GOP Rep. Norwood
Wednesday, August 5, 1998
Before health care became one of the hottest issues in the 1998 campaigns, Rep. Charlie Norwood was one of the first Republicans pushing for new managed care laws. The congressman answered questions in a live, hour-long online discussion from his office in the Longworth Building on Capitol Hill.
Bensalem, PA: A major cause of the high cost of health care is the high cost of administration. What can be done to reduce administrative costs in the health care sector?
Rep. Charlie Norwood (R-Ga.): There is a perception that is correct that there are many costs in health care today being expended that don't necessarily deliver health care. And the caller correctly perceived that one of those costs are in administration that occurs when third parties are involved. One of those costs is attributed to the government that is involved in government-run plans but another is when managed care companies and insurance companies are placed in between the patient and provider of care. One of the solutions this Congress perceives is that the PSOs that tends to remove the middle man. The longterm correction to this is to have the relationship in health care return to be one between the patient and the doctor. That is being studied as we study how to look at health care for the 21st Century.
York, PA: What makes you confident that an appeals board or some such mechanism will curtail HMO abuses and help patient care? Doctors are not going to leave their offices to go to some distant site to argue care.
Rep. Charlie Norwood (R-Ga.): The second part of the question is that doctors are not envisioned to leave their offices. One of the changes in our health care bill is that internal appeals process will now be manned by the physician in medical claims or the dentist in dental claims rather than a health care bureaucrat or clerk. the external review part of the process will be overseen by licensed practicing physicians or dentists that specialize in the subject being questioned -- cancer related question goes to oncologist, and so forth. These external appeal boards will operate similarly to how we appeal today except I personally envision the use of telemedicine and teledentistry to come into play. The primary health care giver will furnish the health care appeals board all information necessary to make a medical necessity decision. Indeed it's possible that the patient might be present to the external appeals board. No doubt we've overlooked some things but it is the best we've had in 23 years and it is our effort to have medical necessity decisions made by the health care professional, not a health care accountant.
New Orleans, LA: You seem to have been "bought off" by the GOP leadership on the ERISA reform issue. Your HR 6920, "single issue" bill seems ideal with protection for employers and minimal cost, according to at least five studies, including GAO. Why have you caved?
Rep. Charlie Norwood (R-Ga.): The caller from Louisiana doesn't know me as well as the people of Georgia or he would know that I can't be bought off by anybody. The entire ERISA issue was one that I brought up three years ago and still strongly believe in. That is, anyone making decisions of medical necessity should be held responsible for those decisions in a state court of law. At the time we started this issue we had no support from the president, from the AMA, or from the leadership in either house, Republican or Democrat. My goal is now and always has been to have public policy once again regarding health care insurance. In this town, where 535 people can have an opinion, it turns into the politics of the possible. We have very good, though imperfect, patient protections that I want to see turned into law and this ERISA provision, though you can't sue HMOs for malpractice claims, which I believe you should be able to do, you can sue HMOs now in an expedited fashion in order to receive your benefits in time for treatment. You can win your benefit court costs and legal fees and the HMO can be held liable up to $250,000. That's a great improvement but I agree with the caller that eventually we will get the ERISA provision that you called about just not in the 105th Congress.
Edgewater, MD: I do not understand how the government ever became involved in this issue to begin with. Health insurance, like every other aspect of my life, is none of the government's business. Just how did this happen? Also, the last thing I ever want is to be enrolled in Medicare -- how do I opt out of this? My understanding is it is mandatory. Is this true? Thank you.
Rep. Charlie Norwood (R-Ga.): I agree with this caller that government got involved in health care insurance starting in 1943, when it allowed employers to deduct the cost of health care for employees. It followed up by taking over health care through Medicare and Medicaid. Then in 1973, passed the HMO act and in 1974 ERISA. The combination of these efforts has placed the government in the middle of health care where often it does not belong. You are mandated to go into Medicare at age 65. One of the things we are trying to do is to at least give you choices in Medicare, not just the government-run Medicare we know today, but allowing you to use MSAs (Medical Savings Accounts), provider service networks, and even managed care if you wish.
Norfolk, VA: Why is the federal government creating for the military the worst HMO? We not only had our health care taken away, now we do not have the flexibility of the rest of the federal employees who have Blue Cross/Blue Shield. We are stepchildren of the federal government. The active duty service member defends this county on a daily basis, and deserves the same health care as the rest of the federal government. Please, please look into this for the good of all of those serving our country.
Rep. Charlie Norwood (R-Ga.): I couldn't agree more with the caller from Norfolk. The federal government is not keeping its word to our military retirees and veterans, and I find that personally very offensive. The fist speech I ever gave in Washington was on the evils of Tricare. I still believe that to be so. It is forcing our retirees into a system of managed care where they have no choice of doctor or hospital, where care can be rationed and denied, and where untrained people can try to treat you to save money. My bill to reform managed care I hope will be helpful to Tricare recipients. We have also passed legislation to allow demonstration projects for military personnel to use the same health care plan that congress gets (FEHPP) and demonstration projects to allow local treatment facilities to accept Medicare. These things may be helpful, but it is still the government not keeping its word to the men and women that risk life and limb to defend this country. As long as I am in Congress I will speak out against the government. It doesn't keep its word to our veterans.
