insurance companies don't do; and it would distribute the cost of health care in a more equitable way. BRIEF CRITIQUE OF OTHER BILLS There are a number of other bills on health insurance before Congress. They are not satisfactory to those who favor full health care. for all through the Kennedy-Corman bill for two main reasons. First, they do not fully cover health costs. For the costs that they do cover, they have coinsurance of 20 or 25 percent to be paid by the sick person plus deductibles of $150 which must be paid in full first by those getting health care before they get benefits. The only bill that does not have these is the Kennedy-Corman bill. Good health care is a right, and should be so treated. There is, therefore, no more reason to require those who need medical or hospital care to pay part of the cost when they need it than there is to require those who have children in school to pay directly part of the cost of their children's education. In both cases the cost should be covered by taxes. I will not go into the figures on infant mortality compared with the United States and other countries, except to call your attention to the fact that one oriental country, Japan, and one Communist country, East Germany, and even Spain, has a lower infant mortality that we do, and they have national health insurance. Are there questions? Mr. ROSTENKOWSKI. Thank you, Mr. Lewis. Are there any questions of Mr. Lewis? Mr. COTTER. No; I would like to compliment Mr. Lewis on the very thorough statement. Mr. LEWIS. Thank you. I am sorry the young lady wasn't here when I remarked that I, alone, recognize that women are interested in the national health insurance. Mrs. KEYS. Thank you, Mr. Lewis. I will read your testimony, and it was a pleasure to hear the end of it. Mr. ROSTENKOWSKI. Mr. José García Oller and Mr. Hyman. Gentlemen, if you will identify yourselves and the organization, you may proceed with your testimony. STATEMENT OF JOSÉ L. GARCÍA OLLER, M.D., PRESIDENT, AND EDWARD S. HYMAN, M.D., SECRETARY, AMERICAN COUNCIL OF MEDICAL STAFFS Dr. OLLER. Thank you, Mr. Chairman, members of the committee. I am Dr. José García Oller, and with me is Dr. Edward S. Hyman. Do the members of your committee have a copy of our printed testimony before you? We have extra copies. Mr. ROSTENKOWSKI. Yes; we have the copies of the testimony. Dr. OLLER. Second, Mr. Chairman, we have some additional documentation for reference that we have prepared in these folders for each of the members, too, in view of the short time on this presentation, so you will have documentation for you and your staff to study. Mr. ROSTENKOWSKI. Your supplementary material will be filed with the committee, Dr. Oller. Your statement will be inserted in its entirety in the record. Dr. OLLER. Yes, and I have here these additional documents. I will submit those and they will not be for the record, because they are available otherwise. Mr. ROSTENKOWSKI. Thank you. Dr. OLLER. So, quickly, Mr. Chairman, the testimony starts with a national health policy. Thereafter, we have our recommendations, and then the testimony itself on page 1, where I shall begin. With your kind permission I will skip those areas where a reading of the testimony might suffice. INTRODUCTION Mr. Chairman, members of the subcommittee, I am Dr. José L. García Oller, president and founder of American CMS, the American Council of Medical Staffs. I have limited my private practice to the field of brain surgery for the past 25 years, and for 15 years served the indigent as head of the independent neurosurgery unit at Charity Hospital in New Orleans. I am a graduate of the Jefferson Medical College in Pennsylvania, class of 1945. With me is Edward S. Hyman, M.D., secretary of American CMS. A 1946 graduate of the Johns Hopkins medical school, he is a privately practicing specialist in internal medicine for 22 years, and a research biophysicist. CMS FOUNDED IN 1968 CMS was founded in 1968 as a unique grassroots organization designed to obtain the votes of private doctors. This was achieved by organizing through the existing medical staffs of community hospitals-nonprofit or for profit. Because attendance is required at staff meetings, we can obtain consensus through regular votes on issues. Our recommendation for a national health policy is set forth for your study in the printed testimony: 1. Personal, individualized care of high quality, with dignity and privacy, at a cost to the citizen on the basis of a patient-physician agreement is the hallmark of the American system of private medicine. Its continued and expanded availability under free enterprise is the proper goal of our national policy on medical care. Here I would comment that we would like to see the high dignity system extended to the poor. 2. The citizen's right to choose his private doctor, to receive medical care in accordance with his physician's best judgment, and the physician's right to administer it, must not be limited. 3. These decisions are inherent in the practice of medicine: The care, diagnosis and treatment and the admission and discharge of patients from hospitals and facilities. They are to remain the prerogative of the patient's attending physician, not of Government or insurance companies. There shall be no Federal intervention in the private practice of medicine such as: control of admissions by Government committees; treatment of the sick dictated through Government-approved manuals; length of stays in a hospital imposed by computerized averages; and denials of "necessity of hospitalization" determined by Government carriers who have never examined the patient. A. PSRO RATIONING OF MEDICAL CARE PSRO, "sold" as a "cost control" mechanism for national health insurance by the Nixon administration, is in fact a full-scale rationing system which does violence to the principles of the patient's right to privacy and choice of treatment and the physician's right to individualized judgment. B. INVASION OF PRIVACY, RATIONING OF ADMISSIONS, FEDERAL RULEBOOK 1. Section 1155 (b)3 says that PSRO may examine the medical records of patients. 2. Section 1155 (a) provides that for anyone requesting admission to the hospital, a committee will look at his "papers" and decide whether that patient is eligible for hospitalization. 