[Congressional Record Volume 144, Number 73 (Tuesday, June 9, 1998)]
[House]
[Pages H4301-H4310]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                          MANAGED CARE REFORM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 7, 1997, the gentleman from New Jersey (Mr. Pallone) is 
recognized for 60 minutes as the designee of the minority leader.
  Mr. PALLONE. Mr. Speaker, tonight I want to talk about the issue of 
managed care reform. This issue has without question become one of the 
most important issues on the minds of Americans today. Accordingly, it 
has also become one of the most pressing issues before Congress. In the 
last few weeks, there have been front page articles in the New York 
Times and in the Washington Post on the fever pitch the debate has 
assumed on Capitol Hill. This debate, as I will discuss tonight, has 
assumed a clear and identifiable framework. The debate is now one 
between supporters of managed care reform and the Republican leadership 
and insurance industry who are fighting tooth and nail to undermine the 
various managed care reform proposals that have been introduced. The 
issue has reached the dimensions it has because patients are being 
abused within managed care organizations. Patients today lack basic 
elementary protections from abuse and these abuses are occurring 
because insurance companies and not doctors are dictating which 
patients can get what services under what circumstances.
  Within managed care organizations, or HMOs, the judgement of doctors 
is increasingly taking a back seat to the judgment of insurance 
companies. Medical necessity is being shunted aside by the desire of 
bureaucrats to make an extra buck and people are literally dying 
because they are not getting the

[[Page H4302]]

medical attention they need and ironically enough are, in theory, 
paying for their premiums.
  Mr. Speaker, this is not an exaggeration. I decided tonight to bring 
a few examples. Actually there are a number of examples of some pretty 
horrific examples that have been put together from news clips from 
various newspapers nationwide to just give some examples of some of the 
awful stories that have come forward about abuse by managed care 
organizations. I just wanted to give a few tonight. I have in front of 
me about 140 of them and I am certainly not going to go through all of 
them but I would like to give just a few.
  This one is actually from the New York Post, September 20, 1995. It 
describes a 4-year-old girl who ran a high fever following a 5-hour 
hospital stay for a tonsillectomy, which is considered an outpatient 
operation by HMOs. Her mother took the girl to her HMO pediatrician who 
did not take the girl's temperature, did not examine her throat and did 
not refer the girl back to the surgeon, a routine procedure for 
postoperative problems. Unfortunately the girl died of a hemorrhage at 
the surgical site.
  I have another example. This is from the Long Island Newsday, 
February 11, 1996. A mother in Atlanta called her HMO at 3:30 a.m. to 
report that her 6-month-old boy had a fever of 104 and was panting and 
limp. The hot line nurse told the woman to take her child to the HMO's 
network hospital 42 miles away, bypassing several closer hospitals. By 
the time the baby reached the hospital, he was in cardiac arrest and 
had already suffered severe damage to his limbs from an acute and often 
fatal disease and both his hands and legs had to be amputated. A court 
subsequently found the HMO at fault.
  I do not like to give these examples because they really are 
horrific, but there are so many of them. I am just going to give 
another couple because I think that it is important for all of us to 
understand some of the problems that people face out there on a daily 
basis. This one is from the Enterprise Record from January 21, 1996. It 
describes a 27-year-old man from central California who was given a 
heart transplant and was discharged from the hospital after only 4 days 
because his HMO would not pay for additional hospitalization, nor would 
the HMO pay for the bandages needed to treat the man's infected 
surgical wounds. Well, the patient died.
  A lot of these examples do not necessarily involve people who have 
died but who have had severe problems and severe handicaps, lifelong 
handicaps that have resulted from their experience with HMOs. I have 
said because of the importance of this issue there are a number of 
legislative proposals that have been introduced to give patients the 
protections that they deserve. Working with our Democratic Caucus 
Health Care Task Force, which I cochair, the gentleman from Michigan 
(Mr. Dingell) introduced legislation which would provide patients with 
a comprehensive set of protections for managed care abuses. This is the 
Patients' Bill of Rights, as it is called, that so many Democrats have 
now cosponsored, and also some Republicans.
  I should say that the Patients' Bill of Rights is not an attempt to 
destroy managed care. It is an attempt to make it better. Some have 
suggested that in reforming managed care and putting forth a bill like 
the Patients' Bill of Rights that somehow we or those of us who support 
this legislation do not like managed care. That is simply not true. We 
are simply trying to make managed care better because of the problems 
that we have faced with managed care and HMOs in the last few years.

