[Congressional Record Volume 144, Number 146 (Wednesday, October 14, 1998)]
[House]
[Pages H10887-H10889]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




              THE TRUTH NEEDS TO BE TOLD ABOUT HEALTH CARE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 7, 1997, the gentleman from Illinois (Mr. Hastert) is 
recognized for 60 minutes as the designee of the majority leader.
  Mr. HASTERT. Mr. Speaker, I just want to weigh in with the previous 
speaker. I did also teach for 16 years in Illinois, and I see the 
rhetoric and have heard the rhetoric that has been flying across the 
room these last couple of days, and it amazes me too a great deal. When 
I think about education, I think about putting good teachers in the 
classrooms. All the other folderol and bells and whistles, sometimes it 
helps but it does not make the difference whether kids are learning or 
not.
  I think the effort that we have put into this bill, that we 
anticipate to have moving forward, to put the responsibility back home 
with local school boards and with moms and dads and teachers and school 
board members so that they can do the best job and decide who the 
teachers are that should be in their classroom, instead of having 
somebody in Washington, D.C., in the Department of Education, deciding 
which school district should do which and how many people they should 
have in every classroom, let us keep that decision back home.
  Mr. Speaker, I rise today to discuss another issue, and I think it is 
an issue of great importance to the people of this country, and that is 
HMO reform, or managed care reform. Over the last days also I have 
heard great partisan rhetoric on this floor about this issue, and I 
rise today, Mr. Speaker, with some of my colleagues who are also 
concerned about the truth, to set the record straight.
  Mr. Speaker, I understand that this is a political time of year. 
People are running for election. They are looking for political issues, 
and I know that we will listen to all kinds of exaggerations and 
partisan debate on this floor but there is no excuse, Mr. Speaker, for 
the kind of nasty and misleading information I have heard over the last 
few days. The truth needs to be told.
  For six months, 15 of my colleagues and I sat down around a table and 
considered the problem of HMO reform.

[[Page H10888]]

  Let me say at the outset, it is a very real problem. We know that 
from time to time, in a very deliberate situation, that people do not 
always get the care that they think they should need and their doctors 
tell them that they should have. So it is a very real problem.
  People believe that HMO bureaucrats have too much control over their 
health care, and people are afraid that their health care will not be 
there for them when they need it.
  My colleagues and I sat down and listened and learned about the 
problems in the health care industry. We listened to the people who 
were the advocates of the consumers. We listened to doctors. We 
listened to the health care practitioners. We listened to the people 
who bought health care for people who worked for them. We listened to 
the people who owned and worked through the companies that insure 
workers and people who buy insurance.
  Through this whole thing, we tried to listen and understand what the 
abnormalities of the market were. Why were people not getting the 
health care that they needed? We did not attempt to use tragedy for 
political gain, as I have heard some folks shamefully try to do on this 
floor. We listened, and after 6 months of listening to scholars and 
patient advocates and providers, we sat down to begin to solve the 
problems. We came up with a proposal to give people assurances that 
their health care would be there when they need it and we did it 
without the heavy hand of government.
  The last thing that most people want is some bureaucrat in 
Washington, or some bureaucracy in Kansas City or wherever it might be, 
saying that we have to go to this doctor, we have to have this kind of 
treatment, we have to have HCFA, which is the health finance 
organization of the Federal Government, prescribing what kind of health 
care individuals get. There are some in this Congress that would like 
health care to be prescribed by the Federal Government, to control our 
health care, our family's health care, what our children's health care 
is going to be in the future.
  There are many of us who do not think that the Federal Government 
should be able to do that and to micromanage what kind of health care 
we should get. We think that people ought to make choices, that doctors 
ought to make decisions and that health care ought to flow between that 
relationship between a doctor and a patient.
  There are two ways to address the HMO problem. We can throw the 
problem to the courts to decide or we can establish a common sense 
process that gets people the care they need up front. We really want, 
Mr. Speaker, people to get their health care in doctor's offices and 
hospital rooms. We do not want them to get their health care by suing 
and ending up having to go to a lawyer's office or a courtroom to get 
their health care, and that is what the other group of people out there 
believe; that people ought to be able to go to the courts and if they 
are sick and cannot get the health care they need they ought to sue.
  If they end up suing people, the only folks that probably will get 
benefits from that are the heirs because by the time the lawyers and 
the courts get done making the decision on health care, which needs to 
be done in a timely basis, they are probably, in many, many cases, not 
going to be there to enjoy that health care treatment. The care needed 
should be between the patient and the doctor.
  I guess that is one of the predicates that we set down in trying to 
develop a health care program off of, that the relationship between a 
doctor and a patient is pretty special. That relationship between a 
doctor and a patient also should be sacrosanct.
  In the health care situation, especially with HMOs or managed care, 
doctors are contractees or, in a sense, some type of an employee of the 
HMO. When they tell us that we should have this type of treatment or 
they give us this prognosis, and this type of care should be taken care 
of in health care, then that is the care that we should get.

