[Congressional Record Volume 147, Number 33 (Tuesday, March 13, 2001)]
[House]
[Pages H870-H874]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PATIENTS' BILL OF RIGHTS, PATIENT PROTECTIONS, AND HMO REFORM
The SPEAKER pro tempore (Mrs. Capito). Under the Speaker's announced
policy of January 3, 2001, the gentleman from Iowa (Mr. Ganske) is
recognized for 60 minutes.
Mr. GANSKE. Madam Speaker, I appreciate the fervor and emotion that
my colleague just spoke about, especially in dealing with the death tax
situation, because we have many people back in my home State of Iowa
that need this type of relief if, in fact, they are going to pass on
their family farms to their children. The way that that tax is
calculated and who the benefit goes to can be done many ways. One can
say the benefit goes to the person who dies, and that person may have
some considerable assets; but in actuality, it is the person who
inherits that has to pay the tax, and if we look at who these people
are, very, very frequently, they do not have assets. They are not rich,
and then they end up having to sell off half of the farm in order to
pay the Federal taxes. I think that needs to be fixed.
Madam Speaker, I want to speak tonight on an issue that I find
emotional too, and that has to do with the Patients' Bill of Rights and
patient protections as it relates to HMOs.
Madam Speaker, about a week ago I was in my apartment here in
Washington watching C-SPAN; and there was a panel on, a panel of former
Members of Congress, and they were being interviewed and giving
comments about what they thought would happen this year in the
legislative arena. And these pundits were giving their opinions on tax
cuts and prescription drug benefits and other things, and then one of
the panelists said something. He said, ``You know, I think this deal
about patient protection doesn't need to be done. You know, I really
don't know anyone who has been harmed by HMOs.'' Madam Speaker, I
nearly fell off my sofa. I nearly fell off my sofa when this pundit,
this former Member of Congress said, ``You know, who needs patient
protection, HMO reform because, after all, nobody is being hurt.'' I
thought to myself, what world is that man living in? What world is that
man living in?
I thought, does he not read the newspapers? Does he not see stories
like this: ``What his parents didn't know about HMOs may have killed
this baby.'' Maybe this former Member of Congress, who I happen to
know; he is a friend, he is a fine man, but I am thinking to myself,
how could he make this comment?
Does he not see newspapers like this: ``HMOs' cruel rules leave her
dying for the doc she needs.'' Where has he been?
Madam Speaker, before coming to Congress, I was a reconstructive
surgeon. I took care of lots of babies that were born with congenital
defects like this cleft lip and cleft palate. Fifty percent of the
reconstructive surgeons in the country in the last 2 years have had
cases like this denied by HMOs as not being medically necessary. What
world does that man live in? I thought to myself, well, maybe he does
not read the national news magazines. Maybe he did not see the cover on
Time Magazine that featured this family with this little girl, this
little boy, a husband, a mother that documented how the mother died
because the HMO inappropriately denied care. Maybe he does not live in
that world. Maybe he does not read Time Magazine.
I thought to myself, maybe he does not read The Washington Post. Most
people in Washington do, especially former Members, but maybe he does
not. Maybe he did not see the cover story in the Washington Post about
this young lady who was hiking 40 miles west of here, fell off a cliff,
broke her arm, her pelvis, stunned, fractured her skull, laying there
at the bottom of the cliff. Her boyfriend phones in the air flight.
They take her to the emergency room. She is treated, and then the HMO
does not pay her bill because she did not phone ahead for prior
authorization. I thought to myself, what world does this man live in?
I thought to myself, maybe this former Member of Congress has not
been watching any of the debates on the floor of Congress. Maybe he has
not been following the Patients' Bill of Rights, the debate that we
had. Maybe he did not bother to watch the debate we had on the floor
when sitting right in that chair was this little boy a few years
afterwards. This little boy when he was about 6 had a high fever one
night, like about 104 or 105, so his mother phones the HMO, she is told
to take him to this one hospital, the only one that is authorized,
about 70 miles away, he has a cardiac arrest on the way, he ends up
with gangrene in both hands and both feet, and this is what happens
when you have gangrene in both hands and both feet. They have to be
amputated. I thought, maybe that man had not watched our debate here on
the floor. What world is he living in?