3. A Federal rulebook for the diagnosis, care, and treatment of all diseases. Under section three we give you an example: C. THE COMMON COLD TREATED BY PSRO-TYPE GUIDELINES Mr. Chairman, people want to know how PSRO is going to save money as a cost-control mechanism. We have printed for you the official testimony of the San Joaquin Foundation for medical care, where it gave to the Senate Finance Committee examples of numerous guidelines for treatment. We chose their No. 1, the treatment of the common cold. On the left-hand side on page 4, we reproduced the recommendations of the San Joaquin Foundation for medical care (and how our national health service could treat a common cold under PSRO): We have estimated the cost of the treatment of the common cold under the classic San Joaquin formula on right-hand side on page 4: the PSRO cold would cost $41 for treatment. And for the population we have estimated $34 billion, which is 1.6 times as much as all physician's bills in the country, and we have already used it up in the treatment of the common cold. I would submit that this is not our recommendation, Mr. Chairman. This is the San Joaquin Foundation's record from the Senate testimony. CMS has filed a brief on PSRO as amicus curiae in the AAPS suit. We have also filed suit on the PSRO-type Utilization Review Regulations of November 19, 1974. The second problem we would like to mention to you on the regulation of disease, Mr. Chairman, is this: A few years ago, the Bureau of Health Insurance, as described under section E of our testimony, and as shown in our appendix B on page 21, issued a ruling for medicare, that the insurance carrier is to determine the "reasonableness and necessity of a general anesthetic" on a patient, who is undergoing a cataract operation, and that the insurance carrier "will determine the reasonableness and necessity of an assistant surgeon in cataract surgery”. In appendix B, we have a photostat of that ruling that has been issued by medicare, that gets into every operating room in the country and tells the doctor that he cannot put his patient to sleep for one of the most serious operations that we have, and certainly one of the most complicated. This direct intervention in the practice of medicine, wherein the bureaucrat can make a ruling to determine the issues of life and death, is frightening. On page 5, therefore, our recommendations: (1) We believe that the PSRO law should be repealed. (2) We believe that the benefits of any Federal program should be uniform throughout the country, from New York to California, to Louisiana. (3) We believe that the recent medicare ruling on cataract surgery must be overruled. (4) The next part of the presentation is a socioeconomic summary, Mr. Chairman. We have heard of "health crisis" for quite a few years. I assume that many of us have seen the latest Time magazine (and it is one of the enclosures that I have provided the committee members). that is on the newsstands now, on page 68 is the article "Doctors Revolt"; where 15,000 doctors in Britain are now going into their first strike. In the third column there is a statement by Dr. David Owen, Minister of State. were He says, "The health service was launched on a fallacy. We w going to finance everything-cure the nation and spending would drop. That fallacy has been exposed. Now we realize that no country. even if prepared to pay the taxes, can supply everything." This, of course, is a fundamental fallacy, similar to that presented this morning under testimony on the Health Security Act. Namely, the concept, Mr. Chairman, that we should confiscate the $100 billion of health moneys, including those that private citizens use, and have the Government give superior wisdom and guidance to that money. If we apply that to every endeavor, such as the construction workers' industry and we give the Government the ability to dole out the apartments and the homes, I don't believe that would be supported by Mr. Meany. The nine fallacies of the so-called health crisis are covered on pages 5 through 13 of your testimony-I will not go into detail on this because of the time limitation. The first fallacy is that medical care costs and physicians' fees have risen twice as fast as the Consumer Price Index. We have here on page 6 the classic Fortune magazine illustration exposure in 1970. The fact is that, if you compare the services CPI with the medical care CPI, the rise is identical. The point, then, is that there has been a fallacy in comparing medical services to goods, rather than to services. The second fallacy is that physicians' fees are spiraling above the economy. We have a 13-year review from Professor Meyers' book shown on our figure 3, where physicians' fees have risen less than average wages in covered employment. Fallacy No. 3, is that prescription drug prices are escalating. On page 8 we have a study showing that prices have decreased for the last 14 years. We believe that is a very unjust fallacy and accusation. Fallacy No. 4, "the runaway costs of hospital care-and what we need is a federally regulated system." We point out that we have a wage-intensive industry with repressed wages. We all know that they had to "catch up" under minimum wage laws. We must recognize the cost of technological progress, which means dollars, but we also recognize the "blank check" of insurance coverage. Capable witnesses before us have appeared who have covered the "blank check" influence on the escalating costs of hospital care. However, we find out that the national health insurance in this country would multiply that problem manifold. Our recommendation is that if we are to moderate the escalation in Federal and other insurance programs in hospitals, we have to eliminate "first dollar coverage" in medical care. If we have "first dollar coverage." giving equal access to the well and the unwell, we have no choice but to ration the services based on denials of services or onwaiting lines, or on decreased quality. We believe, therefore, that if we are to have a rational system, there should always be a degree of personal financial responsibility of the patient, whereby the patient communicates his consumer choice. Therefore, there is, in our opinion, no way to contain costs unless we have, (1) elimination of "first dollar coverage"; and, (2) direct billing, whereby the patient gets the reimbursement and the patient pays or doesn't pay the doctor according to patient satisfaction. This would keep the doctor's loyalty to his patient instead of to the insurance, the Government, or a computer. We believe the direct billing is essential in the care of the indigent. We believe it is time to give the indigent first-class medical care. Pay the patient and let him decide |