                              {time}  2100

  Mr. Speaker, I cannot emphasize that point enough. Supporters of 
managed care reform want just that, reform, not a dismantling of 
managed care. The Patients' Bill of Rights would help bring about that 
reform by putting medical decisions back where they belong, with 
doctors and their patients, and we have, as I said, seven Republican 
cosponsors for our bill, so it really has become a bipartisan bill.
  Unfortunately the Patients' Bill of Rights does not enjoy the support 
of the Republican leadership, and that is really the rub here. In fact, 
if we are to believe what we read in the paper, it is not just the 
Patients' Bill of Rights that the Republican leadership opposes, they 
appear to oppose the larger notion of managed care reform. They are 
simply not willing to cross the insurance industry in order to give 
patients better protections and doctors greater power over medical 
choices.
  The week before Congress broke for Memorial Day, the chairman of the 
Republicans' health care task force, the gentleman from Illinois (Mr. 
Hastert) announced that he would have a outline of a proposal before 
the recess, the day before the Congress adjourned for the Memorial Day 
recess, and Speaker Gingrich quashed the managed care reform proposal 
that was put forward by his own Republican task force, the Hastert task 
force, and I have to say I think this move even surprised some of the 
Republicans who favored some kind of managed care reform. But following 
the Speaker's rebuke the Washington Post reported that, and I quote, 
``Gingrich's foot soldiers realize that they did not know exactly what 
he wanted. They weren't quite sure, said Representative Harris Fawell. 
The Speaker did not like what he saw and sent his fellow Republicans,'' 
to use their words, ``back to the dugout.''
  So now we know it is clear that the Speaker has rejected the 
Republican proposal, the Republican Task Force on Managed Care Reform 
proposal, because it had too many patient protections on it, and I have 
to repeat that. His own task force, speaking here of his own task 
force, presented him with a proposal that included patient protection 
similar to the Democrats' Patient Bill of Rights, and he rejected the 
proposal because of their inclusion.
  Last week we had the gentleman from California (Mr. Thomas), the 
chairman of the Committee on Ways and Means' Subcommittee on Health and 
a member of this Republican health care task force, call some of the 
ideas for patient protection being pushed by his fellow Republicans 
asinine. What the Speaker and Mr. Thomas are after here is what I call 
a cosmetic fix. They understand that the public is clamoring for 
managed care reform, that the public wants something like the 
Democratic Patient Bill of Rights, but what they are probably going to 
do is come up with something that sounds like a patient bill of rights 
or a patient protection bill without any real patient protections. And 
that is why I think it is so important for us to keep coming to the 
floor on a regular basis explaining why patient protections are needed, 
why we need this managed care reform, and demanding that this House 
take up this issue and pass it in time before we adjourn and before 
this Congress runs out of time.
  I have a lot more that I could say on this issue, but I do not know, 
and I see that my colleague is here from the Committee on Commerce, the 
gentleman from Pennsylvania (Mr. Klink), and I know that he has been 
out there on a regular basis talking to his constituents, having forums 
on this issue of managed care reform, and as I have. We have gotten a 
tremendous response from our constituents, who really are demanding 
that we take up this issue. I yield to the gentleman.
  Mr. KLINK. Mr. Speaker, I thank my friend from New Jersey for 
sticking with this message.
  The point that I would make is that it does not matter who comes into 
our office either here in Washington, D.C., or our offices back in our 
districts. No matter what the issue is that they want to talk to us 
about, whether it is child care or whether it is farm subsidies or 
whether it has something to do with an industry, the conversation 
always gets back to health care and dissatisfaction that people have 
today across the board in this country that they themselves no longer 
have the ability to make the choices as it pertains to health care. 
People today are not empowered to have a conversation with their doctor 
and make medical decisions. It is someone with an insurance company who 
too often is making those decisions for them.
  And I was very interested yesterday in seeing on the ABC Evening News 
an interesting look at HMOs. They said forget about the fact that you 
now have bureaucracies within insurance companies making medical 
decisions as to whether you can go to a doctor, which doctor you can go 
to, whether you can go to a hospital, whether you

[[Page H4303]]

can go to a physical therapist, if you can to go a hospital, how long 
you can go to the hospital. Forget about all that.
  The one thing they promised us they were going to do with HMOs is 
control costs. Guess what? They have not even controlled costs. Their 
costs are going through the roof. People cannot afford it. They are not 
even doing the one thing that they have promised us they were going to 
do.
  My friend from New Jersey is right. The one fear that everyone has is 
that those of us who want to hand control back over to patients again, 
back over to the citizens of this country, hand control to them and 
their doctors to make these decisions, the one thing that everybody is 
saying against us is, well, it is going to cost more money.
  The fact of the matter is it is already costing us more than we can 
afford to pay, and we are still losing lives. And I have said it on 
this floor before, and I will say it again. If you are prolife, you 
cannot agree with a medical delivery system that causes people to lose 
their lives because we do not let them go to a hospital when they need 
to, and the gentleman is right. He has a hundred plus stories; I have 
got as many from my district.
  People are dying, and we are not saying it to be dramatic. It is a 
point of fact. When I go back to my district, we hold these fact-
findings. Someone walks in and says, ``My mother died. They wanted to 
keep her at the Cleveland Clinic, the doctor wanted to keep her, she 
wanted to stay, we wanted her to stay, but the insurance company 
wouldn't let her stay. She was released prematurely, and now she is 
dead.''
  So people are dying. There is case after case where that happens.
  So if you are prolife, you cannot be for that. If you are prochoice, 
you have to want to give people the choice of the doctor that they are 
comfortable with, the choice of the medical treatment they are 
comfortable with. Call it healing. It is what is between our ears is 
that mind. It is feeling safe and secure in who is treating us. And now 
we have that gatekeeper, that primary care physician who we may not 
know, we may not have any knowledge of, and there is increased evidence 
that those primary care physicians too often, not always, but too often 
are put in those positions with the feeling in the back of their 
own mind, and maybe it is not so subtle the way it is put to them, if 
you give too many recommendations out of the network, you will not be 
in that position very much longer.

