2003 Columns

We Must Act Now

One Year Later

Fighting the Terrorists

Tax Day

Caring for Veterans

A Leader at Justice

War Report

Safer Borders

Horror Without Precedent

The New School Year

Saving Our River

A Down Payment on Freedom

'Motor Voter' Out of Control

Care vs. Cost

Protecting Wild Horses

Wanted: Smarter Students

Missouri - America's Heart

Saving Small Business

The Big Tax Squeeze

Missouri Has a Drug Problem

Rover The Voter

Our Country's Fresh Start

Care vs. Cost

The Senate has begun to debate the crucial issue of patients' rights. For better or worse, our health care system today increasingly uses managed care to organize and deliver services.

Over the next week or two, we will debate how to better protect patients while restoring the proper balance between patient care and costs within a system dominated by managed care insurance companies.

All the evidence I have seen indicates that patients need extra protection. Too many patients have been treated poorly by health care insurance companies. The reasons include bad customer service, bad incentives that lead to a conflict between care and the bottom-line, and simple carelessness and neglect.

This is why I have voted in the past for comprehensive managed care reform bills. And it is why I intend to vote at the end of this debate for a good patient protection bill.

But legislating the right solution is a hard thing to do. This debate is about maximizing care while minimizing costs. Good care is expensive, but costs must also be kept low to permit as many people as possible to buy health insurance.

We know our health care system is already strained. Employers are struggling to provide health care coverage to their workers. 43 million Americans lack health insurance coverage. Doing nothing is not an option.

If we do not act, costs will quickly increase anyway. High health care costs means even more Americans will be unable to afford coverage.

Some proposed "solutions" will actually do more harm than good.

For example, if the McCain-Kennedy bill passes, the cost of buying health care would rise to a point where 1.26 million Americans would no longer be able to afford health insurance.

That means that as many as 25,000 Missourians would be forced out of the current health care coverage.

That is one Missourian losing his or her health insurance every hour, 24 hours a day for over three years.

That number is equivalent to three-quarters the population of our state capitol Jefferson City.

Throughout the debate I will be guided by one core principle: doing what is right for the greatest number of Americans, while keeping a close eye on the interests of Missourians.

Here is what I support:
1. Guaranteed access to emergency room care. Americans shouldn't have to worry that their insurance company won't pay for necessary emergency care, or even for care that reasonably seems like an emergency.
2. A guarantee that patients get all information on treatment options. Doctors and patients need to be able to discuss openly all possible treatment options without "gag rules."
3. A right to a quick, independent, and expert appeal process. There must be an appeal to a medical expert outside of an HMO to guarantee that the HMO isn't focusing too much on the bottom line. And the appeal must be quick so patients get care when they need it.
4. Strong managed protections for our children like the ones I included in my Healthy Kids 2000 legislation two years ago. These include:

• Right for a child to go see a pediatrician without being forced to see a non-pediatrician gatekeeper. Pediatricians aren't specialists children need to be referred to, they should be a child's first-line of care.
• Right for a child to see a specialist with pediatric expertise, including going to children's hospitals when necessary. Children are different than adults, and doctors that primarily treat adults are not always prepared to interpret and attend the unique needs of children.
• Right to have a pediatric expert review a child's case when appealing an HMO decision.

The most basic rule in health care is "first, do no harm." I intend to ensure that patients get the care they need, while not harming the coverage provided by our health care system.