[Congressional Record Volume 144, Number 103 (Tuesday, July 28, 1998)]
[Senate]
[Page S9147]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                          NEED FOR HMO REFORM

 Mr. DORGAN. Mr. President, our health care system is in a 
state of crisis--a crisis of confidence. Many Americans no longer 
believe that their insurance companies can provide them with the access 
to care or quality of service they need.
  Today I continue our series of stories describing how some managed 
care plans seem to have put cost saving before life-saving. The 
experience of Clara Davis is just one more example of the pressing need 
for Congress to act now to protect the rights of patients.
  Clara Davis is a retired grocer from Bolivar, Tennessee. In 1995, her 
doctor placed her on the prescription drug Prilosec to control a 
bleeding ulcer. But her health provider changed from a traditional fee-
for-service plan to an HMO, and they told her she would no longer be 
covered for that medication. The HMO would only cover cimetidine, the 
generic equivalent of Tagamet, a different prescription drug.
  Clara's doctor fought vigorously to keep her on Prilosec, which had 
greatly improved her condition, but to no avail. While on the generic 
alternative, Clara's ulcer worsened. At one point, her doctor removed 
her from that medication and began giving her office samples of 
Prilosec whenever possible. But it wasn't enough.
  The ulcer would not go away and required surgery. Thirty-five percent 
of Clara's stomach was removed. During recovery, she suffered a stroke 
that left her partially paralyzed on her left side.
  What happened to Clara Davis should not happen in America. HMOs 
should not dictate which medications a patient should receive when 
their doctors say otherwise. Patients should not have to face surgery 
when a simple switch in medication can remedy the situation.
  Whatever we do will not alleviate the stress that Clara Davis has 
endured. But we can ensure that a doctor's decision will not be 
overruled by an HMO bent on saving money. All medications are not the 
same, and health-care providers should be able to say what is most 
effective to treat their patients.
  Mr. President, we must take up and pass meaningful patient 
protections now. Experiences like Clara's can be prevented if we enact 
legislation such as our Patients' Bill of Rights which protects the 
doctor-patient relationship from interference by HMOs. Insurers should 
have to make available to patients all information on which drugs the 
insurer will be willing to cover, the possible interactions of those 
drugs, and the procedures available for appealing an HMO's coverage 
decisions.

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