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[Time: 21:15]
Although such behavior violates Federal and State law, it is not at all that unusual. Federal antitrust regulators have dealt with more than 50 such cases over the past number of years, and none of these cases, not one, involved collective efforts to improve the health care quality. Every case involved efforts by the providers to raise their fees to anticompetitive levels at the expense of the consumers, employers, and taxpayers who finance programs for seniors, the disabled and the poor.
Testifying before the Committee on the Judiciary last year, Assistant Attorney General of the Department of Justice Antitrust Division Joel Klein stated:
``Our history of investigations, including our recent cases against two federations of competing doctors involving group boycots and price-fixing conspiracies, leads us to have concerns because the proposed bill provides no assurance that health care professionals would direct their collective negotiating efforts to improving quality of care, rather than their own financial circumstances.''
Klein went on to cite a case in which ``Twenty-nine otherwise competing surgeons who made up the vast majority of general and vascular surgeons with operating privileges at five hospitals in Tampa formed a corporation solely for the purpose of negotiating jointly with managed care plans to obtain higher fees. Their strategy was a success. Each of the 29 surgeons gained, on average, over $14,000 in annual revenues in just the few months of joint negotiations before they learned that the Antitrust Division was investigating the conduct. The participants in that scheme did not take any collective action that improved the quality of care.''
This case is typical of what happens when physicians illegally engage in collective negotiations with health care plans.
In April of this year, the Federal Trade Commission announced a settlement with a group of surgeons in Austin, Texas, who used collective negotiations with health plans to win handsome increases in their fees. If we were to pass H.R. 1304, the antitrust exemption would make all of what I just read legal, it is now illegal, and with no oversight at all. At least labor unions must obey the NLRB.
Mr. HALL of Ohio. Mr. Speaker, I yield 2 minutes to the gentleman from Florida (Mr. DEUTSCH).
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Mr. DEUTSCH. Mr. Speaker, I wish all of us could be honest. This rule is maybe the most disingenuous rule I have seen in my 8 years in the United States Congress.
The fact that this rule allows the Coburn amendment on the bill is a convoluted attempt to, I do not know, kill the bill, or put the Democrats in a politically disadvantageous position.
The vast majority of Democrats who are pro-choice, and the majority of Democrats who support this bill, have a Hobson's choice under this rule. If the rule is passed, and then the Coburn amendment with similar things that have passed this floor is then on the bill, then where do Democrats vote?
The reality is that the Coburn amendment is an awful amendment from a policy perspective. It is a gag rule. Let me read what the American College of Obstetricians and Surgeons said about it: ``We must pass a bill that allows health providers to effectively advocate for the care of their patients, not gag providers in an attempt to limit women's access to needed reproductive health services.''
This is a gag rule. It is incredible, the scope of it. It would prevent those physicians who benefit from the Campbell rule from even talking to providers about providing reproductive or family planning services, a complete ban. They could not even talk about that in terms of their negotiation. It is an extremely large attempt to limit women's choices in America.
For the Members, and again, I know this has been a very difficult afternoon for many Members as they have looked at it, because there are many Members who are cosponsors of this; again, a majority of Democrats who want to see changes in health care, who support what the gentleman from California (Mr. CAMPBELL) is trying to do.
But the leadership on the Republican side has created this disingenuous rule. If the rule is defeated, which I urge its defeat, if the rule is defeated the choice clearly falls upon those who created the rule, which is the majority, the Republican leadership.
I urge the gentleman from California (Mr. CAMPBELL) to once again threaten to leave this Congress if his leadership does not give him a true rule and a true vote on the bill.
Mr. HALL of Ohio. Mr. Speaker, I yield 2 minutes to the gentleman from North Dakota (Mr. POMEROY).
Mr. POMEROY. Mr. Speaker, this House is demonstrating that it cannot competently and fairly deal with difficult health policy questions. Reference yesterday, a long, contentious day debating one of the most important issues before this country: whether we can give our seniors prescription drug coverage.
All of that debate and much of the venom generated within that debate concerned an unfair rule cooked up in the Committee on Rules at 2:30 in the morning the morning of the debate. I guess it was not the last bad rule we were going to see on important health policy coming out of the Committee on Rules this week.
So here we are, late in an absolutely exhausting week, considering another vital health policy question under another unfair rule.
Take, for example, the issue of allowing the Coburn amendment and striking the Greenwood amendment. I do not care whether within this body Members are pro-choice, whether they are pro-life, or anywhere in between. The fact of the matter is to allow one side their amendment and not allow the other side their amendment is unfair and speaks to what a skewed, unfortunate rule this is that brings this bill to the floor.
That is not the end of the problems within this bill. Allowing physician collusion on fee structures has obvious consequences for Medicare that pays the bills, for Medicaid. But Members do not see any offsets. We do not see any pay-fors in this legislation. There would surely be a budget point of order that could be raised against this bill, but guess what, they shred the budget rules and waive all points of order. Do not even think about trying to point out that we are spending money we have not offset in the Federal budget, it is waived under this rule.
