WASHINGTON, D.C. | June 23, 2009
I would like to begin by thanking our distinguished panels of witnesses for appearing today. We appreciate that they have taken time out of their busy schedules to share their expertise and experiences with us.
As a physician, there is one certainty I hear from my former colleagues – the status quo in health care is unacceptable. So today, we are at a crossroads. Our broken medical delivery structure is in dire need of meaningful reform. And today’s hearing represents the beginning of an historic debate on how we achieve full access to affordable, quality health care, while preserving the patient-doctor relationship, without undue governmental interference.
When Congress established Medicare, a national health insurance program for seniors more than 40 years ago, it wrote into law, “Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided …”. This remains the law of the land. However, as any physician on the front lines of health care can tell you, those words and that promise ring hollow.
As time has passed, and as I can attest to firsthand after nearly a quarter century as a practicing surgeon, there may have been no greater negative impact on the “manner in which medical services are provided” than the intrusion of the federal government into health care.
Under the current Medicare program, patients are often told which doctors they may see and how frequently. Doctors, in turn, are often told which procedures or tests they may and may not order or provide. This has eroded the ability of patients and their doctors to make independent health care decisions – some of the most personal we make. And the doctor-patient relationship, once sacrosanct, is being trampled by coverage rules, inflexible regulations, and one-size-fits-all policies.
To exacerbate the matter, most medical practices, including some of the largest and most respected institutions in the nation, find it necessary to limit the number of Medicare patients they see. The delivery system devised and controlled by Washington is clearly not the model for reform.
As this Committee begins to critically analyze the Tri-Committee Draft Proposal for Health Care Reform, I raise these specific points because I fear we are not only repeating the same mistakes but taking them a step further by permanently institutionalizing them into our health care delivery system.
Take for instance the newly created Health Benefits Advisory Committee. It is being established to make recommendations on minimum health benefit standards and cost-sharing levels. It will be comprised mainly of federal bureaucrats and presidential appointees. It, just like the Comparative Effectiveness Research Council enacted earlier this year, will not necessarily have a single actively practicing physician among its members. Not one! And this is the very type of federal health board, envisioned by some proponents of a government takeover, which could dictate personal medical treatments allowed – solely on the basis of cost.
Having the government defining what “quality” medical care is, this is not what Americans view as the right direction. They know what you know, and that is that quality is best evaluated by patients and their families, making decisions with a knowledgeable, concerned, compassionate physician.
Ask the veteran waiting endlessly for needed surgery because the surgical unit has met its 'quota'. Ask the senior, the new Medicare patient, who cannot find a doctor able to see anymore Medicare patients. Ask those who utilize the Indian Health Service if they receive the choices necessary to respond appropriately to their needs. And ask the Medicaid mom, if the system facilitates her treatment. Ask them.
Ask them if their health care delivery system best responds to their needs. Those are the four health systems Washington currently controls. None of them meet the principles of health care we should hold dear - accessibility, affordability, quality, responsiveness, innovation, and choices.
There are positive solutions - ones that would improve each of these systems - and ease coverage opportunities for those currently uninsured or underinsured. That is what we should be doing, not forcing every single American into a system that, of necessity, will betray those principles dear to all.
In the final analysis, the question becomes, will we allow Americans the opportunity to opt out? Will we allow free people the right to decide? This is not the system I want for my family, and I'd like the panelists to address that question.
When you pour through the pages of this bill, you will see that the Tri-Committee Draft Proposal for Health Care Reform is based on a “government-as-solution” philosophy. This means more federal supervision and administration. It will ultimately come to rely on mandates, rationing, bureaucracy, and third-party decision-making, all of which interfere with personal, private medical decisions. This is hardly a step that preserves the doctor-patient relationship – the one thing that, arguably, has allowed America to have some of the greatest health care in the world.
This bill offers an approach that is incapable of providing quality care which is accessible, innovative and responsive. Achieving this positive type of change will only be possible by embracing a fundamental rethinking of our health care delivery system which champions personal ownership of coverage.
There are positive solutions to the challenges we face. I’m hopeful the House will allow for an open, vibrant, robust debate and deliberative process – one that respects America’s doctors – but most of all – America’s patients.