Joseph Hoeffel

Mr. HOEFFEL

Mr. HOEFFEL. Mr. Speaker, I thank the gentleman for yielding to me. I rise today to address an issue of critical importance to the people of this country and the 13th District of Pennsylvania. Mr. Speaker, it is time to change the way HMOs do business in this country. Health care quality is suffering because HMOs continue to seek to drive the cost of health care lower and lower. They have succeeded in cutting the cost of health care, but the pendulum has swung too far and we have to take action to protect the health of the American people. When I go home to my district I hear the growing chorus of complaints. It is increasingly difficult for patients to get to see necessary specialists. Patients are being forced to leave hospitals only hours after having complex procedures performed. Prescription drug policies seem to change like the weather. Plan provider networks are small, spotty and too restrictive. Little or no coverage is offered for clinical trials and experimental benefits. Last week in my district the League of Women Voters held a town meeting to discuss Medicare, but it turned into a session complaining about HMOs. The local newspaper, The Intelligencer-Record, covered the meeting the next day with a headline that says ``Crowd Tells of Health Care Horror Stories''. At the meeting Dr. Peter Lantos, of Erdenheim, Pennsylvania, described how he needed prostate surgery. His HMO was unwilling to provide any list of surgeons, making it very difficult for him to make an intelligent choice. He was also told he had to go to a specific hospital, not the one he preferred. Now, Dr. Lantos fought the system. He fought it and he won. But he should not have had to fight, and he certainly lost critical time. And Dr. Lantos is a professional; a physician. He knows how to fight the system. What about average Americans? What kinds of protection do they have? Something surely must be done, Mr. Speaker, for the children who are denied access to pediatric specialists; for the women who want to designate an obstetrician or gynecologist as their primary care provider; for all those suffering from cancer or serious heart disease who want to designate their oncologist or their cardiologist as their primary care provider; for all of those people and others who have been victims, not beneficiaries, of a managed care system that has lost its way. We must find an answer. Yes, we must continue to control costs, but we must achieve four critical reforms. First, we have to make sure that medical decisions are made by medical professionals, not by insurance company bureaucrats and accountants. Secondly, we have to lift the gag rule that is placed on doctors by many insurance plans that prohibit those doctors from describing the full treatment options that their patients have. Thirdly, we have to make sure that patients have the fullest possible choice of plans and providers. And, lastly, we have to make sure that HMOs are held accountable. And, as a last resort, that means giving patients the right to sue their HMOs if an arbitrary coverage denial leads to a bad medical consequence. Those are the steps we have to take. We have to make sure that we provide for good medical care for Americans, and the answer certainly is passage of the Patients' Bill of Rights. It is a bipartisan bill. It has broad appeal. We must answer the call of the American people and pass this legislation. Mr. Speaker, I am providing for insertion into the Record the article I referred to earlier from the Doylestown Intelligencer-Record. Crowd Tells of Health Care Horror Stories (By Stephen Brady) It's frightening to think that a doctor in this day and age would have to see 20 patients an hour to make ends meet. And how could this kind of schedule reasonably be called ``care''? Dr. Peter Lantos of Erdenheim told this story about a doctor friend. Lantos spoke during a public dialogue on the future of Medicare, held last week at Jenkintown Borough Hall and sponsored by the League of Women Voters of Abington- Cheltenham-Jenkintown. It was just this sort of horror story that motivated Rochelle Sonnenfeld of Rydal, the league's chairwoman, to organize the meeting. ``This is a nationwide project. We want to inform the public about Medicare. We want to get legislation passed that is worthwhile. This is a very important issue to millions of people,'' Sonnenfeld said. While Medicare was the announced subject, many in the audience vented about health insurance, especially managed- care providers, or health maintenance organizations. Lantos told his own personal horror story. ``I needed prostate surgery. The surgeon that was recommended by my HMO had a poor reputation, and they still wanted me to use him. I found out they don't give out lists of good surgeons. I had to go through several layers of management.'' Dr. Todd Sagin, a family medicine and health-care policy specialist, was the quest speaker at the dialogue. He described Medicare, its history and development and explained why there is a crisis and what solutions may lie ahead. ``The Medicare program hasn't changed in close to 35 years. By today's standards, it's an inadequate packet,'' Sagin said, adding ``Medicare is financed by employee payroll taxes, and it's going bankrupt.'' Sagin explained why hospital bills may seem inordinately high and outlined the bills' hidden costs. ``Medicare only pays a certain percentage of the costs of a hospital stay. You have the high charges on hospital bills because the doctor is getting a percentage, and the hospital has to pay its own bills. They have to charge more so all their costs are covered.'' In the matter of managed care, he tried to make sense of the maze of contradictions that exist in the field. ``The crux of the matter is who decides what is medically necessary. Medical necessity is in the eye of the beholder,'' he said, adding, ``Most of us want the best technology, the best medical care, and we want access to that care with the least amount of red tape. And we want it at a low cost.'' People who can least afford the medical bills are not the only ones being hurt. ``Our government is being hurt by the high cost of care. We are paying 15 cents on the dollar. ``The companies we work for have to pay the cost, and it will eventually weaken them in the business world.'' Elise Stern of Cheltenham had heard of another horror story. A woman in her 80s was sent home just two days after having a double mastectomy. ``The health-care system should not be for-profit; it should be a social service,'' she said. She also felt that the taxpayers' money could be spent more wisely. ``We are taking money away from the patients and giving it to the stockholders.'' Sagin agreed with her view. ``What degree should Wall Street have in making decisions on health care?'' Lantos agreed, adding, ``I was told I had the choice of one hospital for my operation. I told the HMO I wanted to go elsewhere and was told, `No, you can't.' I got treatment, but I had to fight for it. You shouldn't have to fight for good care.''

Mr. HOEFFEL. I would be delighted to. It is a sad story. I met with a woman from my district last year who reported to me that her husband had become very ill the year before with a head injury. He received care under his managed care plan. His primary care doctor wanted, once he was sent home from the hospital, to give him a very intensive course of therapy and the HMO would not pay for it, or would not authorize it. The family fought, the doctor fought, and they could not get approval. They gave him a lower level of therapy, not what the doctor ordered. Unfortunately, the husband died, and the wife wanted to hold that HMO accountable. She believes that the failure to authorize the more intensive level of therapy led to her husband's death. Now, I do not know if that is true. She does not know. But she wanted to test that. She wanted to hold that health care plan accountable for what she thought was an arbitrary decision, and the law does not allow her to do that today. Part of what the Patients' Bill of Rights would do is to make sure that people can go to court, if they have to, as a last resort, to hold their plans accountable. This bill would do it, and we ought to pass it.