[Congressional Record Volume 144, Number 105 (Thursday, July 30, 1998)]
[Extensions of Remarks]
[Pages E1474-E1475]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


                     PATIENT PROTECTION ACT OF 1998

                                 ______
                                 

                               speech of

                             HON. RON PAUL

                                of texas

                    in the house of representatives

                         Friday, July 24, 1998

  Mr. PAUL. Mr. Speaker, I appreciate the opportunity to explain why I 
cannot vote for the Patient Protection Act (H.R. 4250). However, I 
would first like to express my support for two of the bill's 
provisions, relating to Medical Savings Accounts and relating to the 
proposed national health ID.
  Earlier this week I introduced legislation, the Patient Privacy Act 
(H.R. 4281), to repeal those sections of the Health Insurance 
Portability and Accountability Act of 1996 that authorized the creation 
of a national medical ID. I believe that the increasing trend toward 
allowing the federal government to track Americans through national ID 
cards and numbers represents one of the most serious threats to liberty 
we are facing. The scheme to create a national medical ID to enter each 
person's medical history into a national data base not only threatens 
civil liberties but it undermines the physician-patient relationship, 
the cornerstone of good medical practice. Oftentimes, effective 
treatment depends on a patient's ability to place absolute trust in his 
or her doctor, a trust that would be severely eroded if the patient 
knew that any and all information given their doctor could be placed in 
a data base accessible by anyone who knows the patient's ``unique 
personal identifier.''
  While I was not here in 1996 when the medical ID was authorized, it 
is my understanding that this provision was part of a large bill rushed 
through Congress without much debate. I am glad that Congress has 
decided to at least take a second look at this proposal and its 
ramifications. I am quite confident that, after Congress hears from the 
millions of Americans who object to a national ID, my colleagues will 
do the right thing and pass legislation forbidding the federal 
government from instituting a ``uniform standard health identifier.''
  Mr. Speaker, I am also pleased that Congress is addressing the 
subject of health care in America, for the American health care system 
does need reform. Too many Americans lack access to quality health care 
while millions more find their access to medical care blocked by a 
``gatekeeper,'' an employee of an insurance company or a Health 
Maintenance Organization (HMO) who has the authority to overrule the 
treatment decisions of physicians!
  An an OB/GYN with more than 30 years experience, I find it outrageous 
that any insurance company bureaucrat could presume to stand between a 
doctor and a patient. However, in order to properly fix the problem, we 
must understand its roots. The problems with American health care 
coverage are rooted in the American tax system, which provides 
incentives for employers to offer first-dollar insurance benefits to 
their employees, while providing no incentives for individuals to 
attempt to control their own health care costs. Because ``he who pays 
the piper calls the tune,'' it is inevitable that those paying the bill 
would eventually seize control over personal health care choices as a 
means of controlling costs.
  Because this problem was created by distortions in the health care 
market that took control of the health care dollar away from the 
consumer, the best solution to this problem is to put control of the 
health care dollar back into the hands of the consumer. We also need to 
rethink the whole idea of first-dollar insurance coverage for every 
medical expense, no matter how inexpensive. Americans would be more 
satisfied with the health care system if they could pay for their 
routine expenses with their own funds, relying on insurance for 
catastrophic events, such as cancer.
  An excellent way of moving toward a health care system where the 
consumer is in charge is through Medical Savings Accounts (MSA's). I 
enthusiastically endorse those provisions of this bill that expand 
access to MSA's. It may be no exaggeration to say that MSA's are vital 
to preserving the private practice of medicine.
  MSA's provide consumers the freedom to find high-quality health care 
at a reasonable cost. MSA's allow consumers to benefit when they 
economize in choosing health care so they will be more likely to make 
informed health care decisions such as seeking preventive care and, 
when possible, negotiate with their providers for the lowest possible 
costs. Most importantly, MSA's are the best means available to preserve 
the patient's right to choose their doctor and the treatment that best 
meets their needs, free from interference by an insurance company or an 
HMO.
  Mr. Speaker, all those concerned with empowering patients should 
endorse H.R. 4250's provisions lifting all caps on how many Americans 
may purchase an MSA and repealing federal regulations that discourage 
Americans from using MSA's. For example, a provision in the tax code 
limits the monthly contribution to the MSA to one-twentieth of the 
MSA's yearly amount. Thus, MSA holders have a small portion of their 
yearly contribution accessible to them in the early months of the year. 
The Patient Protection Act allows individuals to make the full 
contribution to their MSA at any time of the year, so someone who 
establishes an MSA in January does not have to worry if they get sick 
in February.

[[Page E1475]]

  This legislation also allows both employers and employees to 
contribute to an employee's MSA. It lifts the arbitrary caps on how one 
can obtain MSA's and expands the limits on the MSA deductible. Also it 
provides that possession of an MSA satisfies all mandated benefits laws 
as long as individuals have the freedom to purchase those benefits with 
their MSA.
  However, as much as I support H.R. 4250's expansion of MSA's, I 
equally object to those portions of the bill placing new federal 
standards on employer offered health care plans. Proponents of these 
standards claim that they will not raise cost by more than a small 
percentage point. However, even an increase of a small percentage point 
could force many marginal small businesses to stop offering health care 
for their employees, thus causing millions of Americans to lose their 
health insurance. This will then lead to a new round of government 
intervention. Unlike Medical Savings Accounts which remove the HMO 
bureaucracy currently standing between physicians and patients, the so-
called patient protections portions of this bill add a new layer of 
government-imposed bureaucracy. For example, H.R. 4250 guarantees each 
patient the right to external and internal review of insurance 
company's decisions. However, this does not empower patients to make 
their own decisions. If both external and internal review turn down a 
patient's request for treatment, the average patient will have no 
choice but to accept the insurance companies decision. Furthermore, 
anyone who has ever tried to navigate through a government-controlled 
``appeals process'' has reason to be skeptical of the claims that the 
review process will be completed in less than three days. Imposing new 
levels of bureaucracy on HMO's is a poor substitute for returning to 
the American people the ability to decide for themselves, in 
consultation with their care giver, what treatments are best for them. 
Medical Savings Accounts are the best patient protection.
  Perhaps the biggest danger these regulations pose is ratification of 
the principle that guaranteeing a patients' access to physicians is the 
proper role for the government, thus opening the door for further 
federal control of the patient-physician relationship. I ask my 
physician-colleagues who support this regulation, once we have accepted 
the notion that federal government can ensure patients have access to 
our services, what defense can we offer when the government places new 
regulations and conditions on that access?
  I am also concerned that this bill further tramples upon state 
automony by further preempting their ability to regulate HMO's and 
health care plans. Under the 10th amendment, states should be able to 
set standards for organizations such as HMO's without interference from 
the federal government. I am disappointed that we did not get an 
opportunity to debate Mr. Brady's amendment that would have preserved 
the authority of states in this area.
  In conclusion, Mr. Speaker, while the Patient Protection Act takes 
some good steps toward placing patients back in control of the health 
care system, it also furthers the federal role in overseeing the health 
system. It is my belief that the unintended, but inevitable, 
consequence of this bill, will require Congress to return to the issue 
of health care reform in a few years. I hope Congress gets it right 
next time.

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