, and then he immediately discharged her.
  Now, I ask you, Mr. Speaker, are HMOs forcing doctors to lie for 
their patients?
  HMOs have pared back benefits to the point of forcing Congress to get 
into the business of making medical decisions. Take for example the 
uproar over so-called drive-through deliveries. This cartoon shows that 
some folks thought health plans were turning their maternity wards into 
fast food restaurants.
  As the woman is handed her new child, the gatekeeper at the drive-
through window asks, congratulations, would you like fries with that?
  Well, in 1995, Michelle and Steve Bauman testified before the Senate 
about their daughter, Michelina, who died 2 days after she was born. 
Their words were powerful and eloquent. Let me quote from Michelle and 
Steve's statement.
  Baby Michelina and her mother ``were sent home 2 hours after 
delivery. This was not enough time for doctors

[[Page H1847]]

to discover that Michelina was born with streptococcus, a common and 
treatable condition. Had she remained in the hospital an additional 24 
hours, her symptoms would have surfaced and a professional trained 
staff would have taken the proper steps so that we could have planned a 
christening, instead of a funeral.
  Her death certificate listed the cause of death as meningitis, said 
Michelle and Steve, when it should have read ``death by the system.''
  In the face of scathing media criticism and public outrage, health 
plans insisted that nothing was wrong, that most plans allowed women to 
stay at least 48 hours, that babies discharged the day of delivery 
were just as healthy as others.

  You know, Mr. Speaker, that line of defense sounds a lot like the man 
who was sued for causing an auto accident. ``Your Honor,'' he says, ``I 
was not in the car that night, but even if I was, the other guy was 
speeding and swerved into my lane.''
  For expectant parents, however, the bottom line was fear and 
confusion. There is nothing more important to a couple than the health 
and safety of their child. Because managed care failed to condemn 
drive-through deliveries, all of us were left to wonder whether our own 
plans place profits ahead of care.
  The drive-through delivery issue is hardly the only example of the 
managed care industry fighting to derail any consumer protection 
legislation. What makes this strategy so curious is that most plans had 
already taken steps to guarantee new moms and infant 2 days in the 
hospital. Sure, there were some fly-by-nights that might not have 
measured up, but most responsible plans had already reacted to the 
issue by guaranteeing longer hospital stays.
  The HMO efforts to reassure the public that responsible plans don't 
force new mothers and babies out of the hospital in less than 24 hours, 
however, was completely undermined by their opposition to a law 
ensuring this protection for all Americans. This was a missed 
opportunity, Mr. Speaker, for the responsible HMOs to get out front, to 
proactively work for legislation that reflected the way they already 
operated.
  Not only would it have improved managed care's public image, but it 
would have given them some credibility.
  So why then did managed care oppose legislation on this issue? 
Because the HMO industry is Chicken Little. Every time Congress or the 
States propose some regulation on this industry, they cry, ``The sky is 
falling; the sky is falling.''
  I would suggest that by endorsing some common-sense patient 
protections, managed care would be more believable when they oppose 
legislation.
  Today's managed care market is highly competitive. Strong market 
rivalry can be good for consumers. When one airline cuts fares, others 
generally match those fares. In health care, when one plan offers 
improved preventive care or expanded coverage, other market 
participants may follow suit.
  But the competitive nature of the market also poses a danger for 
consumers. In an effort to bolster profits, plans may deny coverage of 
care that is medically necessary, or they may gag their doctors to cut 
costs.
  Some health plans have used gag rules to keep their subscribers from 
getting care that may save their lives.
  During congressional hearings 2 years ago, we heard testimony from 
Allen DeMeurers, who lost his wife, Christy, to breast cancer. They are 
pictured here with their children. When a specialist at UCLA 
recommended that Christy undergo bone marrow transplant surgery, her 
HMO leaned on UCLA to change its medical opinion.
  Mr. Speaker, who knows whether Christy would be with her two children 
today had her HMO not interfered with her doctor-patient relationship?
  HMO gag rules have even made their way on to the editorial pages. 
Here is one such cartoon. A doctor sits across the desk from a patient 
and remarks, ``I will have to check my contract before I answer that 
question.''
  Dr. Michael Haugh is a real live example of this problem. He 
testified before the Committee on Commerce and told how one of his 
patients was suffering from severe headaches. He asked her HMO to 
approve a specific diagnostic procedure. They declined to cover it, 
claiming that magnetic resonance arteriogram was ``experimental.''
  Now, remember, Dr. Peeno testified about the clever ways that health 
plans decide not to cover requested care.

