[Congressional Record Volume 144, Number 65 (Wednesday, May 20, 1998)]
[Extensions of Remarks]
[Pages E910-E912]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


         ON THE SPEAKER'S VISION FOR HEALTH IN THE 21ST CENTURY

                                 ______
                                 

                         HON. RICHARD K. ARMEY

                                of texas

                    in the house of representatives

                        Wednesday, May 20, 1998

  Mr. ARMEY. Mr. Speaker, I would like to insert in the record a 
transcript of a recent speech on the subject of health in the 21st 
century by the Speaker of the House, the gentleman from Georgia, Mr. 
Gingrich.
  As is so often the case, this speech by the gentleman, given to the 
American Association of Health Plans in mid-February, is full of 
insight.
  At a time when the liberals and some doctors' associations are 
pressing for new government mandates on health insurance companies, and 
President Clinton is trying to achieve socialized medicine 
incrementally, it is important that we step back, as the Speaker wisely 
observes, and rethink the whole question of how to improve health and 
not just health care or health insurance.
  In the coming health-care revolution, which promises to be an age of 
highly informed consumers and entrepreneurial doctors and insurers 
coming together to provide ever greater quality for customers at ever 
lower cost--in such an age the old prescriptions of regulation and 
mandates will be shown for the anachronisms they really are.
  America's health-care system, for all its many faults, is still the 
best system in the

[[Page E911]]

world when it comes to the quality of our doctors, our drugs, our 
devices, our treatments, our techniques, and our technologies.
  But all of that progress would be threatened by the Democrats' 
``Patients' Bill of Rights Act,'' H.R. 3605. This bill puts me in mind 
of medieval barbers applying leeches. It is one of the more misguided, 
irresponsible, and politically inspired bills I have seen. It is a 
breath-taking collection of costly mandates and grants of bureaucratic 
power. It would regulate the health insurance industry in every 
imaginable way. It would eliminate all but the most restrictive HMOs. 
It would enable nurses and doctors to go on strike. It would divert 
scarce health resources to lawyers and bureaucrats. It would make 
insurance unaffordable for millions of working Americans. It would 
swell the ranks of the uninsured. And it would impose innovation-
stifling restrictions on the practice of medicine, just to name a few 
of its likely effects.
  Happily, I have confidence that this Congress is not going to pass 
this backward bill, or anything like it. Members are increasingly aware 
of the dangers of such politically inspired legislation, and will, I 
think, warmly embrace the happier, freer vision for health in America 
outlined in the address of the gentleman from Georgia. I commend that 
address to the attention of all of my colleagues.

    ``Health Care Reform in 1998: What Can We Expect From the 105th 
    Congress?''--Keynote Address by Newt Gingrich, AAHP 1998 Policy 
                     Conference, February 22, 1998

