[Congressional Record Volume 144, Number 59 (Tuesday, May 12, 1998)]
[Senate]
[Pages S4640-S4642]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        HEALTH CARE LEGISLATION

  Mr. DASCHLE. Mr. President, there is no one from the Republican side 
of the aisle on the floor at this moment, so I do not want to propound 
the request until someone is available. But I do want to put our 
colleagues on notice that I would like very much to be able to propound 
a unanimous consent request within the next few minutes that would do 
two things: First, it would ask that Senator D'Amato be recognized to 
offer a bill regarding inpatient hospital care for breast cancer with a 
time limit of 2 hours for debate on the bill, with no amendments or 
motions in order thereto, and that when all time is used or yielded 
back, the Senate proceed to vote on passage of the D'Amato bill, and 
that immediately upon disposition of the D'Amato bill, the Senate then 
proceed to the immediate consideration of the Daschle-Kennedy Patient 
Protection Act with a time limit of 2 hours for debate, with no 
amendments or motions in order thereto, and that when all time is used 
or yielded back, the Senate proceed to vote on the passage of the bill 
with all time equally divided and controlled in the usual form, and 
that the above occur without intervening action or debate. I would ask 
that those bills begin to be considered at 11 o'clock.
  As I said, Mr. President, I will not ask unanimous consent at this 
time simply in deference to our colleagues. But let me again explain 
what it is we are attempting to do here. It is our hope this week, in a 
very limited timeframe, that we can pass two bills of great concern and 
importance to this country, first and foremost, a bill that many of us 
have cosponsored dealing with the need to protect patients in an array 
of different health circumstances that they face. More and more, the 
American people are saying they are victimized, not assisted, by HMOs. 
More and more, they are saying that managed care is not working as it 
is supposed to. More and more, they are saying that we are facing some 
critical decisions that we must make if we are going to ensure that 
managed care and HMOs work right.
  Day after day, our caucus has come to the Senate floor recognizing 
the importance of calling the attention of this country to victims of 
our current managed care system. These victims have lost their health, 
and in some cases, their lives as a result of very critical decisions 
being made erroneously by people sitting at computers instead of by 
doctors and nurses in the hospital rooms and clinics of this country.
  We have introduced legislation that would provide protections to 
patients. It recognizes that in this HMO, managed care environment we 
have to do a lot better job of focusing on patients,

[[Page S4641]]

and not on bottom-line calculations that are oftentimes used regardless 
of patients needs. The Patient Protection Act is absolutely essential 
to that effort. We also recognize that there is a need, as part of the 
legislation, to deal with the problem of premature release of patients 
when they have mastectomies.
  Senator D'Amato and Senator Feinstein and others have made a real 
effort to highlight that particular problem. And we are very supportive 
of that effort. So we hope we can pass both bills. Let us pass the 
Patient Protection Act. Let us pass the Feinstein-D'Amato mastectomy 
bill. Let us do it en bloc. Let us do it: 2 hours and 2 hours. We are 
prepared to do it this morning. We can get on with that and also the 
array of other very important technological bills that we will be 
bringing up. I thank very much the Senator from Montana for affording 
me the opportunity to make my presentation. As I noted, just as soon as 
we find a Republican colleague on the floor I will pose this unanimous 
consent request.
  Mr. DORGAN. Will the Senator yield?
  Mr. DASCHLE. I will be happy to.
  Mr. DORGAN. Mr. President, as I understand the minority leader, he is 
talking about the desire to bring to the floor of the Senate for a vote 
the patients' bill of rights. As the Senator knows, we have every day 
brought to the floor of the Senate a discussion about the specific 
problems that patients are encountering out in this country who have 
been hurt by managed care institutions or organizations and find that 
their health care decisions are all too frequently not made by the 
doctor in the doctor's office or in the hospital but by some insurance 
accountant someplace 500 or 1,000 miles away. And the result has been 
catastrophic for some of the patients in this country who have not been 
able to get the health care they need. As I understand it, this piece 
of legislation talks about the ability to get the health care you need 
from the doctor you choose, the ability to get to an emergency room 
when you need one, and a full range of similar concerns that affect 
patients.