                              {time}  2015

  Dr. Haugh explained the situation in a letter to his patient. In it 
he wrote: ``The alternative to the magnetic resonance arteriogram is to 
do a test called a cerebral arteriogram, which requires injecting dye 
into the arteries, and carries a much higher risk to it than the MRA. 
It is because of this risk that I am writing to tell you that I still 
consider that an MRA is medically necessary in your case.''
  Two weeks later the medical director of BlueLines HMO wrote to Dr. 
Hough. He said, ``I consider your letter to the member to be 
significantly inflammatory. You should be aware that a persistent 
pattern of pitting the HMO against its member may place your 
relationship with BlueLines HMO in jeopardy. In the future, I trust you 
will choose to direct your concerns to my office, rather than in this 
manner.''
  This is amazing. The HMO was telling this doctor that he could not 
express his professional medical judgment to his patient. Cases like 
these and others demonstrate why Congress needs to pass legislation 
like the Patient Right to Know Act, to prevent health plans from 
censoring exam room discussions.
  This gag rule cartoon is even more pointed. Once again, a doctor sits 
behind a desk talking to a patient. Behind the doctor is an eye chart 
saying, ``Enuf iz enuf.'' The doctor looks at a piece of paper and 
tells his patient, ``Your best option is cremation, $359, fully 
covered.'' And the patient says, ``This is one of those HMO gag rules, 
isn't it, doctor?''
  The HMO industry continues to fight Federal legislation to ban these 
gag rules. The HMOs and their minions here in Congress still keep the 
Patient Right to Know Act from coming to the floor, despite the fact 
that it has 299 cosponsors, Members of Congress, on the bill. The bill 
is endorsed by more than 300 consumer and health professional 
organizations and has already been enacted into law for Medicare and 
Medicaid patients.
  Mr. Speaker, I ask the Members, what is wrong with cover all 
Americans? Even some executives of major managed care plans have 
privately told me that they are not opposed to the ban on gag rules, 
because they know that competition can result in a race to the bottom 
in which basic consumer protections are undermined.
  My bill to ban gag rules presents managed care with an opportunity to 
be on the vanguard of good health care. Instead, they are frittering 
away another opportunity, just like they did with the drive-through 
delivery issue. And in opposing a ban on gag rules, HMOs have only 
fueled bipartisan support for broader and more comprehensive reform 
legislation.
  In recognition of problems in managed care, last September three 
managed care plans joined with consumer groups to announce their 
support of an 18-point agenda. Here is a sample of the issues that the 
groups felt required nationally enforceable standards: guaranteeing 
access to appropriate services, providing people with a choice of 
health plans, ensuring the confidentiality of medical records, 
protecting the continuity of care, providing consumers with relevant 
information, covering emergency care, disclosing loss ratios, banning 
gag rules.
  These health plans and consumer groups wrote, ``Together we are 
seeking to address problems that have led to a decline in consumer 
confidence and trust in health plans. We believe that thoughtfully 
designed health plan standards will help to restore confidence and 
ensure needed protection.''
  Mr. Speaker, I could not have said it better myself. These plans, 
including Kaiser Permanente, HIP, and Group Health of Puget Sound, 
probably already provide patients with these safeguards. So it would 
not be a big challenge for them to comply with nationally enforceable 
standards. By advocating national standards, these HMOs distinguish 
themselves in the market as being truly concerned with the health of 
their enrollees.

