[Congressional Record Volume 144, Number 94 (Wednesday, July 15, 1998)]
[Senate]
[Pages S8266-S8267]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  Mr. DeWINE. Mr. President, I rise tonight to talk about health care, 
managed care, and the several proposals in Congress that attempt to 
address these issues.
  Mr. President, just this morning, the assistant Republican leader, 
Senator Nickles, and his Republican working group, unveiled an outline 
of a bill they are developing, a bill that they intend to shortly 
introduce.
  This is clearly an issue that affects all Americans. Back home in 
Ohio, I hear constantly from my constituents about the issues involving 
managed care and the new world of health care that we all live in.
  Mr. President, I recognize and share the concerns that many Americans 
have with the cost and the quality of health care and of managed care. 
As the father of eight children, I visited emergency rooms and I 
visited pediatricians' offices. I hear and I understand parents' 
concerns about all the new hurdles in health care. I understand the 
problems of parents struggling to try to get a doctor's appointment for 
their children, the difficulty in trying to get managed care plans to 
authorize care, and the concern that their children will not get needed 
care if that care is not authorized.
  Mr. President, these are problems shared by millions of American 
families. They are problems Congress must deal with. But as we look at 
this issue, and all the problems and concerns that go with them, we 
need to be careful. We need to be careful that we do not create 
solutions that are really worse than the problems.
  For example, as we look at regulating managed care, we have to be 
careful about the impact of proposed regulations on the availability of 
that care. Certainly I do not believe any of us wants to see fewer 
people being able to get health insurance as a result of our good 
intentions. That is why we need to be sure that whatever Congress does, 
we do not cause health care costs to significantly increase. We know 
that the only result of higher costs will be a health care system that 
many companies and individuals will simply not be able to afford, 
meaning more Americans will be denied quality health insurance.
  So where do things stand right now? Obviously, several health care 
proposals already have been introduced and talked about, such as the 
Patient Access to Responsible Care Act, or PARCA, and also the 
Democrat's Patients' Bill of Rights. Other options are being developed. 
I already mentioned the legislation being developed by my colleague 
from Oklahoma, Senator Nickles, and a Republican working group. The 
House of Representatives is considering their own proposals as well.
  The bottom line is this: It is clear that Congress needs to consider 
managed care reform legislation. I am eager to work with my colleagues 
to make sure some crucial issues, particularly the issues that face 
America's children, are in fact addressed.
  Mr. President, while I would like to see specific language--after 
all, as we always say, the devil is always in the details--I believe 
that the legislation unveiled today by the Senator from Oklahoma, 
Senator Nickles, and the rest of the working group, represents a 
positive--a positive--start on the road to reform.
  I am particularly pleased that the bill includes a guarantee that 
children will have direct access to pediatricians. I have said it many, 
many times on this floor, but let me say it again this evening--
children are not just little adults. Their health care needs are 
unique. When a child goes to a doctor's office, that child needs to see 
someone who has been specifically trained to deal with the unique 
issues of pediatric care; that child needs to see a pediatrician.
  I am very pleased that my discussions with Republican task force 
members on pediatric issues has helped produce a provision in the 
working group bill that would guarantee our children will be, in fact, 
treated by pediatricians.
  Mr. President, there are several additional ways that we can further 
improve the quality of children's health care as a part of this overall 
managed care reform effort. I would like to talk about these additional 
ways right now.
  Specifically, Mr. President, I believe there are three key issues 
that would go a long way to addressing the health care needs of our 
children: No. 1, additional pediatric protections beyond what is 
already now in the bill. In addition to guaranteeing access to 
pediatricians, other basic protections for children should be addressed 
to help make sure that health plans are addressing specific pediatric 
needs.
  The most important of these is making sure that when a child faces a 
serious health problem that calls for specialty care, that that child 
has access to a health care provider with pediatric training or 
experience. This could mean that a child with a heart murmur would be 
guaranteed access to a pediatric cardiologist. It could also mean that 
a baby in need of intensive hospital care and monitoring has access to 
a children's hospital, a children's hospital to make sure that 
pediatrics-specific equipment and care is available for that baby.
  Mr. President, my wife Fran and I have personal experiences with our 
children and with children's hospitals. When your child--my child--has 
a serious medical problem, you want the best care, you want the best 
specialists. Many times, quite bluntly, that means going to a 
children's hospital.
  Specialists trained to treat adults often do not have the expertise 
that children need. That is not their specialty. I would hope that our 
efforts of managed care reform include making sure children have access 
to the necessary pediatric expertise, whether that be from the initial 
treating physician being a pediatrician, or whether it means ultimately 
going to a children's hospital.
  Mr. President, it is important that these basic protections are in 
place for children, because pediatric care is probably the part of 
managed care that we really know the least about. The truth is, we just 
don't know how well managed care takes care of our kids. The measures 
of quality and studies we have that evaluate managed care simply have 
not looked at children. In the absence of this evidence, I think that 
some basic protections for children are required, and they certainly 
make sense.
  I also don't believe the cost of these pediatric protections will 
amount to a great deal. As we all know, children comprise about 30 
percent of our population, but a much smaller part of the cost of 
health care, a much smaller. I don't believe that making sure children 
can see pediatricians and pediatric specialists will have an increase 
on health care costs. In fact, it should have the opposite effect. It 
could and should reduce costs. This kind of access could cut down on 
unnecessary trips to doctors, emergency rooms, and work as a good 
avenue for preventive medicine. Preventive medicine is important for 
all of us, but nowhere is it as important as it is in dealing with our 
children. Let me say that again. As the father of eight, I think anyone 
who has had children knows that and understands that preventive care is 
the key.
  Let me move to the second point and the second suggestion, that is 
pediatric quality-related research. One important trend we have seen 
lately in our health care system is the effort to measure quality and 
improve the science of health care quality. The ability to measure this 
is vitally significant. But as with many parts of our health care 
system, not enough attention has focused on children. It is reported 
that only about 5 percent of this research is aimed at our kids. What 
is the result? We just haven't had the same type of advances and 
quality improvements for our children that we have seen for adults.
  I have introduced a bill that tries to fix this by focusing attention 
on pediatric quality-related research. Among other things, our bill 
includes dedicated funding to make up for the lack of health care 
outcomes and quality-related information for children. The legislation 
being developed by the Republican working group already includes a