Mr. Speaker, the Committee on the Judiciary has ruled on this bill, but the Committee on Commerce has not ruled, the Committee on Ways and Means has not ruled. This is an unfair rule. It should be voted down.
Mr. HALL of Ohio. Mr. Speaker, I yield 2 minutes to the gentlewoman from Colorado (Ms. DEGETTE).
Ms. DEGETTE. Mr. Speaker, the Republican leadership is truly offering us a Hobson's choice here. I am a cosponsor of this bill and proud to be one, but I am standing here to urge defeat of this rule because of the Coburn amendment.
The Coburn amendment could gag physicians and other providers in two ways. First, providers who have a medical and ethical responsibility to promote the well-being of their patients could be unable to advocate with health plans on their patient's behalf for comprehensive reproductive health care.
Second, providers could not negotiate against any onerous restrictions that appear in their contracts.
Why did the Republican leadership do this? They did this because they know pro-choice Members like myself, who also are cosponsors of the bill, will never support legislation with provisions that could be construed as gag rules.
The gentleman from Pennsylvania (Mr. GREENWOOD) was denied the opportunity to offer a second degree amendment that would have clarified and improved the bill. Was this allowed? No, it was not. Tragically, we have to defeat this rule. We have to send it back, and we have to say, let us pass a bill that is free of poison pills.
We have sadly, in my view, reached a point in this Congress where virtually no health care legislation can be passed. The Committee on Commerce, on which I sit, has repeatedly failed to mark anything up, including a children's health bill, because of repeated and ill-fated efforts to impose abortion language.
The National Institutes of Health has not been reauthorized for years because of the threat of anti-abortion riders. We have reached a virtual gridlock over abortion riders in every form imaginable. The American public needs to know this, and they need to know how wrong it is.
So let us defeat this bill. Let us send it back to the Committee on Rules. Let us write a clean bill. Let us allow the Greenwood amendment to go forward, and let us pass legislation that will allow doctors to organize, just as my colleague, the gentleman from California (Mr. CAMPBELL), wants to have happen.
Mr. GOSS. Mr. Speaker, I yield 3 minutes to my colleague and friend, the distinguished gentleman from California (Mr. ROHRABACHER).
Mr. ROHRABACHER. Mr. Speaker, tonight I rise in strong support of the rule and even stronger support for the bill of the gentleman from California, H.R. 1304. I do so as a strong advocate of market-related solutions to meet many of today's challenges. This is a market-based solution.
Ours is a multi-layered system of competing interests and checks and balances. America's health care is part of that system, but yet, it is an area today where we see justified concern and even perhaps alarm.
Our citizens feel out of control. The HMO revolution that brought costs under control has brought with it new problems and new complications and new frustrations. New checks and balances have not emerged to see that the power vested in this new power, the HMOs, the new power that is vested in them and the authority that they have is not abused or that the cost controls do not go too far.
The gentleman from California (Mr. CAMPBELL) is, as I said, offering a market-based approach to this challenge, instead of just strengthening government or putting new regulations in place. H.R. 1304 empowers health care professionals to balance the new power of the business managers who make policy decisions for America's health care, health care that is so vital to our families and the American people.
Doctors should be able to act together as a unit if they choose to do so, just as investors, managers, and other voluntary associates join together to form HMOs and other businesses.
The Campbell bill would result in a new balance that will well serve the families and people of our country. This system of competing interests has worked very well in other industries. It has worked to make us the most effective system in the world at providing
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The gentleman from California (Mr. CAMPBELL) is to be applauded for his creativity and his innovative approach. Rather than just trying to offer simplistic answers of giving more regulations or having more government that costs money, he is empowering people to do a better job and to work together to provide health care for America.
Let us make sure that we use the power of the market. Let us make sure we use voluntary association, just as we have in every other industry, to provide quality health care to our people, and health care that we can ensure will not be abused because there is too much power just in the hands of the managers. This is true in every other industry, it will be true in health care as well.
I rise in strong support of the rule and the Campbell amendment.
Mr. HALL of Ohio. Mr. Speaker, I yield 2 minutes to the gentlewoman from California (Ms. PELOSI).
Ms. PELOSI. Mr. Speaker, I thank the gentleman for yielding time to me.
Mr. Speaker, I rise with great reluctance in opposition to this rule. I say ``reluctance'' because I do support the bill. We need to strengthen the ability of physicians to be effective advocates for the health care needs of their patients.
However, by choosing once again to bring legislation to this floor that attempts to limit a woman's right to choose, the Committee on Rules has undermined the spirit of this legislation. This bill seeks to assure patient safety and increase the quality of health care by allowing physicians to collectively have a greater say in negotiations on the terms of a health plan.
The intent is to clearly empower physicians in their relationship with HMO administrators, some of whom attempt sometimes to put profits over patient care when making decisions about medical care.
Mr. Speaker, reproductive health services are an essential component of primary care for women. To my male colleagues, I say this again, gentlemen, reproductive health services are an essential component of primary care for women.