  And we have got time after time where people are being denied 
insurance because of preexisting conditions; time after time when 
doctors are being told you cannot be in the system, and they are not 
told why they cannot be in the system, just their insurance company 
said, we already have enough doctors. I would ask is that not restraint 
of trade if a doctor is not able to see their patients anymore?
  What about the providers of other services? What about the visiting 
nurses who are not included in that system anymore? What about the 
people who make the prosthetics, the artificial limbs, the artificial 
legs, and you are told you cannot go to that prosthesis manufacturer 
anymore, you have to go to somebody 2 hours away, an hour and a half 
away, 3 hours away that you never heard of before. Why? We do not 
understand why.
  What about the formularies that these HMOs have created where you 
cannot get the medicine that is the latest, the best medicine? You have 
to take the cheapest drug in that classification of drugs. Why are we 
working in this House of Representatives as Republicans and Democrats 
together to get the latest pharmaceutical products safely on the market 
again if our constituents do not have access to those drugs?
  These are all questions that we have to answer, and what our 
Patients' Bill of Rights is saying is put that control back in the 
hands of the patients again. Empower the people of this country to 
participate in the decisions of their medical care. Do not leave it in 
the hands of those insurance companies alone.
  When the Clinton health care plan was being chastised, when it was 
being ripped apart, when insurance companies were spending tens of 
millions upon tens of millions of dollars to talk about the fact that, 
oh, you do not want the Federal Government to control your health care, 
well, Mr. Speaker, now you do not have the Federal Government in 
control, you have the insurance companies in control, completely in 
control. How does it feel? How does it feel now that we have completely 
lost control?
  My dear friend from New York, I think, was looking for a moment of 
time, and if the gentleman would continue to yield, we might be able to 
accommodate her.


                          Days of Remembrance

  Mrs. MALONEY of New York. Well, I really join the gentlemen with 
their concern on the Patient Bill of Rights, and I am a strong 
supporter of it, but I really rise with these few seconds today to 
remember the more than 6 million men, women and children who perished 
during the Holocaust.
  On Thursday, April 23, we remembered the victims of the Holocaust at 
the United States Holocaust Memorial Museum's 1998 Days of Remembrance. 
This year's theme, Children of the Holocaust, their memories, a legacy, 
paid tribute to the more than 1.5 million children who lost their 
childhoods, their friends and their families throughout one of the 
darkest periods in our history.
  It is particularly fitting that this year's theme centers on children 
because of the U.S. Holocaust Memorial Museum's exhibit, the Story of 
Daniel. The museum has collected the stories of numerous children 
through their diaries and poetry written throughout World War II and 
compiled them into one story of a young boy, Daniel. This exhibit was 
designed to teach our children what the children in World War II 
experienced. It tells and retells the stories of those children so we 
may never forget their stories of the Holocaust.
  On behalf of the Days of Remembrance Committee of the United States 
Holocaust Memorial Museum, I would like to submit into the Record the 
speeches delivered in the memory of more than 1.5 million children that 
lost their lives in the Holocaust.
  Mr. Speaker, I enter into the Congressional Record the following 
speeches:

         Children of the Holocaust: Their Memories, Our Legacy

   Remarks of Benjamin Meed, Chairman Days of Remembrance Committee, 
                United States Holocaust Memorial Council

       Members of the diplomatic corps, distinguished members of 
     the United States Senate and House of Representatives, 
     members of the United States Holocaust Memorial Council, 
     distinguished guests, fellow survivors and dear friends, 
     welcome to the 19th national Days of Remembrance 
     commemoration.
       First, let me take this opportunity to express our 
     gratitude to the members of the United States Congress for 
     their strong support of the Holocaust Memorial Museum. The 
     enormous success of the Museum and its educational and 
     Remembrance programs is due, in large part, to your efforts 
     on our behalf. Thank you.
       We gather together again to remember those whom we loved 
     and lost in the pit of hell--the Holocaust. We dedicate this 
     commemoration to all the precious children of the Holocaust, 
     their memories, our legacy. More than a million and a half 
     children--almost all of them Jewish--were struck down without 
     pity. They were murdered simply for who they were, Jews.
       The young ones, who were silenced forever, were the hope 
     and future of our people. We will never know the extent of 
     human potential that was destroyed--the scientists, the 
     writers, the musicians--gifted talent burned to ashes by 
     German Nazi hate.
       At such tender ages, our children grew old overnight. They 
     quickly learned how to conceal pain and how to cover up fear. 
     More importantly, with natural compassion, they comforted 
     those around them. The writer and educator Itazek Katznelson 
     was so touched by an abandoned little girl caring for her 
     baby brother in the Warsaw Ghetto that he composed a poem 
     about her. And I quote:

     Thus it was at the end of the winter of 1942
     in such a poor house of shelter for children,
     I saw the ones just gathered from the streets.
     In this station, I saw a girl about five years old.
     She fed her younger brother--and he cried.
     The little one was sick.
     In a diluted bit of jam, she dipped tiny crusts of bread
     and skillfully inserted them into his mouth.
     This my eyes were privileged to see--
     to see this mother of five years, feeding her child
     and to hear her soothing words.