But I will tell my colleagues this: this little boy who, when he came
to the floor for that debate, was now about 6 or 7, pulls on his leg
prostheses with his arm stumps. But do my colleagues know what? This
little boy is real; and if he had a finger, Madam Speaker, and we could
prick it, he would bleed. And if he had a hand, some day he would be
able to caress the cheek of the woman that he loves, and maybe he would
be able to play basketball. But do my colleagues know what? According
to this pundit, this former Member of Congress sitting on this panel,
after all, there is not anyone being injured by HMOs; it is just
baloney.
{time} 2115
Madam Speaker, I beg to differ. People come up to me all the time
here in Washington and back home in Iowa. They tell me about stories
like this, how it is affecting them or their family.
Just a few days ago, about a 48-year-old woman came up to me. She had
had a mastectomy for cancer. She had been going through chemotherapy.
Her physician had recommended that she have an important test to see
whether the tumor had returned. Her HMO denied it. She came up to me in
tears in Des Moines, Iowa. She battled that HMO through an internal
review and finally they said yes. Then, when she was going to go for
her test, they pulled the rug from underneath her and they said no.
She said, Greg, I had to do something I have never done before. I had
to ask my husband to carry on for me on this fight, because that HMO
has just worn me out. I asked my husband to carry on this fight because
I didn't have the energy. I don't have the energy anymore to fight that
HMO.
Do Members know what? If that woman dies because she has not gotten
her test, what is the HMO out? Nothing, because she is dead. That is
not fair and that is not justice. I beg the pardon of that pundit who
was on that panel, that man who I like but who does not seem to
understand or has been insulated in some way from what has gone on
everywhere else in this country.
Why do Members think the biggest line in the movie As Good as It Gets
was when Helen Hunt tells Jack Nicholson, ``You know, that HMO is just
preventing my son with asthma from getting the care that he needs.''
Then she went into a long string of expletives.
My wife and I were in the theater that night. We saw something we had
[[Page H871]]
never seen before: People stood up and clapped. What world is that man
living in?
Well, Mr. Speaker, Members on both sides of the aisle in both Houses
who have been fighting for 5 or 6 years now to get a strong Patients'
Bill of Rights passed, they will not give up, because we know that this
is affecting millions of people every day on decisions that some HMOs
are making.
We need to fix that. We need to fix that here in Washington, because
this problem was started by Washington. It was started right here in
1974, when Congress passed a law which took that oversight of insurance
plans away from the States, for heaven's sake, where it had been for
200 years, took it away from the States under a bill called the
Employee Retirement Income Security Act, ERISA; they took it away from
the States and put nothing in its place, and basically gave immunity to
health plans, employer health plans, from the consequences of their
decisions, an immunity that no other industry in this country has.
Madam Speaker, I sit on the Committee on Commerce. Last year we heard
testimony on the tire problem, where tires were blowing out. At last
count, there were about 118 people killed from that. Madam Speaker,
what do Members think would happen if Congress passed a law that gave
legal immunity to tire makers? Why, we would be run out of Washington
on a rail.
Yet, we are dealing with today a law that gives an HMO that makes
this kind of decision that results in this kind of injury for somebody
who gets their insurance from their employer a free ride. It needs to
be fixed. It needs to be fixed.
It is a pretty difficult fight. The HMO industry, their business
allies, and some in Congress have fought this tooth and nail. They have
spent $100 million at least trying to prevent the Patients' Bill of
Rights from actually becoming law.
Our first victory, though, came in 1999 when the House overwhelmingly
passed the bipartisan bill that I and my colleague, a conservative
Republican, the gentleman from Georgia (Mr. Norwood), and a Democrat,
the gentleman from Michigan (Mr. Dingell), wrote. We passed that bill
by a vote of 275 to 151 in the face of very stiff HMO industry
opposition.
For the last 6 months, the gentleman from Michigan (Mr. Dingell), the
gentleman from Georgia (Mr. Norwood), and I rewrote our bill. We
negotiated with Senator McCain to bring him into this fight. On
February 6, we introduced our bill, H.R. 526, the Bipartisan Patient
Protection Act of 2001, and Senators McCain, Edwards and Kennedy
introduced a companion bill in the Senate.
Madam Speaker, this bill represents a meaningful bipartisan
compromise on patient's rights issues such as scope, who does the bill
cover; plan accountability; employer liability.
I want to go into some more detail. My bill, the Ganske-Dingell bill,
includes the basic protections that need to be addressed in this
debate, such as the right to choose one's own doctor; protections
against one's doctor being gagged by HMOs, not being able to tell us
the whole story; access to specialists, such as pediatricians and
obstetrician-gynecologists; access to emergency care; access to plan
information, so we know what is going on in the plan.
