[Congressional Record (Bound Edition), Volume 146 (2000), Part 17]
[House]
[Pages 25582-25586]
[From the U.S. Government Publishing Office, www.gpo.gov]



                          MANAGED CARE REFORM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 1999, the gentleman from Arizona (Mr. Shadegg) is recognized 
for 60 minutes as the designee of the majority leader.
  Mr. SHADEGG. Mr. Speaker, I appreciate this opportunity to address my 
colleagues and to talk about, in fact, the exact same subject that my 
colleague from the other side of the aisle, from the Democrat side of 
the aisle, just addressed. He talked about a wide range of medical 
issues. I am going to do that in this hour as well, but I am going to 
begin by focusing on the issue of patients' rights legislation, the 
issue of HMO reform, the issue of managed care reform. After I have 
spent some time on that and focused on why that issue is so critical 
and why I so strongly disagree with much of what was just said and how 
sad I think it is that this debate has boiled down to this struggle 
where one side is saying the other side is just carrying the water for 
a special interest, then I would like to turn perhaps in the latter 
half of the hour to the issue of the Medicare drug benefit and perhaps 
other topics that are worth talking about and that were raised in the 
remarks in that regard.
  Again, I want to focus tonight on the issue of patients' rights 
legislation, the issue of a Patients' Bill of Rights, the critical 
question facing our country of managed care reform, HMO reform. We are 
in the midst as everyone knows of a political campaign. There are ads 
running across the country saying that it is sad that my party, so 
these ads say, has blocked, the Republican Party, has blocked the 
passage of patients' rights legislation. I simply want to start by 
saying that is not true. Indeed, the opposite is true. We have worked 
very hard to pass patients' rights legislation that will help patients. 
That is the key difference. Sometimes it is said that the devil is in 
the details and the devil is in the details.
  In this case there are two competing ideas on patients' rights 
legislation: one is the idea advanced by Democrats, the idea which they 
are pushing, the idea which their ads talk about, the idea which the 
President is saying he supports; and that proposal sadly does not help 
patients. That proposal helps trial lawyers. Rather than just talk 
about that, I am tonight going to explain exactly, precisely, how their 
legislation would advance the cause of trial lawyers but do literally 
nothing to help and in fact hurt patients and weaken the position of 
doctors to control health care in America. I think that is the debate 
that needs to occur.
  I think we need to understand why, yes, patients' rights legislation 
is vitally important for this country. There are serious problems in 
managed care. But how you enact that legislation, what it does, is so 
critically important and why, sadly, the bill that the Democrats are 
advancing, and they call it a patients' rights piece of legislation, in 
fact is fatally flawed in its structure, because instead of giving 
patients more power, instead of giving doctors the ability to set the 
standard of care and to decide how patients are treated in America, 
that legislation takes power away from HMOs, and that is good, but 
instead of giving that power and that authority to set the standard of 
care in America to doctors where it belongs and to patients where it 
belongs, their legislation gives that ability to trial lawyers to take 
the issue directly to court.
  We have heard just a few minutes ago in the rather partisan remarks 
by my colleague from the Democrat side that the Republicans are for the 
special interest of HMOs and that Democrats are for the people. Sadly, 
that charge is just flat false. Let me start with my position. I have 
been passionately fighting for patients' rights legislation, the right 
patients' rights legislation, for the last 2 years. I have met with 
countless doctors from all over the country, many in my State, I cannot 
tell you how many, my own medical association in Arizona; and I have 
talked with them for hours and hours about how do we go about fixing 
the problem with managed care in America, how do we deal with the 
problems that have been created by managed care in America.
  In every one of those conversations, I have never once heard, well, 
Congressman, the way to fix it is to let lawyers step into the middle 
of the process, take a claim by an injured patient, take my request as 
a doctor to get my patient care and have a lawyer step in and rush to 
court and file a lawsuit. Never has a doctor in America in my home 
State or anywhere else that I have met with said the answer to this 
problem is to let the trial lawyers address the issue. The reality is 
we do need patients' rights legislation to change managed care and to 
make it more pro-patient and more pro-doctor.
  But we need legislation that will accomplish that goal, that will 
take power away from the managed care industry, to tell doctors how to 
treat their patients and move that power over to patients and doctors 
to determine what the standard of care ought to be in America.
  I am adamantly for managed care reform, and I am a Republican and I 
have fought for that legislation since I have gotten here. One of the 
offhand remarks of my colleague just a moment ago was that the 
conference only met a few times. Well, my colleague was not on the 
conference. I was on the conference. We spent countless hours trying to 
reconcile the differences between a pure trial lawyer piece of 
legislation that will not help patients and a piece of legislation that 
would advance the cause of doctors and patients. I am going to explain 
that in my remarks. I tell you that every other Republican with whom I 
served on that conference committee and the Speaker himself who was 
asking in the last several weeks to try to bridge this gap and try to 
pass legislation, they are all adamantly for the passage of meaningful 
legislation that will empower patients and doctors and solve this 
problem.
  As to my own bona fides on this issue with the gentleman from 
Oklahoma (Mr. Coburn), who is going to join me later in this Special 
Order, we wrote the Coburn-Shadegg managed care reform bill, the 
Coburn-Shadegg patients' rights legislation. That bill would have put 
the emphasis precisely where it should be. It would have empowered 
doctors and patients to resolve medical questions, doctors in 
consultation with their patients to set the standard of care; and it 
would not have given that power over to trial lawyers. It is sad that 
it has gotten tied up in this kind of a debate, but it has.
  Everyone who understands managed care reform understands that we need 
to reform the system in a way that will be pro-patient. Let us start 
with why we need managed care reform. It is important to understand how 
managed care works in America. It was a reform idea itself to try to 
hold down the costs of medical care in America. In that sense, it has 
worked to some degree; but sadly it has been abused, and it is 
susceptible of abuse and we need to fix that.
  Let me talk about why we need to fix it. Right now in America, in our 
managed care system, a given doctor meets with his or her patient, does 
an examination and decides the patient needs a particular type of care. 
And so that doctor makes the recommendation for the care and goes to 
their managed care plan and says, ``My patient needs this care.'' There 
is an initial review of that claim, sadly often by an HMO bureaucrat, 
not a medical personnel, but