       How can we survivors forget these martyred children? Their 
     lives, their laughter, their gentle love, their strength and 
     bravery in the face of certain death are still part of our 
     daily lives. Their acts of courage and resistance remain a 
     heroic inspiration. Their

[[Page H4304]]

     cries to be remembered ring across the decades. And we hear 
     them. They are always in our thoughts, in our sleepless 
     nights, in our pained hearts.
       Like all survivors, there are many horrible events that I 
     witnessed, but one particular event deeply troubles me and 
     hounds me. It was in April, fifty-five year ago, almost to 
     this day. Passing as an ``Aryan'' member of the Polish 
     community, I was Krasinski Square near the walls of the 
     Warsaw Ghetto. Inside the Ghetto, the uprising was underway. 
     Guns and grenades thundered; the ghetto was ablaze. From 
     where I was standing, I could feel the heat from the fires. 
     There were screams for help from the Jews inside the walls. 
     But the people surrounding me outside the walls went about 
     their daily lives, insensitive to the tragedy-in-progress. I 
     watched in disbelief as, across the Square, a merry-go-round 
     spun around and around to the joy of my Polish neighbor's 
     children, while within the Ghetto only a few yards away, our 
     Jewish children were being burned to death. To this day, that 
     scene still enrages me. How can one forget the agony of the 
     victims? How can we explain such moral apathy of the 
     bystanders?
       Many of us were children in the Holocaust. Whether by luck 
     or by accident, we survived. Liberation by the Allied Armies 
     restored us to life, and our gratitude to the soldiers will 
     always remain. The flags that stand behind me from the 
     liberating divisions of the United States Army and from the 
     Jewish Brigade are far more than cloth. In 1945 and today, 
     they are the symbols of freedom and hope for us survivors. 
     Today we are bringing history together.
       Liberation offered new opportunities and we seized them. 
     The transition was very brief. We helped to create a new 
     nation--the State of Israel, which celebrates its 50th 
     anniversary this year. Our history might have been very 
     different if only Israel had existed 60 years ago. 
     Nevertheless, we are here, and Israel is our response and 
     Remembrance of the Holocaust. Mr. Ambassador Ben Elissar, 
     please convey to the people of Israel our commitment and 
     solidarity with them.
       Many survivors became part of this great country that 
     adopted us, and we are grateful Americans. Although we are 
     now in the winter of our lives, we look toward the future, 
     because we believe in sharing our experiences--by bearing 
     witness and educating others--there is hope of protecting new 
     generations of men, women and children--who might be 
     abandoned and forgotten, persecuted and murdered. We remember 
     not for ourselves, but for others, and those yet unborn. 
     Knowing that the impossible is possible, there is the chance 
     that history can be repeated--unless we are mindful.
       The task of preserving Holocaust memory will soon pass to 
     our children and grandchildren; to high school and middle 
     teachers; to custodians of Holocaust centers; and, most 
     importantly to the United States Holocaust Memorial Museum. 
     But monuments of stone and well-written textbooks are not 
     enough. Personal dedication to Remembrance--to telling and 
     retelling the stories of the Holocaust with their lessons for 
     humanity--must become a mission for all humankind, for all 
     generations to come.
       In these great halls of Congress, we see many symbols of 
     the ideals that America represents--liberty, equality and 
     justice. It was the collective rejection of such principles 
     by some nations that made the Holocaust possible. Today, let 
     us--young and old alike--promise to keep an ever watchful eye 
     for those who would deny and defy these precious principles 
     of human conduct. Let us remember. Thank you.
                                  ____