My bill covers all 190 million Americans in private insurance,
including ERISA plans, non-Federal government plans, and plans in the
individual market. The bill addresses the concerns of those who want to
protect States' rights by allowing States to demonstrate that their
insurance laws are at least substantially equivalent to the new Federal
standards, thereby leaving in place equivalent or stronger State laws.
States can continue to enforce their patient protection laws under our
bill.
Under our bipartisan bill, patients would be assured that doctors can
make medical decisions involving the medical care. When a plan denies
coverage, a patient would have the ability to pursue an independent
review of the plan's decision by a panel of medical experts,
independent of the health plan. That decision would be binding on the
plan.
Our bill outlines a new compromise on liability, a new compromise on
liability that provides for meaningful accountability for injured
patients. We took the lead from the Supreme Court in its case Pegram v.
Hedrich, and addressed the desire of multistate employer plans for
uniformity of benefit decisions.
The new bill creates a bifurcated Federal and State liability system.
Injured patients can hold health plans accountable in State court for
disputes involving the quality of medical care, those involving medical
necessity decisions. However, patients who were injured by a plan's
administrative nonmedical decision to deny benefits or coverage would
proceed to Federal court, and additionally, punitive damages are
prohibited in State court unless the plan shows a willful or a wanton
disregard for patients' rights or safety.
Our bill also addresses other concerns raised by the bill that passed
the House in 1999. For instance, our new bill says, ``Employers may not
be held liable unless they `directly participate' in a decision to deny
benefits that result in injury or death.''
Madam Speaker, I have talked to business groups all across the State
of Iowa, employers who run small businesses. I asked them, I say,
``When you hire an HMO to provide a health plan for your family and for
your employees, do you as an employer ever get involved in the medical
decision-making?'' And they say, ``Not on your life. Number one, it is
a privacy issue. We do not want to know what is happening to our
employees in their private medical life. We do not want them to know
what is going on in our family, either. But we do not get involved in
that.''
Under our bill, Madam Speaker, that employer cannot be held liable.
In recent months, the debate on patient protection has focused on
whether or not and to what extent we should hold HMOs accountable when
they make medical decisions that harm patients, or even cause them to
die.
In recent weeks, congressional offices have been inundated, as I am
sure the gentlewoman's office has, Madam Speaker, with messages
opposing a strong patient protection bill of rights like our Bipartisan
Patient Protection Act of 2001.
I feel, Madam Speaker, that our colleagues need to hear the truth
about the liability provisions in our bill, and why I have included
those liability provisions in our bill.
Madam Speaker, many opponents to liability provisions in patient
protection bills such as the Ganske-Dingell bill say, Why do we need
them in the first place? Well, the goal of the liability provision is
to ensure that patients receive the proper health care when they need
it, and that a patient has a right to redress when the plan makes a
medical decision to deny a claim for benefits and causes injury or
death.
Under current law, as I said, the patient has access to an internal
review process. If there is still a dispute upon conclusion of the
plan's internal process, the patient may only seek the value of the
benefit in Federal court under section 502 of ERISA. There is no
provision under current law for consequential damages caused by the
failure to provide the benefit, whether or not there was an injury.
Some States, however, have passed provisions that would allow the
patient to hold some health plans accountable in State court for
failing to provide adequate care.
Madam Speaker, under our new liability provision, when a patient is
denied a benefit, he or she will have access to a swift internal review
process and a strong independent external review process to help settle
disputes, and that, in the vast majority of times, will get the patient
appropriate care.
If the patient feels he or she is owed a benefit under the review
process, they will have access to existing 502 ERISA remedies in
Federal court to seek the benefit, but not other damages. In those rare
cases when a patient suffers harm or death as a result of the plan's
action, a patient will have access to Federal court under ERISA section
502 if the dispute was a purely administrative contractual decision. In
order to prevail and recover limited damages, the patient would need to
show that the plan acted negligently in making the decision, and that
the decision caused the patient's injury or death.
[[Page H872]]
But, Madam Speaker, if the dispute involves a medically-reviewable
decision, the patient will be able to seek redress in State court under
applicable State law. Generally, our bill prohibits punitive damages if
the health plan follows the review process and follows the
determination of the external review entity.
