The SPEAKER pro tempore. Under a
previous order of the House, the gentleman
from Texas (Mr. PAUL) is recognized
for 5 minutes.
1999 Ron Paul 103:1 Mr. PAUL.
Mr. Speaker, as an M.D. I
know that when I advise on medical
legislation that I may be tempted to
allow my emotional experience as a
physician to influence my views. But,
nevertheless, I am acting the role as
legislator and politician.
1999 Ron Paul 103:2 The M.D. degree grants no wisdom as
to the correct solution to our managed-care
mess. The most efficient manner
to deliver medical services, as it is
with all goods and services, is determined
by the degree the market is allowed
to operate. Economic principles
determine efficiencies of markets, even
the medical care market, not our emotional
experiences dealing with managed
care.
1999 Ron Paul 103:3 Contrary to the claims of many advocates
of increased government regulation
of health care, the problems with
the health care system do not represent
market failure. Rather, they
represent the failure of government
policies which have destroyed the
health care market.
1999 Ron Paul 103:4 In today’s system, it appears on the
surface that the interest of the patient
is in conflict with the rights of the insurance
companies and the Health
Maintenance Organizations. In a free
market, this cannot happen. Everyone’s
rights are equal and agreements
on delivering services of any kind are
entered into voluntarily, thus satisfying
both sides.
1999 Ron Paul 103:5 Only true competition assures that
the consumer gets the best deal at the
best price possible by putting pressure
on the providers. Once one side is given
a legislative advantage in an artificial
system, as it is in managed care, trying
to balance government-dictated advantages
between patient and HMOs is impossible.
The differences cannot be reconciled
by more government mandates,
which will only make the problem
worse. Because we are trying to patch
up an unworkable system, the impasse
in Congress should not be a surprise.
1999 Ron Paul 103:6 No one can take a back seat to me regarding
the disdain I hold for the
HMO’s role in managed care. This entire
unnecessary level of corporatism
that rakes off profits and undermines
care is a creature of government interference
in health care. These non-market
institutions and government could
have only gained control over medical
care through a collusion through organized
medicine, politicians, and the
HMO profiteers in an effort to provide
universal health care. No one suggests
that we should have universal food,
housing, TV, computer and automobile
programs; and yet, many of the poor do
much better getting these services
through the marketplace as prices are
driven down through competition.
1999 Ron Paul 103:7 We all should become suspicious
when it is declared we need a new Bill
of Rights, such as a taxpayers’ bill of
rights, or now a patients’ bill of rights.
Why do more Members not ask why the
original Bill of Rights is not adequate
in protecting all rights and enabling
the market to provide all services? If
over the last 50 years we had had a lot
more respect for property rights, voluntary
contracts, State jurisdiction,
and respect for free markets, we would
not have the mess we are facing today
in providing medical care.
1999 Ron Paul 103:8 The power of special interests influencing
government policy has brought
us to this managed-care monster. If we
pursued a course of more government
management in an effort to balance
things, we are destined to make the
system much worse. If government
mismanagement in an area that the
Government should not be managing at
all is the problem, another level of bureaucracy,
no matter how well intended,
cannot be helpful. The law of
unintended consequences will prevail
and the principle of government control
over providing a service will be
further entrenched in the Nation’s psyche.
The choice in actuality is
government-provided medical care and its inevitable
mismanagement or medical
care provided by a market economy.
1999 Ron Paul 103:9 Partial government involvement is
not possible. It inevitably leads to
total government control. Plans for all
the so-called patients’ bill of rights are
100 percent endorsement of a principle
of government management and will
greatly expand government involvement
even if the intention is to limit
government management of the health
care system to the extent necessary to
curtail the abuses of the HMO.
1999 Ron Paul 103:10 The patients’ bill of rights concept is
based on the same principles that have
given us the mess we have today. Doctors
are unhappy. HMOs are being attacked
for the wrong reasons. And the
patients have become a political football
over which all sides demagogue.
1999 Ron Paul 103:11 The problems started early on when
the medical profession, combined with
the tax code provisions making it more
advantageous for individuals to obtain
first-dollar health care coverage from
third parties rather than pay for health
care services out of their own pockets,
influenced the insurance industry into
paying for medical services instead of
sticking with the insurance principle of
paying for major illnesses and accidents
for which actuarial estimates
could be made.
1999 Ron Paul 103:12 A younger, healthier and growing population
was easily able to afford the fees required
to generously care for the sick. Doctors,
patients and insurance companies all
loved the benefits until the generous third-party
payment system was discovered to be
closer to a Ponzi scheme than true insurance.
The elderly started living longer, and medical
care became more sophisticated, demands increased
because benefits were generous and
insurance costs were moderate until the demographics
changed with fewer young people
working to accommodate a growing elderly
population — just as we see the problem developing
with Social Security. At the same time
governments at all levels became much more
involved in mandating health care for more
and more groups.
1999 Ron Paul 103:13 Even with the distortions introduced by the
tax code, the markets could have still sorted
this all out, but in the 1960s government entered
the process and applied post office principles
to the delivery of medical care with predictable
results. The more the government got
involved the greater the distortion. Initially
there was little resistance since payments
were generous and services were rarely restricted.