[[Page 25583]]

a nurse or someone else; and let us assume it is turned down by the 
plan. There then is in some instances an internal appeal, an appeal to 
doctors at the managed care plan. If you follow that structure, if 
there is no appeal beyond that, you have a doctor, a treating 
physician, saying that his or her patient needs care. And then you have 
a managed care bureaucrat, an HMO bureaucrat, saying, no, you do not 
get the care. That is where the first point of abuse is.
  In America today under that system, a managed care bureaucrat can 
turn down the request for care by the treating physician, and they can 
turn it down perhaps for the wrong reason. They can turn it down to 
protect the profits of the managed care company, rather than to protect 
the care of the individual. I have been working on this issue, and I 
have been in my district when hundreds of people have talked to me over 
time about how they or a member of their family, their mother, their 
father, their daughter, their sister, their brother was abused by a 
managed care company when the treating physician said my patient needs 
this care and the HMO denied the care for a specious reason.
  So what is wrong with that structure? The thing that is wrong with 
that structure is that under that structure, the managed care plan, the 
HMO, is telling the treating physician how he should care for the 
patient. In medical jargon, that really means the managed care plan is 
setting the standard of care for any individual patient under a set of 
circumstances. That is crazy. Managed care plans are essentially 
insurance companies. They ought to try to hold down excessive costs, 
but managed care plans should not set the standard of care. HMO 
bureaucrats should not tell doctors how to treat patients. That ought 
to be a decision made by doctors. They were trained to practice 
medicine. HMO bureaucrats were not trained to practice medicine. So the 
current system is backward. It lets doctors be told how to practice and 
how to treat their patient and what the standard of care in America is 
for a given set of circumstances by an HMO bureaucrat. So that is why I 
fought for managed care reform. They can deny that care for monetary 
reasons, not reasons of care.
  The second reason that we need managed care reform is actually a 
tragedy, and it falls into my own area of expertise. And, that is, that 
as a result of, I believe, an unintended consequence of a Federal law 
called ERISA, a managed care company in America today can deny care; 
and if they negligently deny care, in that example I just gave, they 
make a mistake when they said the treating physician may not provide 
this care, if when they do that the patient is injured or dies, there 
are no damages. There is no recovery. That managed care plan can simply 
walk away and say, ``Wow. Our mistake injured or killed somebody, but 
since we're a managed care plan and we are operating under this Federal 
law called ERISA, we can't be held accountable.'' I think that is an 
outrageous structure for the law. Every one of us knows that if we make 
a mistake, if we, let us say, run a red light at an intersection and 
our negligence injures or kills somebody, we are responsible for that 
injury and hopefully our insurance policy will make the injured person 
whole, will pay damages for them. Sadly, even though every business in 
America, every homeowner in America, every car driver in America, every 
one of us in America is legally accountable when we injure or kill 
somebody, that is not the case for federally governed ERISA managed 
care plans. They have as a result of this Federal law an interpretation 
of it by the United States Supreme Court, immunity. They cannot be held 
liable when they injure or kill someone. That is a tragedy, and it 
should be fixed. That is why I have fought for patients' rights 
legislation and fought to hold plans accountable.
  The best story on that is the story of Mrs. Corcoran. Mrs. Corcoran 
became pregnant. She was an employee of Southern Bell in Louisiana. It 
was her second pregnancy. She applied for benefits. Her treating 
physician was treating her through the course of the pregnancy. At one 
point he told her she needed to go to the hospital, to be in the 
hospital for the balance of her pregnancy so that if there was a 
problem with the baby, and it was her second pregnancy and she had had 
a difficulty the first time, he said, If you're not in the hospital, 
there is a danger you will die or a danger your baby will die.
  Tragically, her HMO denied her that benefit and said, No, we won't 
pay to put you in the hospital. We'll pay for a little bit of home 
nursing, somebody to come by and visit you. Even more tragically, the 
worst possible circumstance happened. While Mrs. Corcoran was home, her 
baby went into distress, still in the womb; and notwithstanding that 
they did everything they could, her baby died as a result of the fact 
that she was not in the hospital. Mr. and Mrs. Corcoran, tragically 
hurt by this event, filed a lawsuit to recover damages; but of course, 
they did not sue their doctor. Their doctor had done the right thing. 
He had said you should be in the hospital but their HMO had said, No, 
I'm sorry, we won't put you in the hospital and we won't pay for it. 
Under the current Federal law, the law provides that the Corcorans 
cannot recover, could not recover, did not recover any damages for the 
death of their child. That is an outrage, and it has to be fixed.
  The next question is, why then, Congressman, have you not embraced 
and why have Republicans not embraced the Democrat Patients' Bill of 
Rights? There is a simple answer to that, and I am going to explain it 
here today. It is because the Democrats' Patients' Bill of Rights will 
not help Mrs. Corcoran. The Democrats' Patients' Bill of Rights would, 
in fact, hurt patients. It would, in fact, hurt doctors. It would, in 
fact, hurt businesses across America; and it would, in fact, cause more 
uninsured Americans. There is one group that the Democrats' Patients' 
Bill of Rights would help and there, is one group that is supporting 
the Democrats' Patients' Bill of Rights, and that group is tied to them 
through contributions, and that is the trial lawyers.