[[Page H1848]]

  Noting that they already make extensive efforts to improve their 
quality of care, the chief executive officer of Health Insurance Plan, 
known as HIP, said, ``Nevertheless, we intend to insist on even higher 
standards of behavior within our industry, and we are more than willing 
to see laws enacted to ensure that.'' Let me repeat that: ``We are more 
than willing to see laws enacted to ensure that result.''
  One of the most important pieces of their 18-point agenda is a 
requirement that plans use a layperson's definition of an emergency. 
Too often, health plans have refused to pay for care that was delivered 
in an emergency room.
  The American Heart Association tells us that if we have crushing 
chest pain, we should promptly go to the emergency room, because that 
could be a warning of a possible heart attack. But sometimes HMOs 
refuse to pay if the tests later on are normal. Mr. Speaker, if the HMO 
only pays when the tests are positive, I guarantee that people will 
delay getting proper treatment for fear of them getting a big bill. 
They could die if they delay diagnosis and treatment.
  Another excuse HMOs use to deny payment for ER care is the patient's 
failure to get preauthorization. This cartoon vividly makes the point: 
``Kuddlycare HMO. My name is Bambi. How may I help you? You are at the 
emergency room and your husband needs an approval for treatment? 
Gasping? Writhing? Eyes rolled back in his head? Doesn't sound all that 
serious to me. Clutching his throat? Turning purple? Uh-hmm. Have you 
tried an inhaler? He's dead? Well, then he certainly doesn't need 
treatment, does he?'' And then the reviewer puts down the phone and 
says, ``People are always trying to rip us off.''
  Does this cartoon seem too harsh? Ask Jacqueline Lee. In the summer 
of 1996 she was hiking in the Shenandoah Mountains when she fell off a 
40-foot cliff. She fractured her skull, her arm, her pelvis. She was 
airlifted to a local hospital and treated. Now, Members will not 
believe this. Her HMO refused to pay for the services because she 
failed to get ``preauthorization.'' I ask the Members, what was she 
supposed to do, lying at the bottom of the 40-foot cliff with broken 
bones? Call her HMO for preauthorization?
  I am sad to say that, despite strong public support to correct 
problems like these, managed care regulation still seems stalled here 
in Washington. Some opponents of legislation insist that health 
insurance regulation, if there is to be any at all, should be done by 
the States. Other critics worship at the altar of the free market and 
insist that it is ``the invisible hand'' that cures the ills of managed 
care.
  I am a strong support of the free market, and I wish we could rely on 
Adam Smith's invisible hand to steer plans into offering the services 
that consumers want.
  While historically State insurance commissions have done an excellent 
job of monitoring the performance of health plans, Federal law puts 
most HMOs beyond the reach of State regulation. Let me repeat that. 
Most people do not know this. Federal law puts most HMOs beyond the 
reach of State regulation.
  So we ask, how is that possible?
  More than 2 decades ago Congress passed the Employee Retirement 
Income Security Act, which I will refer to as ERISA, in order to 
provide some uniformity for pension plans in dealing with different 
State laws. Health plans were included in ERISA almost as an 
afterthought, and the result has been a gaping regulatory loophole for 
self-insured plans under ERISA.
  Even more alarming is the fact that this lack of effective regulation 
is coupled with an immunity from liability for negligent actions. Let 
me repeat that: This lack of effective regulation is coupled with an 
immunity from liability for negligent actions. If the HMO has made a 
negligent action which has resulted in harm or death of a patient and 
they are under the ERISA exemption, they are scot-free of any 
liability.
  Mr. Speaker, personal responsibility has been a watchword for this 
Republican Congress. This issue is no different. I have worked with the 
gentleman from Georgia (Mr. Charlie Norwood) and others to pass 
legislation that would make health plans responsible for their conduct. 
Health plans that recklessly deny needed medical service should be made 
to answer for their conduct. Laws that shield them from their 
responsibility only encourage HMOs to cut corners.
  Take this cartoon, for example. With no threat of a suit for medical 
malpractice, an HMO beancounter stands elbow to elbow with the surgeon 
in the operating room.

