[Congressional Record Volume 144, Number 52 (Friday, May 1, 1998)]
[Senate]
[Pages S4136-S4137]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                       HEALTH CARE BILL OF RIGHTS

  Mr. DORGAN. Mr. President, following the business of the Senate 
today, there was an hour of morning business and a number of Members of 
the Senate came to the floor to comment on the hearings that were held 
yesterday and, I think today, before the Senate Finance Committee. 
These are hearings about the Internal Revenue Service. I am going to 
talk about that in a bit because the hearings are dealing with, at 
least from what I have read, some abuses in the Internal Revenue 
Service. Some of the instances that have been disclosed in these 
hearings represent abusive behavior on the part of some employees of 
the Internal Revenue Service. I will comment on that in a moment, but 
first I want to talk about some other abuses first that relate to 
another agenda that many of us want brought to the floor of this 
Chamber to be debated as soon as is possible. I am referring to abuses 
in the area of health care, particularly with regard to managed care 
organizations in our country.
  We know that some in this Chamber and in the Congress do not want to 
address the issue of managed care because the largest insurance 
companies in the country do not want it addressed. It would be 
difficult and inconvenient for some insurance plans if the Congress 
addressed these issues, so there is some stalling going on. However, we 
intend to, every day that we are in session and have the opportunity, 
come to the floor of the Senate and talk about some specific instances 
of abuse that the American people have suffered at the hands of their 
health care plans. In many respects, we have a wonderful system of 
health care in this country--new medicines and procedures, breathtaking 
medical advances--but this is only true for the people who have the 
quality care available to them.
  Let me talk about one American named Buddy Kuhl from Missouri who is 
dead now. Buddy had a heart attack on his 25th wedding anniversary. He 
was told by his doctor that he required specialized heart surgery, but 
because the hospital in his hometown did not have the necessary 
equipment for that surgery, the doctor arranged for the

[[Page S4137]]

surgery to be performed in St. Louis. When the hospital requested 
precertification for the surgery, the utilization review coordinator--
that is quite a title, utilization review coordinator--at Mr. Kuhl's 
HMO refused because the St. Louis hospital was outside the HMO's 
service area. So the surgery was canceled. The HMO, instead, sent Mr. 
Kuhl to another doctor to determine whether the surgery could be 
performed locally. The second doctor agreed with the first one that the 
surgery had to be performed in St. Louis.
  So 2 weeks later, finally the HMO and the accountant who makes these 
judgments decided they would pay for the surgery in St. Louis, but by 
that time, the surgery could not be scheduled for another 60 days. By 
the time the doctors in St. Louis examined Mr. Kuhl, his heart had 
deteriorated so much that surgery was no longer a possibility. Instead, 
they concluded he needed a heart transplant. Although the HMO refused 
to pay for the evaluation for a heart transplant, Mr. Kuhl managed to 
be placed on the transplant waiting list in St. Louis. Tragically, he 
died waiting for that heart transplant. Mr. Kuhl was only 45 years old, 
and he left behind a wife and two children. And the Kuhl family 
attorney said this: ``He did what his HMO told him. Unfortunately, he's 
dead because he did.''

  Mr. President, Mr. Kuhl's case is not an isolated one. There is case 
after case all across this country. Do you think this family has any 
recourse against their managed care organization? No, because that 
organization cannot be sued. They can make a decision that will lead to 
a patient's death but a law called ERISA, an acronym unfamiliar to the 
widow of Mr. Kuhl, prevents certain types of health plans from being 
sued.
  Some of us in this Chamber believe that health care ought to be a 
function of doctors providing the health care, rather than some 
insurance company executive prescribing what is necessary for the 
medical care of a patient 500 miles away. Yet that is the way health 
care has evolved. Ask any doctor and you will discover the truth of 
that statement.
  Some of us believe there ought to be a patients' bill of rights that 
would provide some very basic protections to consumers in their 
dealings with their health plan. For instance, every patient in this 
country should have the right to know all of their medical options, not 
just the cheapest, all of the medical options to treat their disease or 
their problem, not just the least expensive. And patients and their 
families ought to have the right to address the wrongs that are done 
them when a managed care organization's bad decision leads to long-term 
disability or death.
  When you hear the stories of the abuses in managed care, and, yes, 
they are abuses, it is perfectly understandable, I suppose, why many 
organizations resist every step of the way any effort to bring to the 
floor of this Senate a patients' bill of rights. But if we are talking 
about abuses in this Congress and it is perfectly appropriate to talk 
about the abuses in the IRS, let us also talk about abuses we can stop 
in the area of managed care. Just as we ought to stop the shameful 
abuses that are occurring at the IRS, let us also make sure that 
Americans who walk through a doctor's office door or through a hospital 
entrance understand that their care is not going to be a function of a 
profit and loss statement but rather a function of a health care 
provider responding in a caring way to their health care problem.
  Regrettably, that is not happening in this country today. We can 
remedy this if we understand exactly what is happening. We will come 
every day to the floor of the Senate to talk about the abuses in 
managed care until those who schedule the business of the Senate decide 
that this is an important enough issue for the American people that it 
ought to be high on the agenda of the issues to be considered here in 
the Congress.
  Let me finish by telling a story I read about not too long ago about 
a woman who had just been the victim of an accident and had suffered a 
brain injury. As her brain was swelling and she was laying in the back 
of the ambulance, she informed the driver of the ambulance that she 
wanted to go to a hospital that was farther away. After she recovered, 
she was asked why she told the ambulance driver she wanted to go to the 
hospital that was farther away even though it was the closer hospital 
that was affiliated with her health care plan. And she explained that 
she knew by having read and heard about what had happened with her 
neighbors and others, that the hospital would evaluate her care in the 
context of profit and loss, and she wanted everything that was humanly 
possible to be done by doctors and nurses to save her life. That is the 
concern of people about managed care. I am not suggesting that all 
managed care in this country has disserved the needs of the patients in 
this country. That is not the case. In some cases it has reduced the 
cost of health care and still provides decent service.

  But you know and I know that all across this country there are 
examples of managed care organizations that are forcing doctors to sign 
contracts that say to a doctor, ``Don't let one of your patients show 
up at an emergency room. If you do, if one of your patients comes into 
an emergency room, guess what, we are taking it out of your pocket.'' 
You talk about a disincentive. That represents a conflict of interest, 
yet that is what is going on in these managed care organizations, 
because it is becoming for them not so much a delivery of health care, 
it is a function of profit and loss.
  We ought to begin to separate that discussion just a bit by passing a 
patients' bill of rights. To those who say they don't want to bring 
that to the floor, I say you are going to be annoyed then, because 
every day we will come to the floor to talk about this, and one day, 
one way, sooner or later, we are going to debate this on the floor with 
a piece of legislation we call the Patients' Bill of Rights. You may 
not think that now, but before the end of the year it will be here and 
you will vote on it.

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