[Congressional Record Volume 145, Number 98 (Tuesday, July 13, 1999)]
[Senate]
[Pages S8311-S8312]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                         CHILDREN'S HEALTH CARE

  Mr. REED. Mr. President, we are engaged in a historic debate about 
the future of health care in the United States. I have tried very 
diligently to ensure that children are a large part of this debate.
  In conjunction with those activities, yesterday I had the opportunity 
to visit with pediatricians and pediatric

[[Page S8312]]

specialists in my State of Rhode Island at Hasbro Children's Hospital, 
an extraordinary hospital in Rhode Island. I am very proud of it. While 
listening to those professionals, I got a sense of the real needs we 
have to address in this debate on the Patients' Bill of Rights.
  First of all, there is tremendous frustration by these physicians and 
medical professionals about their ability to care for children, their 
ability to effectively provide the kind of care which parents assume 
they paid for when they enrolled in the HMO. They are frustrated by the 
mindless rules. For example, one physician related to me there is the 
standard practice of giving a child a complete examination at the age 
of 1. He had a situation where a child came in at 11 months 28 days. 
They performed the examination, and the insurance company refused to 
pay because, obviously, the child was not yet 1 year old. That is the 
type of incredible, mindless bureaucracy these physicians are facing 
every day.
  I had another physician tell me--and this was startling to me--she 
was treating a child for botulism. She was told the company was 
refusing to pay after the second day. She called--again, here is a 
physician who is spending valuable time calling to find out why there 
is no reimbursement--and she was told simply by the reviewer--not a 
physician, the reviewer--that according to the guidelines of that HMO, 
no one can survive 2 days with a case of botulism; therefore, they were 
not paying for more than 2 days. Mercifully, the child survived, and 
eventually I hope they were paid for their efforts.

  These are the kinds of frustrations they experience. This is 
throughout the entire system of health care. There are some very 
specific issues when it comes to children. One is the issue of 
developmental progress. An adult is generally fully developed in 
cognition, in mobility, in all the things that children are still 
evolving. Yet managed care plans seldom take into consideration the 
developmental consequences of a decision when it comes to children. 
Unless we require them to do that, they will continue to avoid that 
particular aspect. So a child can be denied services.
  For example, special formulas for infants can be denied because the 
HMO will say: Well, it is not life-threatening; there is no serious, 
immediate health consequence. But the problem, of course, is, unless 
the child gets this special nutrient, that child is not going to 
develop in a healthy fashion. Five, six, seven, eight years from now, 
that child is going to have serious problems, but, in the view of an 
HMO, a dollar saved today is a dollar saved today. Oh, and by the way, 
that child probably will not even be in their health care system 5 
years from now, the way parents and employers change coverage.
  We have to focus on developmental issues. We also have to ensure 
children have access to pediatric specialists. There is the presumption 
that a rose is a rose is a rose, a cardiologist is a cardiologist is a 
cardiologist, when, in fact, a pediatric cardiologist is a very 
specific discipline requiring different insights and different skills.
  We also have to recognize that many very talented pediatricians find 
themselves overwhelmed today with the young children they are seeing. I 
had one physician tell me he sees children who have problems with 
deficit disorders, problems with attention issues, and they have 
prescribed some very sophisticated pharmaceutical pills and 
prescriptions that he, frankly, has trouble managing because he is not 
a child psychiatrist. Yet they have difficulty getting access from the 
general practitioner to the specialist, the child psychologist to the 
child psychiatrist.
  The other thing is, the system has been built upon adult standards. 
One of the great examples given to me is that there are new standards 
now to reimburse physicians when they are doing a physical, but they 
are based upon adult standards. The important things a physician has to 
do to evaluate a child are not even compensated because they are 
immaterial to an adult. Why would the company spend money paying a 
doctor to do that? This whole bias towards adults distorts the care for 
children in the United States.
  The Democratic alternative which is being presented today recognizes 
these issues in a very pronounced and emphatic way. We do explicitly 
provide for access to pediatric specialists; we do specifically 
require, in making judgments about health care, the development of a 
child must be considered as part of the medical necessity test; and we 
also talk about developing standards, measurements, and evaluations of 
health care plans that are based on children and not just adults.
  I urge all of my colleagues to endorse this concept. The best reason 
to pass this Democratic alternative is to help the children of America.
  The PRESIDING OFFICER. The Senator's time has expired.
  Mr. REED. I thank the Chair.
  The PRESIDING OFFICER. The Senator from Maryland is recognized for 5 
minutes.
  Ms. MIKULSKI. I thank the Chair.

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