                              {time}  1745

  The Democrats' Patients' Bill of Rights, the bill that has been 
debated on this floor, the bill that the President says he wants to 
pass, moves power away from HMOs and moves it directly to not doctors, 
not patients, it moves it directly to lawyers. That is a problem, and 
let me explain how that Democrat Patients' Bill of Rights, it is known 
as Dingell-Norwood, works. The Vice President referred to it in the 
debate the other day. I do not know that the average American out there 
listening knows the word Dingell-Norwood, so I am just going to refer 
to it as the Democrat Patients' Bill of Rights, but it is the bill that 
Vice President Gore wants us to enact. It is the bill the President has 
asked for us to enact.
  If you live in a congressional district where there is a commercial 
running right now, it is the bill when they say pass a Patients' Bill 
of Rights, they want you to pass the Democrat Patients' Bill of Rights, 
the Dingell-Norwood Patients' Bill of Rights, which will not help 
patients, will not help doctors. It will cause a flood of lawsuits.
  Now, let us start kind of with a fundamental issue in this debate, 
and to do that I want to refer to a chart. This chart asks the basic 
question that anybody concerned about health care ought to ask, and 
that is health care in America, who should make medical decisions? 
Right now one issue is, well, should HMOs make medical decisions? We 
just talked about how under the current structure HMOs, managed care 
companies, indeed maybe even managed care bureaucrats, get to make 
medical decisions. Should HMOs make decisions? I do not think so.
  Another alternative is the one I favor, and that is the one here at 
the bottom; and we have put a red check to show that is where I believe 
the power ought to be. Should patients and doctors, or doctors in 
consultation with their patients, make medical decisions? I think the 
answer to that question is obviously that as between HMO bureaucrats 
making medical decisions, what should be the standard of care,

[[Page 25584]]

