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Association of American Physicians and Surgeons, Inc.
A Voice for Private Physicians Since 1943
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Congress is back in session, and election-year posturing has begun. Both parties want to appear to be advocates of patients' "rights."

The conference committee will try to reconcile differences between the Senate and House versions, the latter including the Norwood-Dingell and the Talent bills. "Organized medicine" is pushing for Norwood-Dingell.

Everyone recognizes that medical insurance has become unaffordable for many Americans. The main reasons: mandates, regulations, litigation, and the federal tax code. Every time Congress tries to "fix" the problem, it imposes more mandates and regulation. Not surprisingly, premiums go up; ditto the number of uninsured.

Clearly, many Americans are unhappy with the coverage that their employers have purchased for them. But what choice do they have? Anything else has to be bought with after-tax dollars (thus, workers have to produce nearly twice as much to earn enough to pay a comparable premium). Moreover, most group policies are based on employment, so most self-owned policies must be individual policies, which are much more costly.

With Norwood-Dingell, many employers are likely to drop coverage altogether. Is that what Congress intends? Better to have an alternative before smashing the marketplace that now exists.

Even worse, Norwood-Dingell would have a much heavier impact on fee-for-service plans than on the managed care that it is supposed to reform. It might force FFS plans to become managed- care plans in order to comply.

The answer is not to regulate managed care more heavily, but to deregulate the alternatives and eliminate tax discrimination.

Only one part of the deceptively titled "Patients' Rights" legislation deserves to survive: portions that expand and deregulate medical savings accounts.


  • Post this alert in your office and your hospital, and distribute it to colleagues, along with a sample comment letter on your letterhead.
  • Post the sample patient letter in your office and provide patients with writing materials and stamps. Also post a sign- up sheet so patients wishing information on futures issues can provide a FAX number or e-mail address.
  • Post your letters and suggestions on our forum, aaps.forums.commentary.net.
  • Write to your own congressional delegation (see ) and to conferees (FAX numbers posted at www.aapsonline.org under Patient Protection and Rights or by FAX from AAPS). Conferees are: Senators Gregg, Hutchinson, Nickles, Enzi, Gramm, Frist, Jeffords, Harkin, Kennedy, Dodd, Mikulski, and Rockefeller; Representatives Goss, Burton, Scarborough, Boehner, Talent, Fletcher, McCrery, Archer, Thomas, N. Johnson, Bliley, Bilirakis, and Shadegg.
  • Send us a copy of your congressman's reply.


The Hon. ________
U.S. House of Representatives
Washington, DC 20515


The Hon. ________
U.S. Senate
Washington, D.C. 20510

Dear Representative or Senator ______:

This is to express my concerns about "Patient Protection" legislation, S. 1344 and H.R. 2990, which is now in conference committee.

I am a (occupation, nature of business, number of employees if applicable). I (receive, provide) health insurance (through my employer, to my employees) (can't afford insurance). I am very concerned about the cost and availability of a wide variety of insurance plans, and in preserving the patient's freedom of choice of insurance plan, including a low-cost, high-deductible indemnity plan.

Every time Congress passes a bill to "protect" us, the cost of insurance goes up, and the number of choices goes down. I am concerned that if Norwood-Dingell passes, we will see an avalanche of lawsuits and lawyers will make more money. All of us will pay for that. However, an increased ability to sue will not assure good medical care. And forcing insurers to fill out more paperwork and satisfy more federal requirements simply adds useless costs.

I am especially concerned that Norwood-Dingell, in applying the one-size-fits-all rules to all plans, will force fee-for- service plans (which simply reimburse subscribers for care instead of providing for or arranging care) to become managed-care plans so that they can control "providers" and comply with the regulations. Managed care abuses will only get worse if people don't have any alternatives.

Congress should get rid of tax favoritism toward employer- owned health insurance. People should be able to own their insurance and a medical savings account plan without tax penalty. Direct payment for most medical expenses decreases costs, both through competition and reduction of overhead, and keeps the patient in charge. Most of this natural advantage is lost if patients have to use after-tax dollars to purchase such plans.

Bad HMOs and managed care plans survive only because government protects them against competition from better plans. Regulation doesn't help; instead, it makes things worse. Bigger and more ruthless companies can cope with or circumvent the rules while smaller, patient-friendly competitors are forced out of business.

Maybe politicians think they can win votes by making a show of punishing big bad corporations. They are not going to win mine by increasing costs and decreasing choices. I hope you will work to defeat bad legislation and to pass a bill that expands medical savings accounts and removes the shackles that are crippling them.

Sincerely yours, ____