Statement by Representative Greg Ganske

March 6, 1998

Thank you, Mr. Chairman. I look forward to serving on this Commission. We know the problem -- many future recipients and limited resources. But in dealing with this dilemma, we need more than green eye shades -- we need to examine some fundamental questions: What is Medicare's ethical vision? What ethical vision do we - both as a Commission and as a society -- have of Medicare reform?

I think there are several parts of that vision.

First, we should acknowledge the individual's fundamental dignity. This means that each senior citizen has a right to receive certain services necessary to promote health, to receive treatment for illness and trauma, to carry on with life when confronted with chronic disease, and to be comforted when dying.

The basic dignity and sacredness of each person requires that society enable individuals to pursue their own purposes in life. As the saying goes, "without your health, you have nothing."

A second element of any ethical vision must also include a commitment to the community. This vision must be shaped by the realistic understanding of the resources available for health care. After all, community health depends not just on medical services, but also on education, housing, creating jobs, cleaning up the environment, reducing violent crime.

A third ethical concern we should consider is whether physicians, hospitals, or other providers will have to take on the role of agents of the state in rationing care.

The doctor-patient relationship rests on a series of ethical standards. Providers are expected to be professional, to adhere to standards, to undergo peer review. But most of all, they are expected to serve as advocates for their patient's needs -- not to be government or insurance apologists. It is in the interest of our citizens that their doctor fight for them and not be the "company doc."

Part of our ethical challenge is to maintain the integrity of that doctor-patient relationship -- while at the same time trying to live within the constraints of limited resources. This will not be easy.

And, Mr. Chairman, I would add that the responsibility for financial solvency is not just ours. All physicians must ask: "What would happen if every doctor acted for every patient as I am about to act?" Patients and families must ask themselves: "what would happen if everyone demanded the ultimate in service and resources that I am asking for?"

Mr. Chairman, as we consider the economic projections, the reform proposals, and the legislative language, we need to be aware of our ethical obligations. Let us set aside self-interest and seek solutions that improve individual and community health.

We will be making serious decisions. I suggest we pray for guidance as these decisions will surely have serious consequences for our nation.