Ron Paul
1998 Ron Paul Chapter 84

Patient Protection Act of 1998

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24 July 1998

Friday, July 24, 1998

1998 Ron Paul 84:1
Mr. PAUL. Mr. Speaker, I appreciate the opportunity to explain why I cannot vote for the Patient Protection Act (H.R. 4250). However, I would first like to express my support for two of the bill’s provisions, relating to Medical Savings Accounts and relating to the proposed national health ID.

1998 Ron Paul 84:2
Earlier this week I introduced legislation, the Patient Privacy Act (H.R. 4281), to repeal those sections of the Health Insurance Portability and Accountability Act of 1996 that authorized the creation of a national medical ID. I believe that the increasing trend toward allowing the federal government to track Americans through national ID cards and numbers represents one of the most serious threats to liberty we are facing. The scheme to create a national medical ID to enter each person’s medical history into a national data base not only threatens civil liberties but it undermines the physician-patient relationship, the cornerstone of good medical practice. Oftentimes, effective treatment depends on a patient’s ability to place absolute trust in his or her doctor, a trust that would be severely eroded if the patient knew that any and all information given their doctor could be placed in a data base accessible by anyone who knows the patient’s “unique personal identifier.”

1998 Ron Paul 84:3
While I was not here in 1996 when the medical ID was authorized, it is my understanding that this provision was part of a large bill rushed through Congress without much debate. I am glad that Congress has decided to at least take a second look at this proposal and its ramifications. I am quite confident that, after Congress hears from the millions of Americans who object to a national ID, my colleagues will do the right thing and pass legislation forbidding the federal government from instituting a “uniform standard health identifier.”

1998 Ron Paul 84:4
Mr. Speaker, I am also pleased that Congress is addressing the subject of health care in America, for the American health care system does need reform. Too many Americans lack access to quality health care while millions more find their access to medical care blocked by a “gatekeeper,” an employee of an insurance company or a Health Maintenance Organization (HMO) who has the authority to overrule the treatment decisions of physicians!

1998 Ron Paul 84:5
An an OB/GYN with more than 30 years experience, I find it outrageous that any insurance company bureaucrat could presume to stand between a doctor and a patient. However, in order to properly fix the problem, we must understand its roots. The problems with American health care coverage are rooted in the American tax system, which provides incentives for employers to offer first-dollar insurance benefits to their employees, while providing no incentives for individuals to attempt to control their own health care costs. Because “he who pays the piper calls the tune,” it is inevitable that those paying the bill would eventually seize control over personal health care choices as a means of controlling costs.

1998 Ron Paul 84:6
Because this problem was created by distortions in the health care market that took control of the health care dollar away from the consumer, the best solution to this problem is to put control of the health care dollar back into the hands of the consumer. We also need to rethink the whole idea of first-dollar insurance coverage for every medical expense, no matter how inexpensive. Americans would be more satisfied with the health care system if they could pay for their routine expenses with their own funds, relying on insurance for catastrophic events, such as cancer.

1998 Ron Paul 84:7
An excellent way of moving toward a health care system where the consumer is in charge is through Medical Savings Accounts (MSA’s). I enthusiastically endorse those provisions of this bill that expand access to MSA’s. It may be no exaggeration to say that MSA’s are vital to preserving the private practice of medicine.

1998 Ron Paul 84:8
MSA’s provide consumers the freedom to find high-quality health care at a reasonable cost. MSA’s allow consumers to benefit when they economize in choosing health care so they will be more likely to make informed health care decisions such as seeking preventive care and, when possible, negotiate with their providers for the lowest possible costs. Most importantly, MSA’s are the best means available to preserve the patient’s right to choose their doctor and the treatment that best meets their needs, free from interference by an insurance company or an HMO.

1998 Ron Paul 84:9
Mr. Speaker, all those concerned with empowering patients should endorse H.R. 4250’s provisions lifting all caps on how many Americans may purchase an MSA and repealing federal regulations that discourage Americans from using MSA’s. For example, a provision in the tax code limits the monthly contribution to the MSA to one-twentieth of the MSA’s yearly amount. Thus, MSA holders have a small portion of their yearly contribution accessible to them in the early months of the year. The Patient Protection Act allows individuals to make the full contribution to their MSA at any time of the year, so someone who establishes an MSA in January does not have to worry if they get sick in February.

1998 Ron Paul 84:10
This legislation also allows both employers and employees to contribute to an employee’s MSA. It lifts the arbitrary caps on how one can obtain MSA’s and expands the limits on the MSA deductible. Also it provides that possession of an MSA satisfies all mandated benefits laws as long as individuals have the freedom to purchase those benefits with their MSA.

1998 Ron Paul 84:11
However, as much as I support H.R. 4250’s expansion of MSA’s, I equally object to those portions of the bill placing new federal standards on employer offered health care plans. Proponents of these standards claim that they will not raise cost by more than a small percentage point. However, even an increase of a small percentage point could force many marginal small businesses to stop offering health care for their employees, thus causing millions of Americans to lose their health insurance. This will then lead to a new round of government intervention. Unlike Medical Savings Accounts which remove the HMO bureaucracy currently standing between physicians and patients, the so-called patient protections portions of this bill add a new layer of government-imposed bureaucracy. For example, H.R. 4250 guarantees each patient the right to external and internal review of insurance company’s decisions. However, this does not empower patients to make their own decisions. If both external and internal review turn down a patient’s request for treatment, the average patient will have no choice but to accept the insurance companies decision. Furthermore, anyone who has ever tried to navigate through a government-controlled “appeals process” has reason to be skeptical of the claims that the review process will be completed in less than three days. Imposing new levels of bureaucracy on HMO’s is a poor substitute for returning to the American people the ability to decide for themselves, in consultation with their care giver, what treatments are best for them. Medical Savings Accounts are the best patient protection.

1998 Ron Paul 84:12
Perhaps the biggest danger these regulations pose is ratification of the principle that guaranteeing a patients’ access to physicians is the proper role for the government, thus opening the door for further federal control of the patient-physician relationship. I ask my physician-colleagues who support this regulation, once we have accepted the notion that federal government can ensure patients have access to our services, what defense can we offer when the government places new regulations and conditions on that access?

1998 Ron Paul 84:13
I am also concerned that this bill further tramples upon state automony by further preempting their ability to regulate HMO’s and health care plans. Under the 10th amendment, states should be able to set standards for organizations such as HMO’s without interference from the federal government. I am disappointed that we did not get an opportunity to debate Mr. BRADY’s amendment that would have preserved the authority of states in this area.

1998 Ron Paul 84:14
In conclusion, Mr. Speaker, while the Patient Protection Act takes some good steps toward placing patients back in control of the health care system, it also furthers the federal role in overseeing the health system. It is my belief that the unintended, but inevitable, consequence of this bill, will require Congress to return to the issue of health care reform in a few years. I hope Congress gets it right next time.

1998 Ron Paul 84:11 employer offered health care plans probably should be hyphenated: employer-offered health care plans.

1998 Ron Paul 84:11 review of insurance company’s decisions probably should be plural: review of insurance companies’ decisions.

1998 Ron Paul 84:11 the insurance companies decision probably should be singular and possessive: the insurance company’s decision.

1998 Ron Paul 84:12 a patients’ access to physicians probably should be singular: a patient’s access to physicians.

1998 Ron Paul 84:13 I am disappointed that we did not get an opportunity to debate Mr. BRADY’s amendment that would have preserved the authority of states in this area. Here, Ron Paul does not specify whether he means The Honorable Robert A. Brady of Pennsylvania or The Honorable Kevin Brady of Texas.

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