[Congressional Record Volume 144, Number 94 (Wednesday, July 15, 1998)]
[Extensions of Remarks]
[Pages E1301-E1302]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


                           HEALTH CARE REFORM

                                 ______
                                 

                          HON. LEE H. HAMILTON

                               of indiana

                    in the house of representatives

                        Wednesday, July 15, 1998

  Mr. HAMILTON. Mr. Speaker, I would like to insert my Washington 
Report for Wednesday, July 15, 1998 into the Congressional Record.

                          Managed Care Reform

       The most important political issue today, and for the past 
     decade, is health care. Several prominent publications have 
     identified health care as the defining issue of the 1990s. I 
     agree. In meeting after meeting in southern Indiana I have 
     noticed how persistently the question of health care comes 
     forward in discussions. It is the issue that bubbles and 
     seethes beneath the surface at all times simply because it is 
     the most personal and real issue that touches the hopes and 
     fears of every American.


                      Popular views on health care

       I find Hoosiers overwhelmingly want everyone to have access 
     to health care services but they split on how to pay for that 
     access. Hoosiers are usually skeptical of government action 
     but I do not find them objecting to a prominent role for 
     government to play in health care. They do not want a 
     comprehensive plan like the one President Clinton proposed in 
     1994, but they do want to see the government assuring access 
     to affordable health care, vigorously policing the providers 
     of health care such as insurance companies, demanding more 
     generous coverage from employers, and ensuring that their 
     existing benefits are not cut back. Futhermore, they do not 
     want to see any interference with the doctor-patient 
     relationship.
       When it comes to the issue of managed care, most people 
     recognize that managed care plans have helped to hold down 
     costs and provide preventive health care. But they also worry 
     that managed care can sometimes interfere with the doctor-
     patient relationship and impede access to medical treatment. 
     They want government to hold managed care plans accountable. 
     The general view seems to be that Hoosiers will support 
     tougher government oversight of managed care plans but they 
     do not want the government to come in and take over health 
     care.


                             Mixed success

       In light of widespread support for changes in the health 
     care system, I am struck by the number of Hoosiers who say to 
     me that they are quite satisfied with their own health care. 
     Their personal experiences have largely been positive. They 
     recognize the successes of the American health care system. 
     Vaccination rates are up, premature births are down, more 
     women are getting mammograms, and the move to managed care 
     has saved billions of dollars in health care spending. They 
     and their families are probably as healthy today as they ever 
     were and for the most part they have affordable health 
     coverage.
       Nonetheless, underlying these successes is the fear that 
     the system will not continue to work for them and be there in 
     times of crisis. Hoosiers really worry about how they would 
     handle a major illness, and they tell me again and again of 
     acquaintances who were simply wiped out financially by a 
     major medical problem. Many feel overwhelmed by the red tape 
     and bureaucracy in today's health care system. They are 
     uncomfortable that power has shifted in the health care 
     system from the physicians to the insurance companies and 
     managed care plan administrators.


                         Congressional Outlook

       President Clinton made health care a central theme of his 
     first term in office when he

[[Page E1302]]

     put forward his sweeping health care proposal which featured 
     universal coverage and a mandate on employers to provide 
     health insurance for their employees. But his plan was 
     decisively rejected and led, in large part, to the change of 
     control in Congress in 1994. The Clinton health care proposal 
     was rejected because people felt it was too massive, too 
     complex, and its consequences too uncertain. The bill was 
     about 1300 pages in length.
       Although the rejection of Clinton's proposal made both the 
     Congress and the President wary of comprehensive health care 
     reform, the issue did not die. Today, members of Congress are 
     keenly aware of the intensity of their constituents feelings 
     on health care. The public is demanding better care for less 
     money. They do not like the high cost of health care or the 
     restrictions on its availability. They know the shortcomings 
     in today's system: too many Americans, especially children, 
     do not have adequate health care coverage; long-term care for 
     older persons is unaffordable to most Americans; and many 
     feel that managed care plans focus more on holding costs down 
     than providing quality care.


                           Incremental reform

       On health care, as on many issues, Americans are more 
     comfortable with incremental steps and skeptical of massive 
     changes in one swoop. For the next few years, my guess is 
     that the Congress will proceed with improvements in health 
     care on a step-by-step basis. That's what it tried to do two 
     years ago with the Kennedy-Kassenbaum legislation which 
     mandated portability in most insurance plans, enabling 
     workers to change jobs and not be dropped for preexisting 
     conditions, and last year when it expanded coverage for 
     children.
       In the Congress, both parties are proposing plans to patch 
     up managed care with such measures as expanding a patient's 
     ability to choose a doctor and to receive emergency care and 
     to appeal plan decisions to a neutral third party.
       It is quite possible that the Congress will approve this 
     year a sensible, but modest, health care reform package which 
     I would expect to support. The elements of the package would 
     likely include new opportunities for patients to appeal to a 
     neutral third party when their health plans deny them care, 
     give more information to help them select doctors and health 
     plans, provide women the right to see a gynecologist, 
     guarantee emergency room access without prior approval from 
     managed care plans, protect personal medical information, and 
     allow doctors to discuss with their patients a full range of 
     medical options.


                               Conclusion

       We are in the midst of major changes in health care 
     coverage. A decade ago, the majority of Americans received 
     health care through traditional fee-for-service plans. Today 
     most Americans receive their health care through managed 
     care, usually through HMOs. Lower costs and a wider array of 
     benefits, including prescription drug benefits, are often 
     seen as advantages of managed care plans. As the reform 
     debate goes forward it is important to build on the success 
     of what is developing into a more efficient health care 
     system, while improving both the quality of care and patient 
     satisfaction with their health care services. My guess is 
     that health care reform will be on the agenda of the Congress 
     for many years to come.

     

                          ____________________