       Let me tell you where I think we are on health, and I want 
     to start with a very simple planning model of eight words. I 
     want to share this model with you because I think it's the 
     heart of our current challenge in health. It's four words 
     that are a hierarchy and then four words that are a straight 
     line. The top word is ``vision,'' and I think this is the 
     place we most have failed. What is our vision of America's 
     future in health? And notice, I didn't say ``health care.'' I 
     think when you say ``health care,'' you've already come down 
     a layer of detail.
       Our interests ought to be health and then, secondarily, 
     health care. Take the example of diabetes. We know there are 
     Indian tribes that have 50 percent diabetes rates. If we 
     could save 45 of that 50 percent from needing kidney 
     dialysis, we would lower the cost of health care because we 
     would increase health. So it's very important at the vision 
     level what words do you use, what do they mean, because that 
     then defines all the other layers.
       The second layer is strategies. What are your strategies 
     for getting something done? For example, I am passionate 
     about preventive care and wellness, and one of our strategies 
     in Medicare reform was to begin to move towards more early 
     screening, more preventive care, which we believe will 
     ultimately save money, but is scored in this city as a cost. 
     The Centers for Disease Control estimates if you had really 
     effective screening and education on diabetes, it would save 
     $14 billion a year. Yet you cannot get the Congressional 
     Budget Office or the Office of Management and Budget to score 
     that.
       The third level is a project, and a project in this model 
     is the real building block of management, but it's an 
     entrepreneurial model, so I want to give you a definition. 
     A project is a definable, delegatable achievement. That's 
     a very important distinction.
       The bottom line is tactics. What do you do every day? And 
     tactics relate directly back to the top. For example, if 
     you're interested in preventive care and wellness, one of the 
     things you do every day to remind people that they have an 
     obligation to check at least once a year to see how they are 
     doing. One of the things you try to figure out is to remind 
     diabetics they have an obligation every day, several times a 
     day, to check their blood sugar, so that it's a very 
     different model than the model we've traditionally had.
       Now, coming off of tactics, I put four words in a straight 
     line because they are a process; that is, they are not a 
     hierarchy. They are all equally important, but they occur in 
     a sequence, the words which we use for what we think is the 
     essence of leadership, and they are very simple, but I think 
     they apply directly to the challenge you all face: listen, 
     learn, help, and lead. Now, we figured out in a democracy in 
     the Information Age, the first job of leadership is to 
     listen.
       Now, we put ``learn'' second because we discovered two 
     interesting phenomena about Americans. Americans will spend a 
     lot of time with their eyes glazed over standing next to 
     somebody at a cocktail party while that person babbles. That 
     is not listening; that's patience. We also discovered that 
     most Americans have a habit of paying very careful attention 
     to their own arguments. If you get in an argument, you really 
     listen to yourself when you argue. When it's the other 
     person's turn, you pretend to listen, but you're actually 
     restructuring your own argument. That's not listening; that's 
     cheating.
       What we are trying to do is what consultants describe as 
     appreciative understanding. You have to understand what the 
     other person is saying and appreciate why it is true for 
     them. You don't have to agree with them. You don't have to 
     sympathize, but you have to understand what they are saying. 
     So you haven't finished your listening/learning phase until 
     you know what they are saying and why they think it makes 
     sense, even if you don't.
       Now, in a rational world, as a general principle, if 
     somebody will listen to you and learn from you, you help 
     them. First of all, because they ventilate. You help them, 
     second, because you put them in that position where you might 
     ask them good questions, so they think thoughts they never 
     had before; you open them up. You might have ideas they 
     didn't have. You may have information to empower them that 
     they didn't have. You may actually have authority or 
     resources you can give to them.
       In a rational world, if somebody knows you will listen to 
     them, learn from them, and help them, they will ask you to 
     lead. Now, what I usually do is I draw a line, then, from the 
     word ``lead'' back up to ``vision.'' You then say: Here is my 
     vision, here are my strategies, here are my projects, here 
