[Congressional Record Volume 144, Number 24 (Tuesday, March 10, 1998)]
[Senate]
[Pages S1687-S1688]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                          AGENDA FOR CONGRESS

  Mr. DORGAN. Mr. President, I wanted to take just a minute to discuss 
an item that has shown up in a number of newspapers and columns in the 
last week or two. I will read a couple of headlines. ``Congress and the 
Clock.'' ``They Seem at Times to be Running on an Empty Tank.'' ``A Do-
Nothing Congress Could Turn Into a Do-Little Congress.'' ``AWOL 
Congress.''
  The point that is made by some editorial writers and some others is 
that there is not much of an agenda. Well, we have the highway bill on 
the floor of the Senate now. This is very important. I want very much 
to get this done and get it done promptly. This is last year's business 
being done this year. Let's get it done and provide some certainty with 
respect to our plans and our desires to invest in our country's 
infrastructure, highways and roads.
  When we complete this piece of legislation, it is not the case that 
there is not an agenda here for the Congress to consider. Many of us 
have developed an agenda that is very aggressive. We have an agenda to 
save Social Security first. We would like very much for the Senate to 
vote on that proposition, a sense-of-the-Senate resolution that says it 
is our intention to save Social Security first. The question here is, 
if there is, in fact, a brighter picture ahead with respect to Federal 
deficits, what is to be done. Some want to spend it, some want to 
provide tax breaks. The President says let us save Social Security 
first. I hope very much we can have a vote here in the Senate that says 
we agree, let us save Social Security first. That is the first and the 
best priority for this Congress.
  Second, we want to consider legislation to protect health care 
consumers. There are 160 million people now enrolled in managed health 
care plans in this country. Yes, some managed care plans can and do 
save money. They can, in fact, improve care. But medical decisions 
ought to be made by health care practitioners, not insurance company 
accountants. Many in this country are very concerned about their 
treatment by their managed care plan.
  The President has proposed a patient's bill of rights to provide some 
basic protections for patients. You have the right to know all of your 
medical options, not just the cheapest. You have the right to choose 
the doctor you want for the care you need. And you have the right to 
emergency room care you need whenever and wherever you need it. You 
also have the right to keep your medical records confidential.
  We believe very strongly that one of the first items of business in 
this session of Congress should be to address the question of managed 
care.
  Here is an essay written by Dr. Ronald Glasser titled, ``The Doctor 
Is Not In,'' and subtitled ``On the managed failure of managed health 
care.''
  Let me read a couple of paragraphs of this article by Dr. Glasser, a 
Minneapolis pediatrician and the author of several books. He writes in 
this essay:

       We are born, we live, and then we die, but these days we do 
     so with less and less help from a medical profession paid to 
     discount our suffering and ignore our pain. Proofs of the 
     bitter joke implicit in the phrase ``managed care'' show up 
     in every morning's newspaper, in casual conversations with 
     relatives or friends recently returned from a hospital or 
     from what was once thought of as a doctor's office instead of 
     an insurance company's waiting room, and in a country 
     generously supplied with competent and compassionate doctors, 
     160.3 million of us now find ourselves held captive to 
     corporate health-care systems that earn $952 billion a year 
     but can't afford the luxury of a conscience or a heart.

  Dr. Glasser, in his essay, talks about the denial of certain health 
care. He says,

       Such forced denial of care occurs at a time when 
     new medical and surgical technologies allow physicians to 
     treat and often cure any number of conditions that only a 
     few years ago could barely be diagnosed; organs now can be 
     digitally reconstructed in three dimensions to locate 
     previously inoperable tumors; heart attacks can be stopped 
     with injections of a compound known as tPA; blind people 
     may wake up and see with implanted plastic lenses, one-
     and-a-half-pound premature babies, once given up for lost, 
     routinely are nursed to health; a new generation of 
     medical research brings us genetically engineered tests 
     and one nearly miraculous drug after the next. At the same 
     moment, presumably well-insured women diagnosed with 
     disseminated breast cancer must hire lawyers to have their 
     health plans pay for life-saving bone-marrow transplants 
     and managed-care companies can deny powered wheelchairs to 
     handicapped children who pass a ``utilization review'' 
     showing them able to stagger twenty-five feet with the 
     help of a walker.

  This is a long and fascinating essay about managed care. My 
colleagues have heard the stories that have persuaded many of us that 
this Congress at least ought to address the question of what patients' 
rights are in managed care.
  A 27-year-old man from central California received a heart transplant 
and was discharged from the hospital after 4 days because his HMO would 
not pay for additional hospitalization. Nor would the HMO pay for the 
bandages needed to cover the man's infected surgical wounds. The 
patient died.
  An otherwise healthy 2-year-old boy who had suffered a fall was taken 
to a local hospital with a stick lodged between his upper lip and his 
gums. Once there, health care providers repeatedly misdiagnosed the 
boy's condition and refused to authorize an $800 CT scan that would 
have confirmed the boy was developing a brain abscess. The result? The 
boy was left blind and brain damaged.
  A 54-year-old man who just had prostate surgery was told by his HMO 
he must leave the hospital within 24 hours of his surgery because the 
HMO wouldn't pay. He had to go home where there was no one to care for 
him even though he was still bleeding, had to wear a catheter to drain 
his bladder, and couldn't walk.
  The stories go on and on. Most of us have heard the stories in our 
hometowns, our States. One managed care organization recently stated it 
would not pay for more than 5 hours of epidural pain relief for labor 
pains. Doctors objected, saying that some labor pains go on for more 
than 20 hours. One wonders whether the insurance company employee who 
said we will limit the coverage for epidural relief to 5 hours has ever 
been in a hospital experiencing the pain of childbirth. My guess is no.
  We now have a circumstance where, all too often, the operation of the 
emergency room is a matter of profit or loss. There was an article 
about a woman in the New York Times recently. She was in an ambulance 
with her brain swelling from an injury just received, and she told the 
ambulance driver, ``Do not take me to the closest hospital.'' And she 
named the hospital farther away where she wanted to be taken that did 
not have a reputation for making cost its bottom line. She said later 
that she didn't want to be