Birmingham, AL: Rep Norwood: In the managed care bill that you introduced, "PARCA," a provision existed that allowed beneficiaries to sue their managed care organizations. Today, however you are supporting the House GOP bill that excludes this provision. The absence of this provision seems to be the biggest difference in the GOP bill and the Dem. Bill. In addition, Clinton said he would veto any bill without the provision. I am curious as to why you have changed your stance on this. Is it for political reasons, i.e. it's better to support your party with elections coming up, or have you truly changed your opinion. If a change in opinion is the case, could you explain the pros and cons of the provision for us. Thank you.
Rep. Charlie Norwood (R-Ga.): I have not changed my opinion. I believe people should be able to sue their managed care companies as was in my bill. I will continue to push for that. Six months ago, when we needed the president to speak out on this subject, he was silent. It was not even in his patients bill of rights that the presidential commission came up with. It was not in the original Kennedy-Dingle bill. Congressman Dingle would not even cosponsor PARCA because it did have the provision to sue managed care companies. In fact, the president and the Democratic congress was not for this provision until the Republican bill didn't have it. The Republican bill does allow you to sue managed care companies before bodily harm or death occurs under contract law with penalties up to $250,000, court cost, and legal fees, and the cost of the benefit. This is a good up-front protection. The idea is to have your child treated in a timely manner, not receive punitive damages after your child has died. The only reason I tabled PARCA to work on the GOP bill was political reality. The 105th Congress was not going to vote to allow us the ERISA provision. I could have passed PARCA in the House, but that wasn't my goal. My goal was to have a law that could go through the House and Senate that would protect patients and become law. I had to give up the ERISA provision to move the process forward and give us an opportunity to have good patient protections and public policy that we have been lacking for the last 25 years. I intend to continue to push the ERISA provision in the 106th Congress and the 107th and the 108th if necessary. One must keep in mind that 535 get an opinion and it turns out to be the politics of the possible. I wanted a good bill, realizing that it would never be everything that I wanted, at least this year. We will keep trying.
Hermosa Beach, CA: Will members of Congress seriously consider policy suggestions submitted by ordinary citizens on the "health care" issue? Earlier today, I faxed a suggestion to your office regarding a simple "fix" for ERISA. Will my three page suggestion every reach your eyes?
Rep. Charlie Norwood (R-Ga.):
I thank you for your fax today regarding ERISA. Yes, members of Congress do consider policy suggestions submitted by ordinary citizens on the health care issue and I will see your fax. We get about 3,000 faxes, telephone calls and letters a month and sometimes we don't see these things in a timely manner, just because of our schedule. But I will see yours. Just keep in mind that the tall list of faxes, phone calls and letters that I receive are prioritized and Georgia faxes are put on top. :)
Great Falls, VA: Did the Patient Protection Act passed on July 24 exclude any important provision of your Patient Access to Responsible Care Act?
Rep. Charlie Norwood (R-Ga.): To the caller from California, as we were talking your fax was placed in my hands. Thanks for contacting us.
The Patient Protections Act did exclude some important position of my Patient Access to Responsible Care Act. I did get about 75 percent of PARCA in to the PPA. I am going to be on conference when the Senate and House meets to blend our bills and have great hopes of improving the final bill, PPA. The PPA doesn't have as good of language or access to specialists, though it is better than what we have today. It did not have the ERISA provision that holds health care accountants responsible for making decisions about medical necessity in a state court of law. It did not [have] continuity of care, but that is in the Senate version. The Point of Service language needs to be improved, that is the freedom to choose your own doctor, though it did have great improvement for medical savings accounts, which gives you great freedom of choice. Obviously, I like my bill (PARCA) better than the PPA, though there are some very good things in the PPA that are not in my bill. The problem is there are 535 opinions and I don't get it all my way.
Boston, MA: What do you mean you can't sue an HMO for malpractice? A woman in Boston, in an ERISA plan, recently won more than $1.5 million because her HMO failed to diagnose and treat her breast cancer quickly. I recently read about another case in Texas where the plaintiff was awarded $5 million from their HMO. This too was an employer provided plan. Isn't the real issue finding a way to resolve coverage disputes in a fair and quick fashion ... before delays can cause harm? When someone dies, no amount of money makes up for the loss ... the lawyers just get richer.
Rep. Charlie Norwood (R-Ga.): Very good point. The problem is that not all judicial circuits are ruling the same way. The ERISA language is fairly clear, stating that HMOs are shielded from reliability under malpractice. A few cases around the country are ruling in favor of the patients but generally courts are looking to Congress to clear up the language. One of the good things about the Republican bill is that it does have up-front accountability holding the insurance company responsible and liable before death and bodily harm occurs. You are correct that a very important issue is finding a way to resolve coverage disputes, but these resolutions must be based on medical necessity using standard clinical criteria. Who should determine medical necessity? A trained physician or an accountant? Hopefully in the PPA we have improved that situation greatly. I never wanted anybody to have to go to court to receive punitive damages, but the threat of punitive damages should make a health care accountant think twice before he or she overrules the doctor in the doctor's medical opinion your child or family member should be hospitalized.
Washingtonpost.com: Thanks for joining us today, Congressman Norwood.
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