[Congressional Record (Bound Edition), Volume 145 (1999), Part 13]
[Extensions of Remarks]
[Page 18358]
[From the U.S. Government Publishing Office, www.gpo.gov]



                          ASSESSING HMO CURBS

                                 ______
                                 

                           HON. DOUG BEREUTER

                              of nebraska

                    in the house of representatives

                         Tuesday, July 27, 1999

  Mr. BEREUTER. Mr. Speaker, this Member highly commends to his 
colleagues the following portions of an editorial ``Assessing HMO 
Curbs,'' which appeared in the July 21, 1999, edition of the Omaha 
World-Herald.

              [From the Omaha World-Herald, July 21, 1999]

                          Assessing HMO Curbs

       A lot of hot air accompanies the debate over whether 
     Congress ought to provide a ``bill of rights'' for people who 
     obtain their health care from health maintenance 
     organizations.
       But one thing is reasonably clear. The debate so far has 
     been less about health care than it has been about 
     campaigning for election in 2000.
       Democrats want to go into the election season with an 
     excuse to portray Republican candidates as indifferent to the 
     suffering of sick and injured people. The theme is part of a 
     blue-print for restoring Democratic Party control of 
     Congress.
       Michael M. Weinstein, in The New York Times, took a calm 
     look at the situation for his readers Sunday. ``The debate 
     consisted largely of name-calling,'' he said, with Vice 
     President Al Gore and House Democratic Leader Richard 
     Gephardt calling the GOP plan a charade and a fraud, 
     respectively, and GOP Sen. Phil Gramm of Texas accusing the 
     Democrats of wanting to destroy HMOs by mandating expensive 
     coverage that would drive costs into the stratosphere.
       ``But the partisanship obscures an important truth,'' 
     Weinstein wrote. ``The substantive differences are narrower 
     than they seem. Removed from the context of election-year 
     politics, combatants on both sides concede they could find 
     ways to give Americans protection from health-care plans that 
     wrongly skimp on coverage.''
       Republicans, said Weinstein, know that their bill would 
     never get past President Clinton. They like the bill because 
     it will help them wring campaign contributions out of HMOs 
     and insurance companies.
       Democrats, the Times writer said, privately concede that 
     their bill overreaches. But it will make them even more 
     popular with their generous long-time allies, the members of 
     the Trial Attorneys Association. The Democratic bill would 
     repeal a ban on lawsuits against HMOs, furthering the 
     attorneys' goal of expanding the field for punitive damages.
       Weinstein identifies four issues that he says should be 
     relatively easy to compromise: A method by which patients and 
     their physicians can appeal to medical authorities the denial 
     of reimbursement by an HMO; a defintion of medical necessity; 
     a modified right to sue for denial of service; and the 
     question of whether the legislation would cover 160 million 
     patients in state-regulated health plans as well as the 50 
     million in employer-sponsored plans not covered by state 
     regulations.
       Political partisanship is not an evil thing. Americans have 
     been well-served by the clash of ideas between two political 
     parties with different philosophical approaches to 
     government. It is part of the system of checks and balances.
       However, there are some things that should be obvious to 
     members of both parties.
       Patients and their physicians tend to overuse health care, 
     driving up the cost. Sometimes they have no other choice. The 
     Wall Street Journal reported yesterday that visits to 
     emergency rooms, one of the most expensive forms of 
     treatment, are up in some places where HMO treatment is not 
     available at nights and on weekends. Some HMOs want the right 
     to decline reimbursement for emergency room treatment. Is 
     that reasonable? In a case of medical necessity, of course it 
     is not.
       HMOs, in attempting to drive the cost back down, have 
     sometimes gone too far in denying care. Although determining 
     the extent of the problem is difficult, it has caused 
     physicians to recoil in horror at the damage done to patients 
     who were sent home from a hospital prematurely or in other 
     ways denied treatment.
       Mandated coverage, such as a patient bill of rights, drives 
     up costs, which are typically passed on to the buyers of the 
     health-care coverage--the same businesses and patient groups 
     that turned to HMOs to keep costs down. Policy-makers must 
     not avoid the question of what would happen if costs were 
     raised so high that more people, because of unaffordability, 
     became uninsured. What would be the logic behind that?
       The question is how to preserve the benefits of cost-
     cutting while minimizing its potential to hurt people. 
     Reasonable people, including a handful of moderate 
     Republicans, seem to be saying that a rational way exists to 
     make the system more humane without sacrificing cost-control.

     

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