                              {time}  2030

  When the doctor calls for a scalpel, the bean counter says ``pocket 
knife.'' The doctor asks for suture, bean counter says ``Band-Aid.'' 
The doctor says ``Let's get him into intensive care,'' HMO bean counter 
says, ``Call a cab.''
  Mr. Speaker, some States have responded. Texas, for instance, has 
responded to HMO abuses by passing legislation that would make ERISA 
plans accountable for improper denials of care. But that law, Mr. 
Speaker, is being challenged in court and a Federal standard is needed 
to protect all consumers.
  The lack of legal redress for an ERISA plan's medical malpractice is 
hardly its only shortcoming. Let me describe a few of ERISA's other 
weaknesses: ERISA does not impose any quality assurance standards or 
other standards for utilization review. Except as provided for in 
Kassebaum-Kennedy, ERISA does not prevent plans from changing, reducing 
or terminating benefits.
  With few exceptions ERISA does not regulate a plan's design or 
content, such as covered services or cost sharing. ERISA does not 
specify any requirements for maintaining plan solvency. ERISA does not 
provide safeguards of a State Insurance Commissioner.
  It seems to me that we can take one of three approaches to reforming 
the way health plans are regulated by ERISA. The first would be to do 
nothing. But, Mr. Speaker, I have demonstrated why I think, and I think 
most of my colleagues would agree, that is not acceptable.
  The second option would be to ask the States to re-assume the 
responsibility of regulating these plans. This was the traditional role 
of States and they continue to supervise other parts of the health 
insurance market. But I will tell why that will not work. Turning 
regulation of ERISA plans over to States will be fought tooth and nail 
by big business and by HMOs and it will not happen.
  That only leaves one viable option: some minimal, reasonable, Federal 
consumer health protections for patients enrolled in ERISA plans.
  There are many proposals on the table, including the Patient Access 
to Responsible Care Act, the Patient Bill of Rights, the 18-point 
agenda released by Kaiser H.I.P. and AARP. Whether we enact one of 
these options or some other yet to be drafted, Congress created the 
ERISA loophole and Congress should fix that loophole.
  Defenders of the status quo sometimes say that making plans subject 
to increased State or Federal regulation is not the answer. They insist 
that like any other consumer good, managed care will respond to the 
demands of the market. I would note, Mr. Speaker, that I know of no 
other industry that is not liable for their acts of misconduct like 
self-insured ERISA health plans. So the shield from liability provided 
by ERISA by itself distorts the health care market.
  It differs from a traditional market in other ways as well. For 
example, the person consuming health care is generally not paying for 
it. Most Americans get their health care through their employer. 
Because the primary customer, the one paying the bills, is the 
employer, the HMOs have to satisfy their needs before they satisfy the 
needs of the patients. And the employer's focus on the cost of the plan 
may draw the HMO's attention away from the employee's desire for a 
decent health plan.
  As Stan Evans noted in ``Human Events,'' many HMOs operate on a 
capitated basis. This means that plans are paid a flat monthly fee for 
taking care of you. This translates to the less they spend on medical 
services, the more profit they make. How many markets, Mr. Speaker, 
function on the premise of succeeding by giving customers less of what 
they want?
  Take a look at this cartoon which illustrates perfectly the bottom-
line mentality of HMO plans. The patient is

[[Page H1849]]