what course of treatment is right for a particular patient, should that 
be decided by a treating physician talking to his or her patient or 
should it be decided by some HMO bureaucrat? That is a no brainer. I 
hope everyone in America agrees it should not be an HMO bureaucrat. It 
ought to be the doctor, the treating physician, who has touched you, 
who knows you, who has known you perhaps for years, who has looked you 
in the eye and assessed your medical condition and says, this is what 
we ought to do for your care. It should not be a bureaucrat at the HMO 
who has never seen you and has just read kind of a cold chart.
  That is where this debate ought to be. It ought to be between HMOs 
making those decisions and doctors and patients making those decisions, 
and that ought to be the fight that is going on right now and on that 
one I think we win. It ought to go to doctors in consultation with 
their patients.
  My friends who are doctors tell me that the practice of medicine is 
more art than science, and what they mean by that is that the doctor 
that is treating you, the doctor that knows you, your own treating 
physician, can sense what really ought to be done about your condition. 
The problem with giving this power to HMOs is that that is a cold 
bureaucratic decision often made by somebody who is not even trained as 
a doctor, perhaps made ultimately by someone that is a doctor but has 
not practiced medicine for many years because they could not hack it in 
the practice of medicine. It should not be made by that person who has 
never touched you or felt you or looked in your eye or tried to assess 
in conversation what is really wrong with you. It ought to be made by 
your treating physician.
  So what is this middle line doing here? Why are lawyers in the 
discussion? Well, the answer is, they should not be. Lawyers should not 
be a part of this discussion. We need to write a patients' rights piece 
of legislation that drives care, a patients' rights legislation or 
patients' rights bill that incentivizes or encourages the system and 
the managed care company to deliver the best possible care at the 
earliest possible moment, and that is the goal.
  The goal is the best care at the earliest moment. I think that 
happens when a doctor, after consulting with his or her patient, says 
this is the care that is right. But how are lawyers in this discussion? 
Well, the answer is, some people who want to reform managed care really 
do not really care about patients and doctors. What they care about is 
litigation. Sadly, what they want to do is create a structure where you 
do not get care very quickly because your HMO decided to approve the 
care recommended by your doctor. You do not get care very quickly 
because an independent external review panel said your HMO, when it 
denied you was wrong and darn well better deliver that care, what they 
say is, we really need to turn this whole thing over to lawyers. We 
need to turn it over to trial lawyers. We need to let the trial lawyers 
get to court quick so that those trial lawyers can drag this out in a 
nice long lawsuit. Do not mess with the doctors. Just get in front of a 
judge, drag the lawsuit out and if nothing else perhaps if we do not 
have a meritorious case, we can exact some kind of a settlement.
  I said earlier that the Democrats' bill, the Dingell-Norwood bill, is 
tragically flawed; and it is. This issue has been little discussed on 
the floor, almost not discussed anywhere across America, but if you 
hear the President or the Vice President call for patients' rights 
legislation, you need to know the bill they are asking for is Dingell-
Norwood; and you need to know that bill will not let your doctor make 
the decision. It will take down a restriction that exists in the law 
right now and let your lawyer, if you get one, quickly rush off to 
court and perhaps win himself a large settlement of which he gets a 
third, or 40 percent.
  Now, I believe in the tort system. I think if somebody hurts you, you 
ought to be able to recover your damages; but I sure do not think our 
first goal in patients' rights ought to be to empower lawyers. I think 
