[Congressional Record Volume 144, Number 56 (Thursday, May 7, 1998)]
[Senate]
[Page S4467]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              MANAGED CARE

  Mr. DORGAN. Mr. President, one of the issues that we think is very 
important and needs to be addressed by this Congress is the issue of 
managed care. A number of us have, every day the Senate has been in 
session recently, brought to the floor stories of what is happening in 
health care in this country and examples why a Patients' Bill of 
Rights, which we would like to see the Congress enact, would be 
beneficial to the American people.
  Today I want to tell you about a man named Frank Wurzbacher of 
Alexandria, Kentucky. Fred received monthly injections of a drug called 
leupron as treatment for his prostate cancer. Under his retiree health 
plan, that treatment, which cost $500 per injection, was fully covered.
  When a different insurance company took over as the plan 
administrator, however, the new company notified Mr. Wurzbacher that 
his coverage for this treatment was reduced from 100 percent to only 
two-thirds of the total cost. In other words, rather than paying the 
full $500 for the shot, the company would pay only $320.
  At the time, Mr. Wurzbacher was a 66-year old retiree. He didn't have 
the extra $180 a month for the leupron injections, so he asked his 
physician what his alternatives were. The physician said the 
aggressiveness of the cancer suggested that the only other alternative 
was the removal of the patient's testicles. The surgery was approved. 
Mr. Wurzbacher had that surgery and then returned home from the 
hospital to find a letter from the insurance company notifying him that 
it had made a mistake and that his plan would, in fact, pay the full 
$500 for the monthly leupron injection. But by then, of course, it was 
too late; the surgery had been done.

  That should not have happened to Mr. Wurzbacher and would not happen 
if the Patients' Bill of Rights were law. Under the Patients' Bill of 
Rights, there would have been an appeal of the new plan administrator's 
decision and that appeal, perhaps, would have then disclosed that the 
coverage for leupron was in fact fully available. Mr. Wurzbacher would 
not have had to go through his operation. Of course, no one can turn 
back the clock, and Mr. Wurzbacher is just one more victim of decision-
making by those who all too often see medical care as a function of 
dollars and cents and the bottom line, rather than as a function of 
saving someone's life.
  The Patients' Bill of Rights simply says that those 160 million 
Americans who are now herded into managed care organizations for their 
health care have certain rights. One of those rights ought to be the 
right to be told all of your medical options for the treatment of your 
disease, not just the cheapest option.
  You also ought to have a right to appeal an adverse decision that is 
made about your health care by your managed care plan. Such an appeal 
may very well have prevented the kind of tragedy that was visited on 
Frank Wurzbacher of Alexandria, KY.
  Mr. President, we hope very much that Republicans and Democrats 
together this year will agree that the issue of managed care and the 
issue of a Patients' Bill of Rights should be brought to the floor of 
the Senate and addressed not only in the Senate, but also by 
legislation enacted by Congress this year. We will continue to discuss 
on the floor of the Senate the stories of the problems people face, one 
by one across this country, with managed care when managed care 
organizations view health care as a function of someone's profit and 
loss statement.
  Let me conclude by describing, as I have on previous occasions, an 
interesting front-page story in the New York Times about a woman who 
had suffered a severe brain injury and was being transported by 
ambulance to a hospital. She had the presence of mind, as her brain was 
swelling from this injury, to tell the ambulance driver she wanted to 
be transported to the hospital farthest away. She said this because she 
knew that the closer hospital, which was affiliated with her health 
care plan, had a reputation for treating emergency room care as a 
function of the bottom line. She wanted to go to an emergency room in 
which someone looked at her and did what needed to be done in every 
circumstance, against all odds, to save her life. She was fearful 
enough of going to a hospital where she would be viewed as a function 
of someone else's bottom line that she wanted to be transported to the 
hospital farther away.
  That relates to this issue. Should health care that relates to a 
specific patient's condition be practiced in a doctor's office or a 
hospital, or should decisions about a patient's health care be made in 
an insurance office 2,400 miles away by some accountant? The American 
people understand what the answer to that question should be. The 
answer is embodied in a proposal called the Patients' Bill of Rights. 
That proposal has been introduced here in the Senate, and I hope very 
soon that we can bring a proposal of this type to the floor of the 
Senate and discuss these central questions about health care in this 
country.
  Mr. President, I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. KERREY. 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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