In our new bifurcated Federal-State liability, this is a significant
compromise. It is a significant move from the State cause of action in
the original bill that passed the House, the Norwood-Dingell-Ganske
bill, in 1999. Our original language did not change the existing remedy
in section 502 of ERISA. Rather, it simply clarified that State causes
of action were not preempted under section 514.
The business and insurance industry raised concerns that this
approach would inhibit their ability to administer a multistate
employee health benefit plan.
{time} 2130
Madam Speaker, we made the step towards the business community. Our
new bill answers that concern by leaving suits involving benefit
administration in Federal court under section 502, thereby allowing
employers and insurers to have uniformity in administering their health
plans across State lines.
The first part of the liability section in our bill adds to that
existing Federal remedy under section 502. Under this new Federal cause
of action, a plaintiff may seek both economic and noneconomic damages.
By excluding medically reviewable decisions from the Federal remedy,
group health plans will only be subject to liability under section 502
for benefit administrative decisions. That includes decisions such as
whether a patient is eligible for coverage, whether a benefit is part
of the plan or other purely administrative contract decisions.
Punitive damages are not allowed under the Federal cause of action. A
civil assessment can be awarded upon showing clear and convincing
evidence that the plan acted in bad faith. That standard carries a high
burden of proof and is consistent with State statutes for the award of
damages. That standard ensures a health plan will not be subject to
these damages for simply making a wrong decision.
The patient would have to show that the plan has demonstrated
flagrant disregard for health and safety in order for the plan to be
liable. Madam Speaker, before exercising that legal remedy, the patient
would have to exhaust both internal and external appeals processes.
If the patient suffers irreparable harm or death prior to completion
of the process, the patient or the plan can continue the review process
and the court can consider the outcome.
The second part of the liability section in the Ganske-Dingell bill
amends ERISA section 514 to allow cause of actions in State court for a
denial of a claim for benefits involving a medically reviewable
decision, a medically reviewable decision that causes harm or death to
a patient.
In our bill, punitive damages are prohibited in cases where the plan
follows the requirements of the appeal processes. That provision
protects plans and businesses when they follow the decision of the
external review panel.
But I ask, Madam Speaker, if an industry exhibited a willful and
wanton disregard for safety, would you grant them immunity? Under
current ERISA law, they have it. We simply say in this section that if
they exhibit willful and wanton disregard for safety that they would be
liable if it results in an injury.
The Ganske-Dingell bill removes the preemption of State law in ERISA
514. That allows injured patients to bring a cause of action in State
court for injuries by a medical decision.
That new provision is a significant compromise, because it limits the
scope of actions that can be filed in State court to those involving a
medically reviewable decision, whereas the bill that we passed here in
1999, the industry said that you could take contractual decisions into
State court. We did not think our bill did that, but we were willing to
clarify that, and that what is what we have done.
In addition, we think that our current bill's bifurcated liability
provision is consistent with the current direction of the courts in
interpreting ERISA law.
Recent Supreme Court decisions and the 5th Circuit decision involving
Texas' health plan liability law would allow the continued development
of State case laws. The health plan liabilities laws that have passed
in nine States, Arizona, California, Georgia, Louisiana, Maine,
Oklahoma, Tennessee, Texas and Washington, would not be preempted in
our new liability provision. It would be under other bills that are
currently being developed, and it would have been under past efforts to
create an exclusive, and this is important, Madam Speaker, under an
exclusive Federal remedy. All of those preempt State law.
Our new bill further clarifies that employers are protected from
liability in either Federal or State court, unless they directly
participate in a denial that causes death or harm.
Madam Speaker, that ``direct participation'' standard was developed
by the gentleman from Tennessee (Mr. Hilleary) and later used in the
Coburn-Shadegg substitute. The business and the insurance communities
said the previous Norwood-Dingell language was too broad because it
held employers harmless unless they exercised discretionary authority
to make a decision on a particular claim.
In a spirit of bipartisan compromise, we rewrote the section. We
moved towards our critics. But what did they do? They took a step away.
They trashed our bill again. Talk about a moving goal post.
In addition to the direct participation protection, our bill
specifically lists decisions that are not considered direct
participation. Those specific actions include the employer selection of
the group health plan, which plan they choose, the health insurance
issuer, third-party administrator or other agent, employers are
protected in any cost benefit analysis undertaken by the selection of
the plan.
They are protected for any participation in the process of creating,
continuing, modifying or terminating the plan or any benefit, and they
are protected for any participation in the design of any benefit under
the plan. There are additional protections for employers who advocate,
who advocate on behalf of an employee in the appeals process.