Doctors like being paid adequately for
services than in the past were done at discount
or for free. Medical centers, always willing
to receive charity patients for teaching purposes
in the past liked this newfound largesse
by being paid by the government for their
services. This in itself added huge costs to the
nation’s medical bill and the incentive for patients
to economize was eroded. Stories of
emergency room abuse are notorious since
“no one can be turned away.”
1999 Ron Paul 103:14 Artificial and generous payments of any
service, especially medical, produces a well-known
cycle. The increased benefits at little or
no cost to the patient leads to an increase in
demand and removes the incentive to economize.
Higher demands raises prices for doctor
fees, labs, and hospitals; and as long as the
payments are high the patients and doctors
don’t complain. Then it is discovered the insurance
companies, HMOs, and government
can’t afford to pay the bills and demand price
controls. Thus, third-party payments leads to
rationing of care; limiting choice of doctors,
deciding on lab tests, length of stay in the
hospital, and choosing the particular disease
and conditions that can be treated as HMOs
and the government, who are the payers, start
making key medical decisions. Because
HMOs make mistakes and their budgets are
limited however, doesn’t justify introducing the
notion that politicians are better able to make
these decisions than the HMOs. Forcing
HMOs and insurance companies to do as the
politicians say regardless of the insurance policy
agreed upon will lead to higher costs, less
availability of services and calls for another
round of government intervention.
1999 Ron Paul 103:15 For anyone understanding economics, the
results are predictable: Quality of medical care
will decline, services will be hard to find, and
the three groups, patients, doctors and HMOs
will blame each other for the problems, pitting
patients against HMOs and government, doctors
against the HMOs, the HMOs against the
patient, the HMOs against the doctor and the
result will be the destruction of the cherished
doctor-patient relationship. That’s where we
are today and unless we recognize the nature
of the problem Congress will make things
worse. More government meddling surely will
not help.
1999 Ron Paul 103:16 Of course, in a truly free market, HMOs and
pre-paid care could and would exist — there
would be no prohibition against it. The Kaiser
system was not exactly a creature of the government
as is the current unnatural HMO-government-created chaos we have today. The
current HMO mess is a result of our government
interference through the ERISA laws, tax
laws, labor laws, and the incentive by many in
this country to socialize medicine “American
style”, that is the inclusion of a corporate level
of management to rake off profits while draining
care from the patients. The more government
assumed the role of paying for services
the more pressure there has been to managed
care.
1999 Ron Paul 103:17 The contest now, unfortunately, is not between
free market health care and nationalized
health care but rather between those who
believe they speak for the patient and those
believing they must protect the rights of corporations
to manage their affairs as prudently
as possible. Since the system is artificial there
is no right side of this argument and only political
forces between the special interests are at
work. This is the fundamental reason why a
resolution that is fair to both sides has been
so difficult. Only the free market protects the
rights of all persons involved and it is only this
system that can provide the best care for the
greatest number. Equality in medical care
services can be achieved only by lowering
standards for everyone. Veterans hospital and
Medicaid patients have notoriously suffered
from poor care compared to private patients,
yet, rather than debating introducing consumer
control and competition into those programs,
we’re debating how fast to move toward a system
where the quality of medicine for everyone
will be achieved at the lowest standards.
Since the problem with our medical system
has not been correctly identified in Washington
the odds of any benefits coming from
the current debates are remote. It looks like
we will make things worse by politicians believing
they can manage care better than the
HMO’s when both sides are incapable of such
a feat.
1999 Ron Paul 103:18 Excessive litigation has significantly contributed
to the ongoing medical care crisis.
Greedy trial lawyers are certainly part of problem
but there is more to it than that. Our legislative
bodies throughout the country are greatly
influenced by trial lawyers and this has
been significant. But nevertheless people do
sue, and juries make awards that qualify as
“cruel and unusual punishment” for some who
were barely involved in the care of the patient
now suing. The welfare ethic of “something for
nothing” developed over the past 30 to 40
years has played a role in this serious problem.
This has allowed judges and juries to
sympathize with unfortunate outcomes, not related
to malpractice and to place the responsibility
on those most able to pay rather than on
the ones most responsible. This distorted view
of dispensing justice must someday be addressed
or it will continue to contribute to the
deterioration of medical care. Difficult medical
cases will not be undertaken if outcome is the
only determining factor in deciding lawsuits.
Federal legislation prohibiting state tort law reform
cannot be the answer. Certainly contractual
arrangements between patients and doctors
allowing specified damage clauses and
agreeing on arbitration panels would be a big
help. State-level “loser pays” laws, which discourage
frivolous and nuisance lawsuits,
would also be a help.
1999 Ron Paul 103:19 In addition to a welfare mentality many have
developed a lottery jackpot mentality and hope
for a big win through a “lucky” lawsuit. Fraudulent
lawsuits against insurance companies
now are an epidemic, with individuals feigning
injuries in order to receive compensation. To
find moral solutions to our problems in a nation
devoid of moral standards is difficult. But
the litigation epidemic could be ended if we
accepted the principle of the right of contract.