in traction while the doctor reviews his chart. The HMO bedside manner, 
the doctor says, ``After consulting my colleagues in Accounting, we 
have concluded you are well enough. Now go home.''
  Are HMOs paying attention to their patients' health or to their 
stockholders' portfolios?
  Stan Evans again hit the nail on the head when he noted ``Paid a 
fixed amount of money per patient regardless of the care delivered, 
HMOs have a powerful motive to deliver a minimum of treatment. Care 
denial, pushing people out of hospitals as fast as possible, blocking 
access to specialists and the like are not mistakes or aberration. They 
stem directly from the nature of the setup in which HMOs make more 
money by delivering less care, thus pitting the financial interest of 
the provider against the medical interest of the patient.''
  His comment raises an important issue. Presented with tragedies like 
those of the Baumans or Mrs. DeMeurers, managed care defenders argue 
that ``those people are just anecdotes.''
  What Mr. Evans points out is that cases like these are not mistakes 
or aberrations or ``anecdotes.'' They are exactly the outcomes we would 
expect in a system that rewards those who undertreat patients.
  Finally, Mr. Speaker, markets only function when consumers have real 
choices. Dissatisfied consumers have limited options. Most employers 
offer employees very few health plans. For many, the choice of health 
plans is simple: ``Take it or leave it.''
  Freedom in the health insurance market for many now means quitting 
your job if you do not like your HMO. There is not a free market when 
consumers cannot switch to a different plan. But even if we were to put 
aside all of these arguments and assume that health insurance was a 
free market, there is still the need for legislation to guard patients 
from abuses. The notion of consumer protections is consistent and 
supportive of our concept of free markets.
  In his book, ``Everything For Sale,'' Robert Kuttner points out the 
problems of imperfect markets. ``Industries such as telecommunications, 
electric power and health care retain public purposes that free-market 
forces cannot achieve. For example, as a society we remain committed to 
universal access to certain goods. Left to its own device, the free 
market might decide that delivering electricity and phone service to 
rural areas and poor city neighborhoods is not profitable, just as the 
private market brands cancer patients as `uninsurable.' ''
  Think for a minute, Mr. Speaker, about buying a car. Federal laws 
ensure that cars have horns and brakes, headlights. Yet despite these 
minimum standards we do not have a ``nationalized auto industry.'' 
Instead, consumers have lots of choices. But they know that whatever 
car they buy will meet certain minimum safety standards. You do not buy 
safety ``a la carte.''
  The same notion of basic protections and standards should apply to 
health plans. Consumer protections will not lead to socialized medicine 
any more than requiring seat belts has led to a nationalized auto 
industry. In a free market, these minimum standards set a level playing 
field that allows competition to flourish.
  Critics of regulating managed care also complain that new regulation 
will drive up the cost of health insurance. How often have I heard this 
argument. In criticizing the Patient Access to Responsible Care Act 
they cite a study showing that certain provisions could increase health 
insurance premiums from 3 to 90 percent. Three to 90 percent. What a 
joke. Such a wide range is meaningless. It must be an accountant's way 
of saying, ``I don't know.''

  Other studies have said that costs may go up slightly but nothing 
near the doomsday figures suggested by opponents of this legislation. A 
study by the accounting firm Muse & Associates shows that premiums will 
increase between seven-tenths of 1 percent and 2.6 percent if the 
Patient Access to Responsible Care Act is enacted.
  And do not let the HMOs tell anyone that the rising premiums we are 
seeing this year are the result of Federal regulation. HMOs have been 
charging below-cost premiums for years, and as a result we are now 
seeing premium increases long before the passage of any Federal 
consumer protection legislation.
  Keep in mind also the shareholder's philosophy of making money can 
come into conflict with the patient's philosophy of wanting good 
medical care. To save money many plans have nonphysician reviewers to 
determine if callers requesting approval for care really need it. Using 
medical care ``cookbooks,'' they walk patients through their symptoms 
and then reach a medical conclusion.
  Unfortunately, the cookbooks do not have a recipe for every 
circumstance, like the woman who called to complain about pain caused 
by the cast on her wrist. The telephone triage worker asked the woman 
to press down on her fingernail and see how long it took for the color 
to return. Unfortunately, over the phone she could not see that the 
patient had fingernail paint.
  How far can this go? Well, like this cartoon shows, pretty soon we 
could all be logging on to the Internet and using the mouse as a 
stethoscope.
  This trend should trouble every one of us. Medicine is part science, 
it is part art. Computer operators cannot consider the subtleties of a 
patient's condition. Sometimes answers can be known by reading a chart. 
But sometimes doctors reach their judgments by a sixth sense that this 
patient is really sick. There are certain things that computers cannot 
comprehend.
  Mr. Speaker, doctors are expected to be professional, to adhere to 
standards and to undergo peer review. Most of all, they are expected to 
be their patients' advocates, not to be government or insurance 
apologists. It is in the interest of our citizens that their doctor 
fights for them and not be the ``company doc.''
  Like a majority of my colleagues, I am a cosponsor of H.R. 1415, the 
Patient Access to Responsible Care Act, otherwise known as PARCA. In an 
effort to derail this legislation, the managed care community has made 
a number of false statements about this bill. For example, they 
repeatedly state that PARCA would force health plans to contract with 
any provider who wanted to join its network. That is clearly a false 
statement.
  In two separate places the bill states that it should not be 
considered an ``any willing provider'' bill. PARCA simply includes a 
provider nondiscrimination provision similar to what was enacted in 
Medicare last year. Provider nondiscrimination and ``any willing 
provider'' are no more the same than equal opportunity and affirmative 
action.
  Mr. Speaker, similarly, some opponents have suggested that the bill 
would force health insurance to be offered on a guaranteed issue or a 
community rating basis, and I say this is a nonissue. The gentleman 
from Georgia (Mr. Norwood) and I oppose community rating and guaranteed 
issue, and will not support any bill that would result in community 
rating or guaranteed issue.
  Mr. Speaker, when I began these remarks I mentioned the focus group 
held in Maryland by Frank Luntz. At end of the session he described a 
package of consumer protections much like the Patient Access to 
Responsible Care Act and he asked participants whether they were in 
favor. All 28 hands shot up. One woman even said she was shocked that 
it did not already exist.
  Next Mr. Luntz asked how many would support the package if it caused 
health insurance premiums to increase 5 percent. All 28 thought that 
was a reasonable price to pay for those protections. In fact, 27 out of 
28 would support the proposal even if it caused insurance premiums to 
increase by 10 percent, and nearly three-quarters still supported the 
package if it caused insurance premiums to increase by 15 percent. Yet, 
as I mentioned, Mr. Speaker, a study by Muse & Associates shows that 
enactment of PARCA would only raise premiums between seven-tenths of 1 
percent and 2.6 percent.
  Mr. Speaker, consumers have lost confidence in their HMOs. The public 
clearly thinks that they have cut costs at the expense of quality. It 
is time for reform. The American public is crying for help and is 
looking to Congress for answers. The time for talking has passed. Our 
goal should be passage of comprehensive patient protection legislation.
  Mr. Speaker, I am committed to seeing legislation enacted by the 
close of