     are my tactics, and you immediately go back to listen and 
     say, what do you think of them? Now I think that model 
     applies exactly to where we are in health in America today.
       Now, let me tell you the mistake I think we all make. When 
     the Clinton administration came in, they saw a charge, which 
     is very real, which is that we need to rediscuss health in 
     America. Notice, I didn't say ``health care.'' This is going 
     to be one of my first real efforts at redefining this 
     dialogue. We should not talk about health care in America 
     until we first finish talking about health in America, 
     because they are not the same topic. And the minute you get 
     into health care, you're already in a narrower and smaller 
     future than if you start by discussing health, a subset of 
     which is health care.
       And I think the president was right in 1993 to say we need 
     a dialogue. I think he was wrong in offering a solution that 
     was a failed, centralized, bureaucratic model of control. And 
     the country, after it thought about it for a year, decided 
     that was the wrong answer. But I think where we all 
     collectively failed is that at that point what we should have 
     said is, okay, now can we go back to the original dialogue? 
     And instead, what happened was all the folks were very busy. 
     Everybody went back to their own game, most of which are at 
     the level of a tactic or a project. So there is almost no 
     vision-level discussion in America about health. And yet the 
     most objective fact about health in America is that it is an 
     obsolete model of delivery based on, first, you have to get 
     really sick.
       We need to return to the overall dialogue on health. Let me 
     give you a very simple premise for that dialogue. The 
     National War Labor Board, in 1943, for totally wartime-
     related, wage-and-price-control reasons, created the tax 
     incentive and the way we now structure third-party payments. 
     And this is entirely an artificial artifact. It makes no 
     sense. If you were to actually sit down and say, let's design 
     health for America, you would not say, if you pay all 
     your own health costs, you get no tax deduction until 
     seven percent of your income has been spent, but if you 
     will go and work for a company, you can get a 100 percent. 
     By the way, if you're self-employed, you won't get the 100 
     percent. It is all a historical anachronism.
       In this national dialogue on health, we need to start with 
     basic health research. We need to look at things like the 
     National Institutes of Health database MEDLINE and the 
     ability to create a computer-based system where any patient 
     anywhere in the country can get access to any information, 
     which is, frankly, going to drive doctors nuts because it's 
     going to mean they are going to have patients with 
     specialized diseases who know more about the state of the art 
     than they do, and you're going to have a patient-led 
     information system.
       And the real reason we are having a fight over HMOs has 
     nothing to do with quality of care; it has to do with power. 
     This is a country which hates concentrations of power, and in 
     a very real sense HMOs are suffering from the same challenge 
     that any other concentration of power suffers from. Americans 
     hate to be controlled. Remember, we did have a flag in the 
     Revolutionary War on which was a snake, and which said: 
     ``Don't tread on me.'' It's very close to the American model.
       There is a wonderful new history by Paul Johnson called ``A 
     History of the American People,'' which I recommended to all 
     of you; he really captured the heart of American 
     civilization. One of his lines is that in 1775, we were 
     possibly the lowest taxed people in the history of the world, 
     and we hated every penny. There was no sense of gratitude.
       Now, the reason I'm suggesting this is, we are trying to 
     design a health system for Americans. Americans believe it is 
     their natural right, that they are endowed by their creator 
     with the right to have total access, with the right to 
     question any authority figure, with the right that if they 
     don't like the first diagnosis, they get a second one. They 
     need a ventilation point that is an authority figure that 
     they can go to beat up the other authority figure that they 
     are mad at. We need to ask: What are the patients' rights? 
     What are their responsibilities? Do they agree those are 
     their rights and their responsibilities? What's their 
     ventilation point?
       There is a power struggle between medical professionals and 
     administrators, and that's a big part of what's happening 
     with the HMOs because every time the medical doctor is mad, 
     he or she explains to the patient that it's the HMO's fault. 
     Or every time they can't do something the patient wants, they 
     say, ``I would, but they won't let me.'' And so you have a 
     real power struggle.