  We should not really have a green-eyed guy or somebody who is the 
clerk of the office answer the phone and say, oh, by the way, Doc, we 
are not going to give that care. That should not happen. Does it 
happen? Yes, unfortunately it does from time to time.
  It is happening less and less, but as cost crunches go on, we will 
see that some insurance companies, some insurance companies are bad 
actors, and they are controlling the amount of health care that their 
customers or the patient can get.
  We think that is wrong. We do not think that insurance companies 
should limit doctors in being able to tell the patients what they think 
is, first of all, wrong with them and, secondly, what they think the 
prognosis or the care should be.
  That contract between the doctor and the patient is sacred. When a 
doctor tells the patient what his illness is and what he thinks the 
care should be, that ought to be carried through. We should not have a 
green-eyed person or a clerk telling us to do this a different way.
  It also sets us up in another situation. We need to be able to not 
allow insurance companies, then, to gag, what the word is, gag doctors 
from being able to limit what doctors could tell their patients.
  In our health care bill, one of the things we did was to put a stop 
to it, that insurance companies could not gag the doctors. We also said 
that, if we needed expedited health care and a specialist, we should be 
able to get in to see that specialist within 72 hours, and that we 
should not be denied, if a doctor says that we need to see the heart 
surgeon or the cancer specialist or the lung specialist, we should be 
able to get in to see that doctor within a very short frame of time so 
that we can get the kind of care we need.
  It really does not make any sense to expand a failed system that does 
not work in a vain attempt to solve a real problem. The solutions we 
came up with are certainly timely. We give people a timely access to 
review.
  Otherwise, if our doctor says that I think you should have this 
treatment, and the HMO says well, the doctor thinks that, but we are 
not going to pay for it, we can immediately go to a doctor for an 
appeal, an independent third doctor for an appeal and have that second 
doctor say I confirm or I disagree.
  Then if that second doctor disagrees, then we have the ability to go 
to a panel of experts and have them get us in in an urgent care 
situation into a hospital room or into the doctor's office or into the 
operating room within 72 hours in an urgent type of situation.
  We also believe that, if we wake up in the morning or in the middle 
of the night, heaven forbid, and we have chest pains and we really 
think that we are having a heart attack, we need to get to the hospital 
right away. We should not have to call an insurance company or the 
``company doctor'' before we can get in to the emergency room.
  This bill says we have an expedited procedure that we can get us into 
an emergency room immediately, the emergency room that is closest to us 
and most convenient to us, that we can get there, and we cannot have us 
3 days later saying, well, I thought I had a heart attack, but the 
company doctors said and insurance company said, well, you really only 
had heartburn and we are not going to pay the bill. We are not going to 
let that happen.
  There is a piece of legislation where we expedited people in health 
care, we got them in the emergency room, and they got the urgent care 
that they needed.
  We also thought that the common sense approach here is most women who 
have to get health care go to the OB/GYN, and they go on a yearly 
basis, so why should they have to go to an HMO, in to an independent 
care giver or a gatekeeper or the doctor that is the general 
practitioner, just to go to the OB/GYN to get their health care?
  The OB/GYN ought to be the doctor of first reference, because that is 
where most people go. We should not have to go to a third party to make 
that happen. So we make that ability to go directly to the OB/GYN an 
important piece of this legislation.
  The same way with families with children. If we have three kids, the 
chances are the doctor that we take those kids to is the pediatrician. 
We should not have to go to a general practitioner before we take our 
kids to the pediatrician to get service. That is common sense. We make 
that happen in this bill that the people have that immediate access.

[[Page H10889]]

  We also go ahead, and we try to do a few other things and try to make 
sure that the people are aware of what their insurance policy covers 
and that they have an appeal process. If they think they should have 
some type of treatment, and they are not getting it, they can have an 
expert tell them what they are entitled to and what they are not 
entitled to. We think that is important. They ought to know that up 
front.
  They also need to have their health records kept in confidence, that 
that information that their doctor accumulates or their pharmacy 
accumulates should not be handed off to another company so that they 
can be solicited for some type of medicine, that people's health care 
and their records of health care are sacrosanct, and that 
confidentiality ought to be in place.
  No amount of money is sufficient. If we do not get the health care we 
need, if we do not get the type of service that we need, if we do not 
get the ability of continuing the access to health care that is there, 
those, I think, are the very, very important things.

                              {time}  1645

  I had about 15 folks who worked with us on a very, very diligent 
basis and tried to put together a piece of legislation that worked.
  At this time I would like to recognize my good friend from St. Louis, 
MO (Mr. Talent), to whom I will yield the balance of my time.

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