[[Page S1688]]

taken to the other emergency room and have somebody make a decision 
about her life that related to their bottom line, to their profit and 
loss. A lot of Americans share her concern.
  So we have an agenda. We have an agenda on managed care that says 
there ought to be a patient's bill of rights. People ought to know what 
their medical options are. No accountant 500 miles away from a hospital 
room or a doctor's office ought to be giving guidance on whether a 
doctor's judgment is appropriate with respect to treatment. And yet 
that is what is happening in this country.
  We have an agenda on managed care. We think it ought to be one of the 
first items of business here on the Senate floor when we finish the 
highway bill. Let's talk about managed care. Let's talk about the 
health care. Let's talk about the 160 million people who are in managed 
care plans and ask the question, what does this plan mean to my health 
care? to my family's health care? to my children's and my parents' 
health care? What does it mean to our pocketbook? What kind of coverage 
exists for us today, tomorrow and next month? This Congress needs to be 
debating and answering some of those questions. These are life-or-death 
issues, not matters of inconvenience.

  So when someone says the Senate doesn't have an agenda, they aren't 
talking about us. We have an agenda, but regrettably, we didn't win the 
Senate. The majority party that controls the Senate won the election. 
We understand that when votes are counted, whatever party wins wins, 
and they control the House and the Senate. But I want everybody to 
understand, when they see an editorial titled ``Congress Gone AWOL,'' 
``Congress and the Clock,'' ``70 days left,'' or ``A do little 
Congress,'' that for some of us there is an agenda.
  Many of us have very strong feelings about what issues the Senate 
should be considering--managed care, education, tobacco legislation, a 
whole series of issues that we want brought to the floor of this 
Congress and debated. The fact is we have some who, without question, 
want to have the engine running but have the transmission in idle. They 
don't want to go anywhere. They just want to claim the car started. We 
would like to put this car in drive and drive towards an objective that 
we think represents the best interests of this country.
  On education, we understand that State and local governments should 
make the main decisions in elementary and secondary education. But many 
of us also believe that we have a national interest in trying to reach 
goals and achievements as a country in elementary and secondary 
education. The President and those of us on this side of the aisle are 
very concerned about trying to find some way to address the issue of 
class size. Are there things we can do with respect to class size and 
modernizing schools? For example, we understand that reducing class 
sizes can have a substantial impact on the teaching of children. 
Smaller class size means more attention is paid to each of the 
children, and we understand that is important.
  The issue of modernizing schools--many of our schools all across this 
country are 30, 40, and 50 years old and in disrepair. I have been in 
schools, unfortunately, like the Ojibwa School on the Turtle Mountain 
Indian Reservation. These are schools children shouldn't be in. Reports 
from the General Accounting Office about the schools say they are 
unsafe. I have seen light fixtures dangling from the ceilings and 
frigid winter air coming through the trailers that masquerade as 
schoolrooms. We can do something as a Congress to modernize schools and 
remedy their state of disrepair. We want to talk additionally about the 
issue of minimum wage, about those at the bottom of the economic 
ladder. We made a couple of adjustments in the minimum wage on a 
bipartisan basis, but we need to further consider how to restore its 
purchasing power, not to a level above where it used to be, but to a 
level comparable to where it historically has been.
  It is interesting in this country that we have a market system that 
is very generous to some and not to others. That is the way the market 
system works, and I accept that. In the market system we have in this 
country we have a right to make choices. I certainly don't want to 
discontinue those choices. But by our choices we've created a system 
where a man who is 7 feet 2 inches tall and can dunk a basketball gets 
$120 million. Where does that come from? It comes from folks who watch 
television or go to a basketball game, if they can afford to do so. But 
that's $120 million for somebody who can dunk a basketball and $30,000 
for an elementary schoolteacher.
  Which one would you pick? We make choices in the public and private 
sectors. Actually, when I refer to the private sector, there are not 
exactly unimpeded economic circumstances in professional basketball, 
where somebody makes $120 million, because it is not exactly an open 
and free market system. There are different circumstances in 
professional basketball because they limit the number of teams and so 
on.
  My point is that the question of what we invest in both publicly and 
privately in this country determines a lot about what kind of a country 
we are going to have in the future. Our agenda, which we think would 
improve this country, deals with health care and education and jobs and 
income opportunity--a whole range of issues that we think represent 
good and strong positions for this Congress to consider. So the reason 
I came to the floor this afternoon is to say that the next time I see 
one of these editorials that says ``do nothing, do little, march in 
place, you know, the car is in idle,'' we have plenty to do. If we 
finish the highway bill this week--and I hope we will and I will 
support all the efforts to get this done quickly--then I hope next week 
we can grab a hold of a significant part of this agenda that we feel is 
important. If we do this, I think the next editorial will say, gee, 
they tackled education and health care and a lot of things that are 
very important to the people in this country.
  I yield back the balance of the time I haven't used.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. D'AMATO. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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