it ought to be to incentivize the best possible care at the earliest 
moment.
  I want to move to one more chart. It is a chart that is a schematic 
of the Democrat Dingell-Norwood bill, and I apologize for having to do 
a schematic, but it is how we can illustrate what is wrong with the 
Democrat legislation and why if you hear a commercial that says, by 
gosh, we need patients' rights legislation, you are right, we do need a 
patients' bill of rights; but we do not need the flawed Democrat bill. 
We need a bill that will get you the best care at the earliest possible 
moment; not a lawsuit.
  Let me explain this bill, and we will walk through it. We talked 
about your doctor consulting with you and then making an initial claim. 
Often unfortunately that is currently done through some bureaucrat at 
the HMO, and they may turn you down. The next step under the Democrat's 
bill is a good one, and that is you ought to have a right to get to a 
doctor at the HMO. That is called internal review. You ought to force 
the HMO not to let a bureaucrat turn you down. The HMO ought to have to 
hire a doctor to make a review of your case. Hopefully, that doctor 
will say you get the care, rather than deny you. So that is a good 
step. That is a step in the right direction.
  Everyone in America ought to have an internal review by the plan and 
let the plan make the right decision. But if they do not, the critical 
question in managed care reform, the critical question for patients' 
rights legislation, is what do we do next? I argue the answer is that 
in every case, what we ought to do after internal review, if this 
managed care company, this HMO denies your treating physician and you 
the care you need, the next step ought to be an external review, what 
we call an external review. That is not complicated. What it is is that 
if the plan will not give you the care you need after their doctor has 
looked at it, you ought to have a right to get to three totally 
independent doctors and to have those three totally independent doctors 
review your claim.
  Now when I say totally independent, what do I mean? Well, the law 
that we talk about would say that these doctors have to be selected 
independently. They cannot be controlled by the HMO. They cannot be 
hired by the HMO. They cannot have a conflict of interest because of 
their connection with or their income from the HMO. They have to be 
totally independent of the HMO so they can make an unbiased decision. 
Obviously, they also need to be independent of your own doctor. So they 
are truly experts. In our bill, we call for them to be practicing 
physicians, with expertise in the field, who are independent of the HMO 
and independent of you and your treating physician.
  Our goal is to have that external review panel of three doctors make 
a quick decision; yes, the patient deserves the care, the plan was 
wrong and, by the way, HMO, if you do not give them the care and they 
get injured or they are injured, then you not only are going to be 
liable for the care you should have given but you are going to be 
liable for all of their economic damages, you are going to be liable 
for all of their pain and suffering; and if the plan acts in an 
arbitrary and capricious fashion, then you are going to be liable for 
punitive damages.
  The bottom line here is that there ought to be a review by three 
doctors very quickly, and we have an expedited time frame to do that. 
Here is the flaw with the Democrat bill, and here is why you see this 
little red circle with a bar through it. It is probably hard to see on 
the TV, but you see under the Democrat Dingell-Norwood bill you do not 
go to external review. As a matter of fact, that will never happen 
under that bill. It will literally never happen, and the three doctors 
over here will not get to set the standard of care by telling plans how 
they should treat patients. They will not get a chance to say was your 
treating physician right or was the plan right. They will not define 
the standard of care in America because under their bill there is this 
gigantic loophole, and it is the lawyers' loophole.
  Here you see the arrow going down. It says, well, guess what? The 
minute