                    Ambassador Ben-Elissar's Address

       In the late 20s and early 30s of this century no one really 
     paid attention to Hitler. In spite of his growing influence 
     over the masses in Germany, no one really cared to take a 
     good look at his ideas and plans described in detail in Mein 
     Kampf. When the general boycott of the Jews was declared in 
     Germany on April 1, 1933, and subsequently, all Jewish 
     physicians, lawyers, and professionals were prohibited to 
     practice their professions, no one thought it was more than a 
     temporary measure taken by an interim government. No one 
     really reacted when, in 1935, the infamous laws on race and 
     blood were adopted in Nurenberg.
       No country in the world declared itself ready, at the Evian 
     Conference on Refugees, in July 1938, to take in a 
     significant number of Jewish refugees from Germany and the 
     recently annexed Austria. The Kristalnacht, in November 1938, 
     opened the eyes of some, but then, when gates to a safe haven 
     were rapidly closing, when for the first time in history Jews 
     were denied even the ``right'' to become refugees, the world 
     remained silent. The only country to recall its ambassador 
     from Berlin was this country--The United States of America.
       There is a lesson to be learned--Whenever a potential enemy 
     wants to kill you--Believe him. Do not disregard his 
     warnings. If he says he wants to take away what belongs to 
     you--Believe him. If he claims he will destroy you--Believe 
     him. Do not dismiss him and his threats by saying he cannot 
     be serious--He can!
       In 1945, the world was at last liberated from the yoke of 
     the most evil of empires ever to exist in the annals of human 
     history. But for us it was too late. We were not liberated. 
     By then we already had been liquidated.
       In 1948, we actually arose from the ashes. Destruction was 
     at last ending. Redemption was at hand. After two thousand 
     years of exile, wandering and struggle the State of Israel 
     was reborn.
       We look back with indescribable pain on the terrible 
     tragedy that has left its mark on us forever. Had the State 
     of Israel existed during the 30s, Jews would not have had to 
     become refugees. They could have simply gone home to their 
     ancestral land. They would have not been massacred. They 
     would have had the means to defend themselves.
       Yesterday, the general staff of the Israeli army convened 
     in Jerusalem at the Yad Vashem Holocaust memorial. Tough 
     soldiers vowed that the Jewish people will never be submitted 
     to genocide again.
       Today, while we are celebrating the 50th anniversary of the 
     State of Israel and commemorating the Holocaust, in the 
     presence of United States senators and representatives, 
     survivors, members of my Embassy and commanders in the Israel 
     Defense Forces, may I state, that for us, statehood and 
     security are not merely words, for us, they are life itself--
     and we are determined to defend them.
                                  ____


                         Miles Lerman's Remarks

       Distinguished ambassadors, honorable Members of Congress, 
     ladies and gentlemen.
       As the Honorable Ambassador, Eliahu Ben Elissar pointed out 
     to you, the State of Israel is celebrating its 50th 
     anniversary of independence.
       The United States Holocaust Memorial Council was pleased to 
     mark this occasion by including the flag of the Jewish 
     brigade in the presentation of the flags of the American 
     liberating units.
       On behalf of the United States Holocaust Memorial Council, 
     I would like to extend our best wishes on this special 
     anniversary to the people of Israel and to the State of 
     Israel.
       It is our most fervent hope that the peace negotiations 
     between the State of Israel and the Palestinian Authority 
     will come to an understanding which will bring peace to this 
     troubled region.
       Happy anniversary and may your efforts for a permanent 
     peace agreement be crowned with full success.
       The theme of this year's national days of remembrance is 
     remembering the children and fulfilling their legacy.
       So let remembrance be our guide.
       One of the expert witnesses called to testify at the trial 
     proceedings of Adolf Eichman in Jerusalem was the world 
     renowned historian Professor Salo Baron.
       In his expert testimony, Professor Baron made the case not 
     only for the terrible losses that the Jewish people suffered 
     at the hands of the Nazis but he more specifically 
     underscored the great loss that humankind at large has 
     suffered for having been deprived of the potential talents 
     and brain power of the one and a half million children who 
     perished in the Holocaust.
       Professor Baron stressed a point that the world is much 
     poorer today because of these great losses.
       He was bemoaning the losses of the future scientists and 
     scholars who did not get to research. He was bemoaning the 
     future composers who did not get to compose; the teachers who 
     did not grow up to teach; and the doctors who never got to 
     heal.
       One and a half million murdered children is such a 
     staggering number that it is most difficult to comprehend. 
     This is why I thought that perhaps singling out and 
     remembering the tragedy of one child would symbolize the 
     great loss of all the children who were annihilated by the 
     Nazis.
       So today let us remember Deborah Katz.
       In the Holocaust archives there is a letter written in 1943 
     by a Jewish girl by the name of Deborah Katz. She was nine 
     years old when she and her family were taken out of the 
     ghetto and loaded into cattle trains destined for the death 
     camp of Treblinka.
       Her parents managed to pry open a small window of the box 
     car and threw the child out hoping that a miracle would 
     happen and she would survive.
       A Catholic nun happened to pass by and found the injured 
     child. She brought her to the convent and hid her among the 
     sisters who gradually nursed Deborah back to health.
       The child was in comparative safety and she had a good 
     chance to survive.
       One morning, however, the nuns woke up and found a letter 
     on Deborah's bed and this is what the nine year old child 
     wrote.
       It's bright daylight outside but there is darkness around 
     me. The Sun is shining but there is no warmth coming from it. 
     I miss my mommy and daddy and my little brother, Moses, who 
     always played with me. I can't stand being without them any 
     longer and I want to go where they are.
       The following morning Deborah Katz was put by the Gestapo 
     on the next trainload * * * destination * * * the gas 
     chambers of Treblinka.
       Today, I want to say to little Deborah, if you can hear me, 
     poor child, and I know that you can. I want you to know that 
     there is no more darkness, thank God. The Sun is shining 
     again and warming little children like you. And what is most 
     important, dear child, I want you to know that you did not 
     die in vain. You have touched the hearts of many decent 
     people, far, far away from the place where you lived and 
     died.