Doctors and hospitals could sign agreements
with patients to settle complaints before they
happen. Limits could be set and arbitration
boards could be agreed upon prior to the fact.
Limiting liability to actual negligence was once
automatically accepted by our society and only
recently has this changed to receiving huge
awards for pain and suffering, emotional distress
and huge punitive damages unrelated to
actual malpractice or negligence. Legalizing
contracts between patients and doctors and
hospitals would be a big help in keeping down
the defensive medical costs that fuel the legal
cost of medical care.
1999 Ron Paul 103:20 Because the market in medicine has been
grossly distorted by government and artificially
managed care, it is the only industry where
computer technology adds to the cost of the
service instead of lowering it as it does in
every other industry. Managed care cannot
work. Government management of the computer
industry was not required to produce
great services at great prices for the masses
of people. Whether it is services in the computer
industry or health care all services are
best delivered in the economy ruled by market
forces, voluntary contracts and the absence of
government interference.
1999 Ron Paul 103:21 Mixing the concept of rights with the delivery
of services is dangerous. The whole notion
that patient’s “rights” can be enhanced by
more edicts by the federal government is preposterous.
Providing free medication to one
segment of the population for political gain
without mentioning the cost is passed on to
another segment is dishonest. Besides, it only
compounds the problem, further separating
medical services from any market force and
yielding to the force of the tax man and the
bureaucrat. No place in history have we seen
medical care standards improve with nationalizing
its delivery system. Yet, the only debate
here in Washington is how fast should we proceed
with the government takeover. People
have no more right to medical care than they
have a right to steal your car because they
are in need of it. If there was no evidence that
freedom did not enhance everyone’s well
being I could understand the desire to help
others through coercive means. But delivering
medical care through government coercion
means not only diminishing the quality of care,
it undermines the principles of liberty. Fortunately,
a system that strives to provide maximum
freedom for its citizens, also supports
the highest achievable standard of living for
the greatest number, and that includes the
best medical care.
1999 Ron Paul 103:22 Instead of the continual demagoguery of the
issue for political benefits on both sides of the
debate, we ought to consider getting rid of the
laws that created this medical management
crisis.
1999 Ron Paul 103:23 The ERISA law requiring businesses to provide
particular programs for their employees
should be repealed. The tax codes should
give equal tax treatment to everyone whether
working for a large corporation, small business,
or is self employed. Standards should
be set by insurance companies, doctors, patients,
and HMOs working out differences
through voluntary contracts. For years it was
known that some insurance policies excluded
certain care and this was known up front and
was considered an acceptable provision since
it allowed certain patients to receive discounts.
The federal government should defer to state
governments to deal with the litigation crisis
and the need for contract legislation between
patients and medical providers. Health care
providers should be free to combine their efforts
to negotiate effectively with HMOs and
insurance companies without running afoul of
federal anti-trust laws — or being subject to
regulation by the National Labor Relations
Board (NLRB). Congress should also remove
all federally-imposed roadblocks to making
pharmaceuticals available to physicians and
patients. Government regulations are a major
reason why many Americans find it difficult to
afford prescription medicines. It is time to end
the days when Americans suffer because the
Food and Drug Administration (FDA) prevented
them from getting access to medicines
that where available and affordable in other
parts of the world!
1999 Ron Paul 103:24 The most important thing Congress can do
is to get market forces operating immediately
by making Medical Savings Accounts (MSAs)
generously available to everyone desiring one.
Patient motivation to save and shop would be
a major force to reduce cost, as physicians
would once again negotiate fees downward
with patients — unlike today where the government
reimbursement is never too high and
hospital and MD bills are always at maximum
levels allowed. MSAs would help satisfy the
American’s people’s desire to control their own
health care and provide incentives for consumers
to take more responsibility for their
care.
1999 Ron Paul 103:25 There is nothing wrong with charity hospitals
and possibly the churches once again providing
care for the needy rather than through
government paid programs which only maximizes
costs. States can continue to introduce
competition by allowing various trained individuals
to provide the services that once were
only provided by licensed MDs. We don’t have
to continue down the path of socialized medical
care, especially in America where free
markets have provided so much for so many.
We should have more faith in freedom and
more fear of the politician and bureaucrat who
think all can be made well by simply passing
a Patient’s Bill of Rights.
Notes:
Verses 1999 Ron Paul 103:1 through 103:11 were spoken on the House floor; the rest of this chapter was inserted into the Congressional Record as an extension of remarks.
1999 Ron Paul 103:6
No one can take a back seat to me regarding the disdain I hold for the HMOs role in managed care. Perhaps Ron Paul misspoke here and meant that he takes a back seat to nobody regarding the disdain.
1999 Ron Paul 103:13
Doctors like being paid adequately for services than in the past...
probably should be
Doctors liked being paid adequately for services that in the past....
1999 Ron Paul 103:23
federally-imposed roadblocks probably should be unhyphenated: federally imposed roadblocks.
1999 Ron Paul 103:25
government paid programs which only maximizes costs. probably should be hyphenated and be:
government-paid programs which only maximize costs.