[[Page 25585]]

you finish internal review you can go straight to court. We do not 
really want an independent panel of doctors to make a decision. We want 
some aggressive trial lawyer to go hire his own expert witnesses who 
will interestingly always side with the trial lawyer, and file a 
lawsuit.
  Now, I said earlier in all of my conversations with doctors across 
America, and I have talked with literally, I think, hundreds, not a 
single one of them, not in Arizona, not anywhere else that I have met 
with them, have they said, you know, Congressman, we really think the 
way to solve the problem with managed care in America is to get people 
to lawsuits, because lawsuits will deliver care. Indeed, none of them 
have said the problem with managed care is that we do not get to court 
quick enough. What they have said is, the plan can turn us down and we 
could get an independent group of doctors to review our request. So 
this is the loophole in their bill; and it is why, and I said earlier, 
that the Democrat's bill is fatally flawed. They talked about how 
Republicans favor the special interests of HMOs. The legislation I 
favor lets HMOs be sued, lets them be held accountable, says if they 
kill Mrs. Corcoran's baby they must pay damages. But it does not carve 
a loophole to prevent people from getting quick care and the proper 
care by letting the case go to court. It rather is legislation that 
says get them care.
  If you talk about special interests, the Democrats have a special 
interest that my colleague on the other side did not talk about a few 
minutes ago, and that special interest is trial lawyers. That is why 
they created this loophole. This, by the way, is a structure that takes 
power away from HMOs and hands that power to trial lawyers. That is 
crazy. What we do need to do is take power away from HMOs to decide how 
you should be treated, or your wife or your daughter or your son. You 
need to take that power away from HMOs and put it in the hands of your 
treating physician and in the hands of an expert panel of independent 
doctors.
  That kind of takes me to the structure that we have proposed; and you 
see here it says, the compromise patients' bill of rights, and it is a 
simple structure. It is a structure that incentivizes or encourages the 
best possible care at the earliest possible moment, because that is 
what managed care reform ought to be about. Tragically, my friends on 
the other side of the aisle, Democrats, adamantly to the death oppose 
this structure. They say absolutely not. We need the trial lawyer plan. 
We do not need the plan that empowers doctors and patients.
  Let us talk about how this structure for the bill is different; and 
again I apologize, but a flowchart really does kind of let you 
understand the legislation. Here in the legislation we are proposing, 
the legislation we have begged the American Medical Association to 
endorse, there is first an initial claim just like the Democrats' bill. 
Then there is internal review, just like the Democrats' bill in 
Dingell-Norwood; but you will notice there is no loophole here. We do 
not let the lawyers cut off external review. What we say is that if the 
plan turns you down at external review and says to your treating 
physician, no, we are not going to give you the care, you would have an 
immediate right, indeed we have three different time procedures, one 
for extremely urgent situations where it is within a matter of hours 
you would have a right to get to external review. If it is less urgent, 
there are two more time frames for less urgent circumstances. But if 
you were denied that internal, you would get to go within hours in an 
emergency situation to the external review that I talked about, and 
that external review is conducted by three independent doctors who will 
get to judge the recommendation of your treating physician that my 
patient needs an MRI, and judge the decision of the managed care 
company that, no, your patient does not need an MRI.
  Those three independent doctors would have to be practicing 
physicians, as opposed to physicians who quit years ago because they 
could not make it. They would have to be experts in the field, and they 
would get to make a decision.
  Now, here is the key: that can happen within hours under certain 
circumstances and once that happens, and it may be hard for you to read 
but right here it says, the HMO is bound by the decision of this 
medical panel and the patient receives the care. You can see that this 
is a quick process. It happens very quickly. By the way, there is no 
lawyer yet. The lawyer did not get in here. The lawyer did not get to 
take the case off to trial court or get into discovery and try to 
extort a settlement. This went straight through. It went through 
internal review, and it went to the external review; and if the 
external review panel says the treating physician is right, you get the 
care. Sadly, the Democrats do not like this bill because it cuts trial 
lawyers out to that point in time.
  Now, what do we do about the people who are truly injured? Well, we 
say in our legislation, if as you have been going through this process 
you were injured, not only do you get the care here but now you have 
the right to go to court after the plan has been told to deliver the 
care, you have the right to go to court and you have the right to 
recover your damages. So it is not that we are against giving people 
access to trial lawyers. I have many friends who are trial lawyers, and 
they do a great service for people who are truly injured. It is not 
that we are against the tort system. Indeed, I am outraged by the fact 
that Mrs. Corcoran, under the current structure of the Federal law, her 
baby was killed by a managed care company, and they did not have to pay 
a dime. They just got to walk away. But the issue is where do you put 
in legal accountability? The Democrats, the Dingell-Norwood bill, lets 
lawyers jump in right up front, boom, here we just get to go straight 
to court.