[[Page H4305]]

       There is a museum in Washington where within the last five 
     years more than 10 million visitors came to remember the 
     horrors of those dark days.
       You are not forgotten, little Deborah, and you will serve 
     as an inspiration to many children throughout the world to 
     make sure that in years to come, no child of any people, in 
     any country, should ever have to go through the agonies and 
     pains that you have suffered.
                                  ____


                   ``Blessed is the Match  *  *  *''

                 (Keynote Address by, Richard C. Levin)

       The main camp at Auschwitz was situated, not in remote 
     isolation, but in a densely populated region. To the east, 
     immediately adjacent to the camp, was a pleasant village, 
     complete with a hotel and shops, built to house SS troops and 
     their families. One mile farther east was the town of 
     Auschwitz, intended by the very men who worked the 
     construction of the camps to be a center of industrial 
     activity, a focus on German resettlement at the confluence of 
     three rivers, with easy access to the coal fields of Upper 
     Silesia. \1\
---------------------------------------------------------------------------
     \1\ Robert-Jan van Pelt, ``Auschwitz: From Architect's 
     Promise to inmate's Perdition,'' Modernism/Modernity, I:1, 
     January 1994, 80-120. See also Deborah Dwork and Robert-Jan 
     van Pelt, Auschwitz: 1270 to the Present, New York: W.W. 
     Norton, 1996.
---------------------------------------------------------------------------
       In his chilling work on the origins of Auschwitz, Robert-
     Jan van Pelt documents the Utopian vision that drove the 
     systematic planning for German colonization of the East. In 
     December 1941, Hans Stosberg, the architect and master 
     planner, sent his friends a New Year's greeting card. On the 
     front he wished them ``health, happiness, and a good outcome 
     for every new beginning.'' The card's central spread depicted 
     his drawings for a reconstruction of the central market place 
     in Auschwitz. The inspiration on the back of the greeting 
     card connected Stosberg's current project with National 
     Socialist mythology:
       ``In the year 1241 Silesian knights, acting as saviors of 
     the Reich, warded off the Mongolian assault at Wahlstatt. In 
     that same century Auschwitz was founded as a German town. 
     After six hundred years [sic] the Fuhrer Adolf Hitler is 
     turning the Bolshevik menance away from Europe. This year, 
     1941, the construction of a new German city and the 
     reconstruction of the old Silesian market have been planned 
     and initiated.''
       To Stosberg's inscription, I would add that during the same 
     year, 1941, it was decided to reduce the space allocated to 
     each prisoner at the nearby Auschwitz-Birkenau camp from 14 
     to 11 square feet.
       How, in one of the most civilized nations on earth, could 
     an architect boast about work that involved not only 
     designing the handsome town center depicted on his greeting 
     card but the meticulous planning of facilities to house the 
     slave labor to build it?
       This is but one of numberless questions that knowledge of 
     the Holocaust compels us to ask. In the details of its 
     horror, the Holocaust forces us to redefine the range of 
     human experience; it demands that we confront real, not 
     imagined, experiences that defy imagination.
       How can we begin to understand the dehumanizing loss of 
     identity suffered by the victims in the camps? How can we 
     begin to understand the insensate rationality and brutality 
     of the persecutors? How can we begin to understand the 
     silence of the bystanders? There is only one answer: by 
     remembering.
       The distinguished Yale scholar, Geoffrey Hartman, tells us, 
     ``the culture of remembrance is at high tide. * * * At 
     present, three generations are preoccupied with Holocaust 
     memory. There are the eyewitnesses; their children, the 
     second generation, who have subdued some of their ambivalence 
     and are eager to know their parents better; and the third 
     generation, grand-children who treasure the personal stories 
     of relatives now slipping away.'' \2\
---------------------------------------------------------------------------
     \2\ Geoffrey Hartman, ``Shoah and Intellectual Witness,'' 
     Partisan Review, 1998:1, 37.
---------------------------------------------------------------------------
       The tide will inevitably recede. And if there are no 
     survivors to tell the story, who will make their successors 
     remember and help them to understand?
       Holocaust Memorial Museum in Washington, along with those 
     of sister museums in other cities, are educating the public 
     about the horrors of the Shoah. Museums, university archives, 
     and private foundations are collecting and preserving the 
     materials that enable us to learn from the past, and it is 
     the special role of universities to support the scholars who 
     explore and illuminate this dark episode in human history. 
     Our universities have a dual responsibility: to preserve the 
     memory of the Holocaust and to seek a deeper understanding of 
     it.
       This is a daunting and important responsibility. To 
     confront future generations with the memory of the Holocaust 
     is to change forever their conception of humanity. To urge 
     them to understand it is to ask their commitment to prevent 
     its recurrence.
       In the words of Hannah Senesh, the 23-year-old poet and 
     patriot executed as a prisoner of the Reich in Budapest, 
     ``Blessed is the match that is consumed in kindling a 
     flame.'' May the act of remembrance consume our ignorance and 
     indifference, and light the way to justice and righteousness.