Although this amendment has been framed as a conscience clause for religious health care entities, it does in fact prevent physicians, regardless of their religion, from even mentioning abortion in their negotiations with health plans.
I repeat some of the points that have been made earlier. The result is that providers who have a medical and ethical responsibility to promote the well-being of their patients would be unable to advocate with health plans on their patients' behalf for comprehensive reproductive health care.
In addition, providers could not negotiate any onerous restrictions that appear in their contracts concerning the provision of abortion services. Such restrictions could include a ban on referring clients for abortion elsewhere, or from even discussing abortion as a medically appropriate and legal option for patients.
Mr. Speaker, reproductive health services are an essential component of primary care for women and must be part of all negotiations. I urge my colleagues to vote no.
[Time: 21:30]
Mr. HALL of Ohio. Mr. Speaker, I yield 4 minutes to the gentleman from Michigan (Mr. CONYERS), the ranking minority member of the Committee on the Judiciary.
Mr. CONYERS. Mr. Speaker, I want to admit that we are now on the horns of a dilemma in terms of the rule. We have a rule that presents an obstacle course of poison pills designed to drag the bill down. Virtually all of the amendments that have been allowed by the Committee on Rules are hostile, in many cases unrelated, amendments.
For example, the Coburn amendment is an anti-choice amendment that would prevent doctors from making referrals for abortion-related services for victims of rape and incest. The Cox amendment is an insult to the collective bargaining idea and would constitute the first-ever Federal right-to-work mandate on the States.
Neither of these amendments have anything to do with the underlying bill, of course, and the Committee on Rules have waived all points of order to leave these poison bills intact. We know the game. It is to split 220 cosponsors of a very important and fine bill.
And so my solution that I propose to my colleagues tonight is that since we have been gamed, I am going to oppose the previous question on the adoption of the rule and ask the Members to support me in opposition to the previous question so that I can offer an amendment that would remove the Cox amendment and also make in order the amendment submitted by the gentleman from Pennsylvania (Mr. GREENWOOD) to the Committee on Rules.
This would allow us to have a clean debate on the underlying legislation, free of the poison pill amendments. And my amendment is supported by NARAL, the Pro-Choice Caucus, the AFL-CIO, and AFSCME. So a vote to defeat the previous question may well be the only chance Members have in this Congress to vote for the right of health care professionals to collectively bargain on behalf of their patients. It is a tough choice. We have been split on this, but I hope it will bring us back together again.
Mr. GOSS. Mr. Speaker, I yield 2 minutes to the distinguished gentleman from Iowa (Mr. GANSKE).
Mr. GANSKE. Mr. Speaker, well, here we are again with a difficult rule. We will see whether we can work this out. I think I need to spend a couple of minutes talking about why this bill should pass.
Blue Cross/Blue Shield of Iowa controls the health care of 98 percent of the hospitals and 90 percent of the doctors. One insurance company controls the access and health costs of 60 percent of insured Oregonians. Market competition in Texas is all but gone. Twenty-four competing companies have compressed into four mega-managed care companies.
Sixty percent of the Pittsburgh market is controlled by one plan. More than 50 percent of the Philadelphia market is controlled by one plan. Each plan has maintained its dominance by virtue of an agreement not to compete in each other's territory.
One insurance company dictates health care in over half of Washington State. Since I came to Congress and closed my practice in 1994, there have been 275 mergers and acquisitions of health plans. There are now seven managed health care plans and Blues control the cost and access of the majority of people in this country.
What does that mean? That means if one is a provider, a doctor , and that HMO controls 50 or 60 percent of their patients and they present a contract and say take it or leave it, and that doctor has a child in college, they are making mortgage payments, how do they turn them down when they have a contract clause that says medical necessity means the shortest, least expensive or least intense level of care as defined by us? Or maybe they say like this Blue Cross/Blue Shield contract of Iowa, where the health plan shifts responsibility to physicians for the health plan's breaches of confidentiality that they release any liability for disclosure made by the company.
Or how about the gag clauses that companies want providers to sign on to? A lot of providers just do not have a choice. I have had a lot of Republican colleagues, when we have had our managed care debate, say just let the market work. If we get to a vote on this, vote ``yes'' because this will let the market work.
Mr. HALL of Ohio. Mr. Speaker, I yield 2 minutes to the gentlewoman from Texas (Ms. JACKSON-LEE).
(Ms. JACKSON-LEE of Texas asked and was given permission to revise and extend her remarks.)
Ms. JACKSON-LEE of Texas. Mr. Speaker, many of the physicians I know in my community need this legislation. Frankly, the physicians are put at a disadvantage with the HMOs and the conglomerates that are now taking over health care. The gentleman from California (Mr. CAMPBELL) had the right idea. But unfortunately, the legislation that we had in the Committee on the Judiciary, I would say to the gentleman from Michigan (Mr. CONYERS), with all the good work that we did, is not here today.
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