[[Page E912]]

       If you look, for example, at the PARCA bill, it is largely 
     a design of all the professionals who now want their share of 
     the pie, and it's their version of how they would redesign it 
     if health care was a pork-barrel project. But what you need 
     to understand is, that is a natural partner of historic 
     evolution once you politicize these decisions.
       I'm not up here today to say anybody is right. I'm up here 
     today saying let's look at the whole country. The M.D. is 
     going to be threatened because the truth is we can begin to 
     turn into expert systems. We can begin to have more 
     preventive care. We can begin to have more patient 
     responsibility. We can begin to have more information to the 
     patient.
       All of that is going to threaten the medical doctor. But 
     their problem now is going to be science and the Information 
     Age, not the HMO administrator. The HMO administrator must 
     recognize that if you don't have a very high-quality 
     response, if you're not very customer oriented, and if you 
     haven't built a very good response system for your customer 
     so that they have a ventilation point where they can get a 
     second opinion, where they can appeal to a higher authority 
     against the authority that's made them mad, you're guaranteed 
     to get political action; that the only way to avoid political 
     action is to have a self-fine-tuning, a self-responding, and 
     a self-evolving system that is customer-friendly and consumer 
     oriented.
       In addition, I would argue that if we are really at the 
     vision level talking about the future of health in America, 
     it's likely to be a different system than anything we've 
     seen, that the ideal model is one that goes back to 
     dramatically strengthening the patient, that the patient 
     ought to have a lot more choices and more responsibilities.
       I've always like the International Paper model where they 
     list every doctor in the area and every hospital in the area, 
     and they say, here is how much they cost, and here is their 
     background, and, by the way, we'll pay 100 percent of the 
     median price. Go to anybody you want to. Now, if you want to 
     go to a more expensive doctor, fine, you pay the additional 
     costs. But it begins to dramatically transfer knowledge and 
     power and responsibility.
       Dr. Tom Coburn, who serves as a Member of Congress for 
     Oklahoma, came up to me at our retreat in Williamsburg, and 
     he said, I think we ought to reapply free-markets principles 
     to health care; and being a conservative, I promptly said, 
     yes, what do you mean? I know it's right theoretically. I 
     know Adam Smith is right theoretically, but what does it mean 
     in the middle of this 1943 tax code, third-party payment, 
     highly convoluted, big structure, HMO, provider-sponsored 
     network, hospital-based, doctor-based, secondary 
     professions--in this mess, this huge, complex ecosystem of 
     health, what does ``free market'' mean?
       He said, I'll tell you a true story. He said, during the 
     break, I had a couple who were between jobs and they had lost 
     their health coverage, but they had savings. She needed an 
     operation. I gave her five surgeons and three hospitals to 
     call. They negotiated. They got an $11,000 procedure for 
     $5,000, but they paid in cash without paper work.
       Now, that's a fairly astonishing number. My guess is all of 
     you could find similar stories or already know similar 
     stories. From my standpoint, what I want to do is say, so how 
     do we maximize the rate of change? Because what the human 
     genome projects is telling you and what lasers are telling 
     you and what all the other breakthroughs are telling you is 
     you're going to see a rate of change in health capabilities. 
     And, again, I don't want to talk about health care yet. 
     You're going to see a rate of change in health capabilities 
     that is stunning.
       So how do we maximize that rate of change? How do we 
     maximize the citizens' access to knowledge, including their 
     knowledge about their own responsibilities and knowledge 
     about their own characteristics and knowledge about how to 
     stay well rather than get sick? How do we maximize the 
     ability to connect the citizen to the professional at the 
     minimum cost with the maximum choice? How do we create 
     feedback loops, both so that we know it's the right 
     professional, and so if something goes wrong, we can check on 
     it?
       And if you could tomorrow morning take your HMO or take 
     your health organization and find a way to have 100-percent 
     deductibility for health, so that a person who paid out of 
     their own pocket had exactly the same deductibility as a big 
     corporation and said to all of your members, ``Here is 
     basically a cafeteria plan. Which of these nine things do you 
     like better?'' you would lose some of your mass purchasing 
     power, but you would put back on their shoulders their 
     responsibility. So you like the HMO? Fine. Come in and join 
     one. You would rather go and buy it all on your own? Fine. Go 
     buy it all on your own.
       And what I'm suggesting is that where we need your help is 
     not only doing better, and a lot of you represent some of the 
     most enlightened and most aggressive and most patient-
     oriented and also most health-research-oriented people in the 
     country. But I'm also asking you to take a little extra time, 
     go back up to the vision level. Help us solve the big issues. 
     Help us think about what do we mean in the 21st century by 
     health in America. What should a citizen have access to? How 
     do we maximize the rate of change?
       And I'll just close with this thought. Health is not a 
     problem. Health is an opportunity. Health will be the 
     largest, foreign-exchange, income earner in the 21st century. 
     If we have the best system of health on the planet, if we 
     have the best research on the planet, if we provide the best 
     care on the planet, as people get wealthier worldwide, they 
     will come to America, either personally, or by electronic 
     means, in order to have access to the finest health in the 
     world.
       We will earn far more money out of providing the best 
     health capabilities on the planet than we will earn out of 
     the motion picture industry, jet airplanes or computers, and 
     we ought to see health as that opportunity--the opportunity 
     to provide the best health for our own citizens and to 
     provide the highest-paying jobs on the planet in a growth 
     industry of enormous potential if we maximize the rate of 
     change and innovation and bring to bear the best science we 
     can as rapidly as we can.
       And if we then educate our citizens into a knowledge-based 
     model of caring for themselves, we will maximize their health 
     and minimize their costs, and we will do so in a way that I 
     think will be profoundly different than the current debate 
     between more bureaucracy-less bureaucracy, more trial 
     lawyers-fewer trial lawyers, and I think we need this much 
     larger level dialogue in order to define where we want to go 
     over the next 15 or 20 years.

     

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