Date: 1984-04-12
Speaker: SAM B. HALL (democrat)
Chamber: H

Mr. Chairman. the Ways and Means Committee medicare assignment amendment poses a dilemma for us that is difficult to resolve. It has a feature that I support. namely. the freeze on medicare payments for one year for doctors services to hospital inpatients. However. the mandated physician assignment language is going to be counterproductive to our entire effort here today. Aside from the fact that this part of the amendment is heavyhanded. and on the surface. seemingly vindictive. it will result in the very opposite of what It is intended to do. I can tell you this from experience. I served on a hospital board of a goodsize hospital for over 15 years before my coming to this body. I know something about the relationship of the doctor and his or her elderly patients. Folks in their senior years have a fear of changing established patterns. especially as It relates to their health care. Once an elderly patient chooses a physician and builds a relationship based on mutual trust. a sudden disruption of this scheme of things can be very traumatic. And make no mistake about It. the business of mandating physician assignment is going to totally discourage a doctor from taking on medicare patients. It limits his or her choice. but speaking strictly from the standpoint of the patients mental well being. It eliminates the choice of doctors. I realize that health care has entered the computer age. like everything else. But we cannot treat people like robots. The relationship of a patient to a physician is a very private matter that should be based on all the values that can be summoned from our JudeanChristian ethic. In short. it cannot be impersonal and cold. That is the kind of health care they have in the Soviet Union. I will tell you something else. This amendment is going to hurt the poor elderly in our rural areas. where we have enough problems getting doctors in the first place. Assuming that doctors In a rural hospital are prohibited because of an unwillingness to conform to mandatory assignment. what is the alternative? I will tell you what it is: No doctors. And no doctors means no hospitals. with the result being curtailment of medical assistance for the elderly. What is wrong with allowing doctors the right to decide on a casebycase basis whether to accept or to refuse medicare assignment? What is the April l. 1984 harm in that practice? I see none. By making this action mandatory on the part of the doctors. it will hurt the elderly much more than it will hurt the doctor. Now. the freeze is fine. I agree to that. And wc are getting cooperation from doctors on this particular matter. But mandatory assignment smacks of undue pressure and heavyhanded force. It will turn doctors away. And those who will suffer will be our elderly. We heard a colloquy on the floor just a few moments ago between the distinguished gentleman for Georgia and the distinguished gentleman from Indiana. and this statement was made: That if this amendment passes. if a doctor does not accept medicare patients. he cannot have any staff privileges in a hospital. If he does not sign this agreement. whether it be a medicare patient or not. that doctor cannot have staff privileges in a hospital. Now. is that right? I do not think so. I urge the defeat of this particular proposition.