[[Page S8267]]

significant focus on health care quality research. My friend from 
Tennessee, Senator Bill Frist, has worked very hard on this part of the 
bill and he has done an excellent job. I believe we should build on 
that effort to focus specifically on children. I believe that would be 
an excellent and an important addition to managed care reform.
  Let me turn to the third item. The third area where I believe we can 
improve this bill, the third item with which I think this Congress must 
deal, the other improvement I would like to see considered, is language 
to strengthen the services provided by our Nation's poison control 
centers. Other than preventive care, much of the health care our 
children receive is based on emergencies, occurs when emergencies 
happen. One of the more common emergencies in children, of course, is 
poison. Each year more than 2 million poisonings are reported--2 
million--over half of which occur in children younger than 6 years of 
age.
  While our Nation's poison control centers do a very good job, a very 
good job responding to these crises, they do face funding problems. 
Many of these centers have been financed through unstable arrangements 
from a variety of public and private sources. Funding difficulties are 
the primary reason that about half of our poison control centers are 
not certified, meaning that they may not be operating at all times or 
that fully qualified experts may not be available around the clock.
  I have written legislation that would deal with this problem by 
providing Federal supplemental assistance to poison control centers. In 
addition, the bill that I have sponsored, and is cosponsored by Senator 
Abraham, would create a single, simple, toll-free number so parents 
will always know who to call in the event of a poisoning emergency, so 
that they always know what number they can call. These measures not 
only would improve the quality of health care services available for 
children's health, they would be lifesavers as well.
  We have before the Senate a very important debate dealing with the 
quality and availability of health care. As always, when we talk about 
health care, we need to be sure we are meeting the needs of children as 
well as adults. So, as we begin the debate and consider the 
legislation, we have a great opportunity, a great opportunity to take 
action that improves the lives of our young people. This Congress 
already has enacted a number of important pieces of legislation that 
will save lives, that will save young lives.
  Last year, for example, we passed important bipartisan legislation to 
improve the quality and the availability of health care for low-income 
children. We also passed bipartisan legislation to reform our foster 
care system, vitally important legislation to reform our foster care 
system that will save lives and is saving lives.
  This Congress clearly has taken the opportunity to improve the lives 
of our children. I am hopeful we will take advantage of this 
opportunity that we face this week and next week, the opportunity that 
is before us, to find the solution that best provides for health care 
quality for our children and for all Americans.

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