Furthermore, our bill clarifies existing ERISA law to make certain
that a group health plan can purchase insurance to cover losses
incurred from suits under this title, just as any medical health
professional would do when they know that they are responsible for
making medical decisions.
Madam Speaker, recently President Bush sent a letter to Congress
outlining his principles for patient protection legislation. And while
the President's principles were in nature general, I was pleased to
note that our bill met almost all of the President's stated goals, and
those goals included providing comprehensive patient protections,
applying those protections to all Americans. That is a significant
improvement over what we saw in the Senate last time, a review process
where doctors make medical decisions and patients receive care in a
timely fashion and protections for employers, but the President calls
for only allowing Federal lawsuits.
Madam Speaker, such an action would preempt State patient protection
laws, including those in Texas, and would treat HMOs differently than
all other businesses that could hurt people.
Madam Speaker, I do not know how you can move everything into Federal
court and then say at the same time that you are preserving State law.
How do you stand, Madam Speaker, in two places at the same time?
As with the President's stated goals, our Ganske-Dingell Bipartisan
Patient Protection Act provides patient protections for all Americans,
as I said. In addition, our bill empowers governors to certify their
State's patient protections provisions as being equivalent to the
Federal floor through a process similar to the one for participation in
the State children's health insurance program, so that States can
continue to enforce their own laws for their citizens.
In addition, our bill has every one of the patients protections
listed in the President's statement of principles, emergency room care,
OB/GYNs for
[[Page H873]]
women, prescription drug coverage, clinical trials, pediatricians,
stopping gag clauses, health plan information choices and continuity of
care.
Our bill provides for a quick internal, independent external review
process modeled after the strong Texas medical care review process,
because getting prompt medical care is the goal of our bill. Our bill
requires exhaustion of the review process. Only if a patient dies or is
irreparably harmed can a family go to court before the review is
completed.
Madam Speaker, it has never been clear to me how you can write a
provision that says you have to go through an appeals process before
you can go to court when the initial decision can result in an injury
in a result such as this.
This mother and father did not have a chance to go through an
internal or an external appeal process before their little boy had his
cardiac arrest en route to the hospital and developed gangrene and had
to have both hands and both feet amputated. But under our bill, because
he suffered irreparable harm, that HMO would be accountable, and it
should be accountable.
Anyone who tries to pass a law that gives a free skate to a health
plan on a case like this I would say is ignoring the scales of justice.
Madam Speaker, I look forward to working with President Bush and my
colleagues to ensure swift passage of the Patient Protection Act so
that the President can sign into law patient protection legislation as
he so frequently talked about during his Presidential campaign.
The HMO industry has made alot of allegations. One of the things that
they have talked about is that employers would be subject to a
multitude of frivolous lawsuits. We have already spoken alot about
that.
As I have said, our bill would allow employers to be liable only,
only if they have entered into the decision-making.
Another HMO allegation is that with a strong appeals process there is
no need for legal accountability for managed care. Madam Speaker, who
are they kidding?
Look, they have legal accountability in Texas, and they need it.
There is a case in Texas where a man was suicidal in the hospital. His
doctor said that he needed to stay in the hospital. His HMO said, no,
he does not; he can stay if his family wants to pay for it, but we are
discharging him. So the family took him home, and that night he drank
half a gallon of antifreeze, and he died.
It is important that Texas has that accountability, that legal, that
liability provision. Because the way that their appeals process is
supposed to work is that if there is a dispute between the treating
doctor and the health plan and it is in a case like this where
something bad could happen immediately, then it goes to an expedited
review before the HMO can kick out the patient, but the HMO just
ignored it.
The HMO just ignored Texas law. And in that situation, that is why
you need at the end of the day accountability and liability for a
health plan that makes that kind of decision that results in a man
going home and drinking half a gallon of antifreeze and dying.
These are real cases. How about a patient who sustained injuries to
his neck and spine from a motorcycle accident? After which, he was
taken to the hospital. The hospital's physicians recommended immediate
surgery, but the health plan refused to certify. The surgery had to be
canceled. Soon afterwards, the insurer did agree to pay, but by then
the patient was paralyzed.
Are you going to tell me that that patient who is going to spend the
rest of his life paralyzed does not have his right to a day in court
because he did not have the time to go through an external appeals
process?
