[Congressional Record Volume 145, Number 56 (Thursday, April 22, 1999)]
[Extensions of Remarks]
[Page E742]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          INTRODUCTION OF THE PATIENT EMPOWERMENT ACT OF 1999

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                        Thursday, April 22, 1999

  Mr. STARK. Mr. Speaker, I am pleased to introduce the Patient 
Empowerment Act of 1999, the second in a series of Medicare 
modernization bills designed to improve program administration and the 
quality of health care for Medicare beneficiaries.
  Mr. Speaker, Medicare beneficiaries currently have little or no 
control over their health care decisions. Instead of choosing the most 
appropriate course of treatment for their particular circumstance, some 
patients are being told what they should do based on an oversupply of 
hospital resources or physician specialists in their area. Many 
diseases have several treatment options available. In most cases, there 
is no evidence to suggest that one course of treatment is better than 
another.
  Dr. John Wennberg, one of the world's most renowned health policy 
researchers, talks about this issue in the 1998 Dartmouth Atlas: ``The 
greater the per capita supply of hospital resources, the greater will 
be their per capita use, and the greater the per capita expenditures.'' 
The Atlas provides overwhelming statistical proof that in the economics 
of health care, supply often drives demand.
  Dr. Wennberg estimates that if Medicare spending for all hospital 
referral regions with higher rates were brought down to the level of 
spending in the Minneapolis region (considered a very high quality of 
care region), Medicare's financial problems would be solved.
  Many costly hospital stays could be averted entirely if Medicare 
beneficiaries were fully informed about their treatment alternatives. 
Not surprisingly, when presented with the range of available options, 
patients will often choose less invasive treatments.
  For example, treatment of benign prostatic hyperplasia, a common 
condition affecting the majority of men over the age of 65, ranges from 
surgical removal to watchful waiting. Each of the options raises a 
number of trade-offs: while surgery is the most effective way to deal 
with symptoms, undergoing surgery presents certain risks. In Wennberg's 
analysis, most men with mild symptoms choose watchful waiting when 
educated about the full range of options, and watchful waiting is 
clearly the least expensive of all the options.
  Patients have long deferred their medical decisions to their 
physicians. But medical care is becoming increasingly complex, and 
improvements in health technology have led to a multitude of available 
treatments. The treatment they choose should reflect the personal 
values and lifestyles of the patient and their family.
  Therefore, I am introducing a demonstration bill to give patients 
more power over their health decisions. The findings from these 
demonstrations could lead to ways to greatly reduce the cost of the 
Medicare program, without jeopardizing health outcomes. I strongly urge 
members to support this legislation.

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