  Is it the request of the minority leader that we have an opportunity 
to vote on that legislation this morning? And if not this morning, at 
least at a time certain at some point this year? As I understand it, 
there are some who don't ever want us to have an opportunity to deal 
with this issue, because the insurance industry and some others, who 
certainly don't want anybody tampering with the circumstances at all, 
prefer we not vote on this. But the American people understand we have 
a serious problem here that needs to be addressed. Is it the intention 
of the Senator to get a vote on this today or at some specific point in 
the future?
  Mr. DASCHLE. It is our desire to see if we can find a way to take up 
this legislation and pass it today. And if not today, at a time 
certain. If we cannot do it for some reason at 11 o'clock this morning, 
we are prepared to set a time--perhaps June 15--perhaps right after we 
get back from the Memorial Day recess. If we are doing the tobacco bill 
next week, and we have technology bills this week, 4 hours today seems 
to me to be a reasonable period of time to debate both of these bills 
and pass them. If we cannot do it today, I think it is incumbent upon 
the Senate to pass this legislation at a time certain--to agree to a 
debate at a time certain. I am sure that will happen.
  Mr. KENNEDY. Will the Senator yield?
  Mr. DASCHLE. I yield to the Senator from Massachusetts.
  Mr. KENNEDY. Is it the position of the Senator that this really is 
the most important health issue that is before the families of America 
today? Is it understood that we have been unable to consider this 
legislation in the Labor and Human Resources Committee, and so this is 
the only way and only means by which we can have the kind of debate 
that families across this country want? Is it the opinion of the 
Senator from South Dakota that this really is a compelling issue, 
perhaps the most important health care issue that families in South 
Dakota and across this Nation care most deeply about--to make sure that 
doctors and not insurance agents are going to be making decisions on 
health care?
  Mr. DASCHLE. Mr. President, I tell the Senator from Massachusetts 
that, just last week, a family from South Dakota told me that if there 
is one thing the U.S. Senate should do this year--this year--it is pass 
the Patient Protection Act. It is to deal with the problems they are 
having with managed care. And it is to deal with the recognition that 
there is a growing problem out there. In poll after poll after poll, 
the American people are saying: We don't care what else you do, do this 
and do it this year.
  So I think it is very clear that the intensity level is as high as it 
can be. People care about this issue, and they recognize the problem. 
People know how difficult it is today to face managed care 
organizations that, in large measure, are not addressing these problems 
as they should. So the Senator from Massachusetts raises the right 
question. Do the American people want us to address this issue? The 
answer is not only yes, but yes with an exclamation point.
  Mr. DURBIN. Will the Democratic leader yield?
  Mr. DASCHLE. I yield to the Senator from Illinois.
  Mr. DURBIN. Mr. President, I thank the Senator for raising this 
issue. I hope that we put it in context. This is an important procedure 
that Senators Feinstein and D'Amato bring to the floor. It addresses 
the issue of mastectomy. It makes certain that women and families have 
peace of mind when they face that procedure. I don't think there is 
going to be any opposition to that bill, and there should not be.
  The Senator from South Dakota makes a point--and I think we should 
make the point--that in this debate there are many other potential 
injustices, and injustices in the health care system. One should 
consider the fact that most Americans say, first and foremost, they 
want to choose their own doctors, and many women say, ``I want to be 
able to make certain during the course of my pregnancy that I have a 
doctor, an obstetrician who I can be confident in, and one who will 
give me advice every time I come in for a visit.'' There are families 
who worry that when their children are brought into a doctor's office, 
they will be referred to the right specialist, the one best for that 
child. They don't want that decision being made by an insurance 
company. They want it being made by a doctor.

  The irony here is that we are saying doctors should make that 
decision. These doctors who have been chosen by the insurance companies 
to be part of their plans should be trusted, and their judgment should 
be trusted. What the Senator from South Dakota is saying is, let's move 
forward on the Feinstein bill, on this important mastectomy protection; 
but let's extend this protection to so many other Americans and 
families and women in other circumstances who are being disadvantaged 
by insurance companies and HMOs that are unresponsive to families and 
their needs.
  I think the Senator from South Dakota puts a challenge to the Senate 
today. Will we do one small, but important, part? Or will we take a 
look at the whole picture and make certain that we can return home 
after this session with the kind of legislation that the American 
people will support? I hope the Republicans will join us. This ought to 
be bipartisan. What is the controversy here when we say patients and 
their families should come first, and protecting the patients when it 
comes to important medical decisions?
  I thank the Senator from South Dakota. I hope we can get the 
assurance from the Republican leadership today that we will not only 
consider the Feinstein-D'Amato bill, but also the patient protection 
that Senators Daschle and Kennedy will offer.
  Mr. DASCHLE. Mr. President, I thank the Senator from Illinois for his 
very good statement. He raises an interesting point that I failed to 
mention. Oftentimes, we talk about this as a matter simply of urgency 
and concern for victims. Indeed, that is the greatest concern--the 
degree to which victims come to us with stories that they believe call 
out for attention to this matter. But there are now over a hundred 
organizations--organizations of all kinds--our doctors, our nurses, an 
array of working organizations in this country, including education, 
you name it--organizations that have come

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forward to say that this isn't just a health issue, this is a worker 
issue, this is a quality of life issue. This is an array of 
organizations that rarely come together on any issue. Philosophically, 
they go from left to right. But the fact is, they care about this issue 
because they know how critical it is that we solve it this year.
  So, as the Senator said, this should not take very long. Indeed, it 
is important that we get on with moving this legislation.
  Ms. MIKULSKI. Will the Senator yield?
  Mr. DASCHLE. I yield to the Senator from Maryland.
  Ms. MIKULSKI. Mr. President, I ask the Senator from South Dakota, our 
Democratic leader, a question. In all of his research on the bill, has 
he not found that this is a very compelling issue for women and for 
children, that there has essentially been a ``moat'' around access to 
medical treatment and, therefore, leaving it to the Senate or 
legislative bodies to make corrections, one procedure at a time, like 
drive-by deliveries, dumping of mastectomy patients? Would it not be 
better to take down the ``moat'' around medical treatment and do this 
in a comprehensive way, especially a way that it affects the women and 
children? Has the Senator found that?
  Mr. DASCHLE. The Senator from Maryland is absolutely right. She said 
it very succinctly. That is, in essence, what this legislation will do. 
This isn't the broad array of health care reforms that we could be 
addressing. This very narrowly focuses on one of the biggest problems 
we have in health care delivery today. I appreciate very much her 
calling attention to that fact.

  Ms. MIKULSKI. I thank the Democratic leader.

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