                         Remarks by Ruth Mandel

       The most vulnerable of victims, the children of the 
     Holocaust speak to us in a very special way. Some of the most 
     powerful echoes to survive that terrible time come to us from 
     their voices. Captured in diaries, in poetry, in art, and 
     later, in the reminiscences of those few who survived, their 
     memories still engage and teach us. Their struggle and their 
     spirit document their time, but serve as a poignant lesson 
     for our own. Among us in the Capitol Rotunda are many 
     reminders of them, and of the importance of securing a 
     different future for the children of today.
       In a few moments you will hear readings from diaries kept 
     by children even as the safe, predictable world they knew 
     shattered in the face of the Nazi onslaught. Their authors, 
     exhausted and hungry, terrified and lonely, and certainly 
     bewildered by their fate, were sometimes too desperate to 
     write, then, having found some small reason for hope, 
     recovered to write again, their words tell us that they were 
     also resourceful, courageous, defiant, and, even at times, 
     humorous.
       You will hear these words from young people themselves--a 
     young man who has worked intensively for two years with the 
     Museum's Fannie Mae Holocaust Education Project, and a young 
     woman, whose grandparents' rescuers were recognized by Yad 
     Vashem as righteous among the nations at the time or her Bat 
     Mitzvah last year. As they read from these diaries, another 
     young woman will assist the memorial candle lighters and 
     place a rose amid the tapers. Romani herself, she is here to 
     commemorate the tragic fate of those gypsies, who, along with 
     their children, were murdered by the Nazis and their 
     collaborators.
       And, you will hear from a Roman Catholic high school 
     teacher whose growing engagement with Holocaust history led 
     to his appointment to the museum's Mandel Teacher Fellowship 
     Program which develops a national corps of highly skilled 
     secondary teachers to serve as community leaders in Holocaust 
     education.
       Also gathered here are some of those who survived the 
     Holocaust as children and teenagers--in ghettos, in camps, in 
     hiding or by fleeing as my parents did with me. As we listen 
     to the voices of children from over 50 years ago, we who 
     survived are heartened that their voices are joined by those 
     of the students and teacher with us today who are 
     representative of the millions of students and thousands of 
     teachers served by the United States Holocaust Memorial 
     Museum in its first five years. With this joining of voices, 
     we forever link the children of the past to the children of 
     the future in a solemn pact of memory and education and 
     charge you with that most sacred task, remembrance.
                                  ____


                      The Hardest Stories to Tell

                        By Daniel C. Napolitano

       My daughter is four years old. Her name is Elena. Each 
     night when I put her to bed she asks, ``Daddy, tell me a 
     story''. So I tell her stories. I tell her stories of heroes 
     and villains; of wise and foolish animals; of good hearted 
     people and of people who know too much for their own good. 
     Sometimes she'll interrupt me and say, ``no, no, Daddy, just 
     tell me a story about what you did at work today'', and that 
     is always the hardest story to tell.
       You see, I am a teacher, and I teach a course on the 
     Holocaust. Everyday I go to work and tell the story of how a 
     society forgot about the importance of honoring the 
     individual life and dignity of every human being; about how 
     the vanities of nationalism superseded the moral wisdom of 
     the ages, and about how people became so concerned with their 
     own welfare that they failed to consider the welfare of their 
     neighbors.
       As a child I never heard the story of the Holocaust. In 
     fact for the first thirty years of my life I heard very 
     little about the Holocaust, and absolutely nothing about the 
     history of antisemitism. Then 8 years ago my life changed. I 
     was asked to teach a course on the Holocaust, and, suddenly, 
     found myself immersed in courses and books on the Holocaust. 
     I began to hear the story, Hearing and telling the story of 
     the Holocaust over the past 8 years has radically altered the 
     way I see my life as a Catholic and as a teacher. As a 
     Catholic I have come to realize that the history of 
     antisemitism and the history of The Holocaust are essential 
     to understanding ourselves as Catholics, Christians and 
     humans; and to appreciating the fullness of Judaism and its 
     rich heritage.
       Hearing and understanding the legacy of our antisemitic 
     actions and teachings gives us a more complete picture of 
     ourselves as Catholics and Christians. Through the study of 
     our ancient and modern failures, our students come to see the 
     import of their moral choices in our own times. In turn they 
     become more committed as individuals, and more committed as 
     people of faith dedicated to bearing witness to the redeeming 
     presence of God in the world.
       As a teacher I have learned the value and power of telling 
     the whole story of life's most tragic events. James Carroll 
     of ``The Boston Globe'' recently noted that ``memory is less 
     a neutral accident of the mind than a conscious 
     interpretation of history, marked as much be deletion as by 
     selection. How a community remembers its past is the single 
     most important element in determining its future.'' I believe 
     that it is in telling the whole story of the Holocaust that 
     we most honor those who lived their lives with dignity, and 
     it is in hearing the whole story that our students and 
     children will learn to live their lives with integrity.