                              {time}  1800

  Our bill says, no. Let us let a panel of three independent doctors 
make the decision, and then, if the plan is wrong and someone has been 
injured, then let us go to court. Let us let someone recover their 
economic damages; if they lost time from work, they ought to be able to 
recover that. If they have suffered pain and suffering as a result of 
this wrongful decision by the HMO, perhaps motivated by their desire to 
keep their profit line looking good rather than the patient's need for 
health care, then they get to recover their economic damages, they get 
to recover what we call their noneconomic damages, which means their 
pain and suffering, and if the plan did not follow the instructions of 
the external panel, then there are punitive damages on top of that. But 
we can see that this structure is designed to empower doctors, not 
lawyers, and that is the huge difference. That is the debate that has 
been going on.
  Sometimes in the last few days when I have been thinking about this 
issue, I thought, how could it have been so complicated for 2 years for 
us not to get across the issue and explain to the American people, 
patients' rights legislation is vitally needed, but the bill they want, 
the bill the Democrats are pushing on us, the bill they talked about in 
their ads and the bill the President will probably speak about many 
times between now and election day, the bill that the Vice President 
will talk about many times between now and the election does not help 
doctors; most importantly, it does not help patients. What it helps is 
trial lawyers. We want a bill that empowers doctors to decide what care 
should be, what the standard of care should be.
  I have to tell my colleagues, and in a moment I want to discuss these 
issues with the gentleman from Oklahoma, I have to say that I am 
amazed. If the Trial Lawyers Association were actively advocating this 
structure, the structure where one gets to court, but they do not get 
to a panel of independent doctors, I could understand that. But what 
puzzles me and what I do not understand is that the American Medical 
Association is supporting that structure, the trial lawyer structure, 
and I do not understand, and I hope some day they will explain to me, 
why the American Medical Association is not supporting a structure that 
will empower doctors rather than lawyers.

[[Page 25586]]

  We do need to diminish the ability of managed care companies to hurt 
people. We do need to take away from HMOs the ability to set the 
standard of care. The standard of care in America ought to be set by 
doctors who are trained in medicine. But, when we take that power away 
from a managed care company and move that power somewhere, I suggest it 
would be a tragic mistake to, as the Democrats propose, move that 
power, to decide how one should be treated as a patient who needs 
medical care, to move that power to a trial lawyer, rather than moving 
it to a trained physician; in our structure, to a panel of trained 
physicians who will tell the HMOs exactly what the standard of care 
ought to be.



             CONGRESSIONAL RECORD 

                United States
                 of America



October 30, 2000