[Congressional Record Volume 145, Number 134 (Wednesday, October 6, 1999)]
[House]
[Pages H9503-H9504]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                          MANAGED CARE REFORM

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Illinois (Mr. Davis) is recognized for 5 minutes.
  Mr. DAVIS of Illinois. Mr. Speaker, we have had a tremendous debate 
all evening on managed care, and we will continue to do so even 
tomorrow.
  I received a letter from a physician in my community that I think 
reflects the position that Americans should take on this issue. It 
comes from a Dr. Elizabeth Burns, medical doctor, professor and head, 
College of Medicine, Department of Family Medicine, University of 
Illinois at Chicago. Doctor Burns said:

       Dear Representative Davis:
       As a practicing family physician in your district, I want 
     to ask you to support meaningful management care reform when 
     it is considered in October by the House of Representatives. 
     Your support for the Bipartisan Consensus Managed Care 
     Improvement Act of 1999, H.R. 2723, or the Health Care 
     Quality Choice Act of 1999, H.R. 2824, would be responsive to 
     the needs of my patients and your constituents. Meaningful, 
     comprehensive managed care reform is greatly needed right now 
     in your district.
       Below are the principles I see as important in any managed 
     care reform proposal:
       Reforms need to cover all health care plans, not just self-
     funded plans. Patient protections should protect all 
     patients.
       Gag clause protections need to be extended to all 
     physicians. Physician patient communication must be protected 
     and extended to health insurers' contracts. Unfettered 
     medical communication is undeniably in the best interests of 
     patients, all patients. Any final bill needs specific 
     language stipulating that any provision of a contract between 
     a health plan and a physician that restricts physician-
     patient communication is null and void.
       Physician advocacy must be protected. Managed care reform 
     must include provisions to prevent retaliation

[[Page H9504]]

     by a health plan towards physicians who advocate on behalf of 
     their patients within the health plan, or before an external 
     review entity. Family physicians, as primary care physicians, 
     play a pivotal role in ensuring that their patients get 
     access to the care they need. Health plans should not have 
     the power to threaten or retaliate against physicians they 
     contract with to provide needed health care services.
       Independent external review standards must be truly 
     independent. Managed care reform must contain a fair, 
     independent standard of external review by an outside entity. 
     It makes no sense to pay an outside reviewer to use the same 
     standard of care used by some health plans which may limit 
     care to the lowest cost option that does not endanger the 
     life of the patient. All of our patients deserve better.
       Patients need the right to seek enforcement of external 
     review decisions in court. Managed care reform must allow 
     patients to seek enforcement of an independent external 
     review entity decision against the health plan. Without 
     explicit recourse to the courts, the protections of external 
     review are meaningless.
       Patients need access to primary care physicians and other 
     specialists. Managed care reform must allow patients to seek 
     care from the appropriate specialist, including both family 
     physician and obstetricians/gynecologists for women's health, 
     as well as both family physicians and pediatricians for 
     children's health. Primary care physicians should provide 
     acute care and preventive care for the entire person, and 
     other specialists should provide ongoing care for conditions 
     or disease.

  And so you see, Mr. Speaker, from patient to physician, from consumer 
to provider, those who want serious reform and serious change know that 
the Dingell-Norwood bill is the way to go.

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