[[Page H1850]]

this 105th Congress, and I am open to working with all interested 
Members, Democrat or Republican, to develop a bipartisan patient 
protection bill. In the meantime, Mr. Speaker, H.R. 586, the Patient's 
Right to Know Act, which has 299 cosponsors and would ban gag rules, 
should be brought to the floor for a vote.

                              {time}  2045

  Mr. Speaker, just last week a pediatrician told me about a 6-year-old 
child who had nearly drowned. The child was brought to the hospital and 
placed on a ventilator. The child's condition was serious. It did not 
appear that he would survive. As the doctors and the family prayed for 
signs that the boy would live, the hospital got a call from the boy's 
insurance company. Explained the HMO, ``Home ventilation is cheaper 
than inpatient care. I was wondering if you had thought about sending 
the boy home.''
  Or consider the death of Joyce Ching, a 35-year-old mother from 
Fremont, California. Mrs. Ching waited nearly 3 months for an HMO 
referral to a specialist, despite continued rectal bleeding and severe 
pain. Joyce Ching was 35 years old when she died from a delay in 
diagnosis of her colon cancer. Joyce Ching, Christy DeMeurers, 
Michelina Baumann, Dr. Peeno's patient, Mr. Speaker, these are not just 
``anecdotes.'' These are real people who are victims of HMOs. Let us 
fix the problem. The people we serve are demanding it.
  To paraphrase Shakespeare: Hath not these ``anecdotes,'' these HMO 
victims' eyes? Hath not these ``anecdotes'' hands, organs, dimensions, 
senses, affections, passions, fed with the same food, hurt with the 
same weapons, subject to the same diseases, warmed and cooled by the 
same winter and summer as these same HMO apologists? If you prick the 
``anecdotes,'' do they not bleed? If you tickle these ``anecdotes,'' do 
they not laugh? If you shortcut their care for profits, do they not 
die? And for those who dismiss them as ``anecdotes,'' will they not 
revenge?
  Mr. Speaker, let us act now to pass meaningful patient protections. 
Lives are in the balance.

                          ____________________