{time} 2145
How about the patient who was admitted to the emergency room of his
community hospital complaining of paralysis and numbness of his
extremities. The treating emergency room physician concluded that the
gravity of the patient's neurological condition necessitated his
immediate transfer to an academic hospital and made the arrangements.
The health plan denied the authorization and recommended others.
By the time the physician was able to have the patient transferred,
the patient had sustained permanent quadriplegia, could not move both
arms or his legs, paralyzed from the neck down.
Now, that patient did not have a chance to go through an internal and
an external appeals process, but he sure as heck did suffer irreparable
harm. Our bill handles that situation. The opposition's do not.
Another HMO industry allegation is that the Ganske-Dingell bill
liability provision would significantly increase the cost of health
insurance. The truth of that allegation is blown way out of proportion.
They always say, yes, if the cost goes up so much, then so many people
are going to lose their insurance.
The Congressional Budget Office scored other liability provisions
such as that contained in the Norwood-Dingell bill that passed in the
106th Congress, showing that premiums would rise about 4.1 percent over
5 years. Critics of our bill pounced on that, that costs were going to
skyrocket. But they were wrong.
The part of the bill that costs the most was not the liability
provision. It was the section designed to prevent the lawsuits that is
common to all of the patient legislation plans that we have seen, and
that was the internal and external review sections.
In addition, the HMO industry failed to note that the total CBO
projection was spread over 5 years with virtually no cost in the first
year and about 1 percent per year after that up to 4 percent total.
Now, compare that with the average 7 percent annual increases in recent
years by the HMO industry itself.
Opponents have cited an ever-changing and ridiculously wide range of
job loss figures for every 1 percent increase in cost. First, the
opponents of legal accountability cite the figures that 400,000
individuals would lose their health coverage for every 1 percent
increase in premiums. When the GAO challenged that figure, saying that
it was based on outdated information and did not account for all the
relevant factors, opponents lowered the job loss figure to 300,000 for
every 1 percent.
Again, the GAO looked at this and caused opponents to lower their
estimate a second time to 200,000. However, none of those predictions
have come to pass. For example, between 1988 and 1996 the number of
workers offered coverage actually increased despite premium increases
each year.
Now, the next allegation I will answer is that consumer support for
patient protection evaporates when they learn that it will cost them
some additional premiums. This is another one of the HMO industry's
distortions. Patients want a real enforceable patient protection Bill
of Rights, and they are willing to pay something for it.
A 1998 nationwide survey by Penn, Schoen & Berland showed that 86
percent of the public support a bill that would give patients' health
plan legal accountability, access to specialists, emergency services,
and point of service coverage. When asked if they would support a bill
if their premiums increased between $1 and $4 a month, 78 percent
supported the bill.
Madam Speaker, the House-passed bill, the Norwood-Dingell-Ganske
bill, would have raised insurance premiums an average of 4.1 percent.
That would have meant increases in employee premiums of about $1.36 per
month for an individual and $3.75 a month for a family member.
Finally, I want to dispel the allegation that patients are satisfied
with the quality of care being provided by HMOs. HMOs frequently do
these surveys of their membership, and they come up with some figure
like 80 percent of the enrollees are happy with their care or
satisfied. What they fail to point out is that these are all the
healthy people in their plan who are not utilizing the plan.
I mean, does anyone think, when they saw that movie ``As Good As It
Gets'' and saw the response to Helen Hunt's descriptor of her HMO that
the public is not aware of this?
A recent public opinion survey found that most Americans believed
problems with managed care have not improved, 74 percent. Most think
that legislative action is either more urgent or equally as urgent as
when this debate
[[Page H874]]
began, 88 percent. A 1999 survey of physicians and nurses reported that
72 percent of physicians and 78 percent of nurses believed that managed
care has decreased the quality of care for people who are sick.
In addition, Republican pollster, Linda Divall, did a post-election
poll right after this last election of issues that the new President
and the newly elected Congress should work together on to accomplish
for the good of the country. In every group, men, stay-at-home moms,
working women, a Patients' Bill of Rights was at the top of the list.
Madam Speaker, the American public wants and deserves a strong
patient Bill of Rights now, this year. It is time for us to put on the
President's desk a bill like the Ganske-Dingell bill or the McCain-
Edwards bill. We need to get it signed into law, Madam Speaker.
Millions of people are having decisions that HMOs are making today.
To go back to what I started about at the beginning of the speech, for
anyone to say that people are not having any problems with HMO, I would
just have to say, what world are they living in?
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