[[Page H4306]]

       When my daughter calls out in the middle of the night and I 
     run to her room, she sometimes says, ``I had a bad dream. 
     Will you hold me?'' As I hold her I think about the mothers 
     and fathers who died in the Holocaust, and were not able to 
     hold their children in the middle of the night. I think about 
     the children who called out and waited for parents who did 
     not come.
       As I hold her I am reminded of the young girl in 
     ``Schindler's list''; the one in the red coat. As she crawls 
     under the bed, she knows that if she can just hide long 
     enough her father and her mother will come take care of her. 
     She knows that parents take care of their children; She knows 
     that adults love children, and want them to be safe. As she 
     crawls under the bed she thinks of the stories her father has 
     told her, and she waits for her daddy to come.
       Sometimes our children are four years old; sometimes 
     they're twelve or sixteen. Regardless of their years, our 
     children long to hear the stories we have to tell them. Do we 
     know enough about the story of the Holocaust and the History 
     of antisemitism to tell it to our children? Do we have the 
     courage to tell them the whole story? We are here not only to 
     remember the lives of those who perished in the Holocaust, 
     but also to reflect upon the lives our children will live. 
     The lives they lead will build upon the stories we decide to 
     tell them. At times these stories will be easy to tell. At 
     other times they will not. Let us not forget that sometimes 
     the most important stories are the ones that are the hardest 
     to tell.
       Thank you very much.

  Mr. KLINK. I thank our friend and would also wish to focus on that, 
but you know, as you were talking, I am also thinking, you know, we 
have got a very shameful situation in our own country right now. This 
is, you know, we kind of call ourselves the land of the free and home 
of the brave, we stand up for the lowest among us, and now we find 
ourselves here in the greatest democratic institution in the world, and 
we cannot get the leadership on the other side to work with us on 
solving this problem so that Americans can have access to the kind of 
health care that they deserve; in fact, the kind of health care that we 
have invested in with our tax dollars, the tax dollars on the 
appropriations bills that we vote on each year whether the Republicans 
are in charge or the Democrats are in charge.
  We are putting funding into medical research. We are pitting funding 
into NIH so that we can develop new and great methods of healing. And 
in the Pittsburgh area where I happen to come from, we were able to see 
tremendous successes back in 1950s. Jonas Salk, the University of 
Pittsburgh, Dr. Sabin and others cured polio. What a phenomenal day 
that was. And Dr. Thomas Starville and others led the world and 
pioneered in transplant surgery so that now some body parts are changed 
like automobile parts.
  It is absolutely amazing. Yet my constituents, who may live almost 
across the street or around the corner from these wonderful medical 
institutions, cannot have access to those places of healing. Our 
constituents cannot get access to those new miracle drugs that are 
finding their way into the marketplace because there is a formulary 
within the HMO that says you cannot have those drugs.
  And here we stand, and we cannot get, and we have, I will say, some 
of our friends on the Republican side have done yeoman work on this 
duty, but they, like us, are foot soldiers; they, like us, are voices 
in the wilderness if we cannot get the leadership to work with us to 
say enough is enough.
  We stand for the lowest people that cannot be here on the floor of 
the House themselves, that their children, their spouses, their 
parents, their neighbors, everyone in their community deserves to have 
access to that medical care. They deserve to make the choices, not the 
insurance company, not a manufacturing plant somewhere who comes in to 
see us to say, ``Well, we don't want the medical costs to go up.''
  I would ask them are they not concerned when their employees are on 
the phone managing an illness in their family? They cannot be 
productive when they are doing that, and people are forced to do that 
today. There are hidden costs because we are not providing people with 
adequate choices where they and their doctors can make the right choice 
to heal them, to make them and their family better.
  Mr. PALLONE. Mr. Speaker, I want to thank the gentleman so much for 
his comments because I know how strongly he feels, and there is no 
question that he is absolutely right about what is going on out there.

                              {time}  2115

  I just wanted to give two examples, if I could, following up on what 
the gentleman mentioned. I do not have the specific physician, but 
there was something on TV that I watched one night, and I do not even 
remember what channel now, but the gentleman was talking about in 
Pittsburgh how so many medical breakthroughs took place, polio and some 
of the other things a few years ago.
  In many cases, what is happening now with managed care and the way 
that it is operating is that those physicians who are on the front line 
and who are coming up with new ways and new techniques of doing things 
are almost penalized.
  We had the example with the physician, and I do not have his name in 
front of me, unfortunately, who had grown up with a deformed ear or 
deformed ears, and he had gone to medical school and made it his life's 
ambition that he was going to develop a way of cosmetic surgery to do 
cosmetic surgery to make particularly children's ears so that they 
would look normal, so to speak, again. He had developed this surgical 
method, and was doing a great job and handling these specialty cases, 
and all of a sudden found that the HMOs would not pay for it. They 
would rather send someone, a young person, to another physician who had 
perhaps not developed this breakthrough technique because it was 
costing less to do so.
  He actually ended up spending most of his time on cosmetic surgery, 
not to denigrate it, but with people who were trying to lose weight or 
take material off their thighs or whatever to make themselves look 
better, and could not devote his time to cases of children who had 
these kind of deformities.
  This is what we are seeing now. We are seeing those physicians who 
have developed new techniques, new technologies, who are the best of 
the bunch, basically not allowed to practice their profession anymore 
because of decisions that are made by these insurance companies. It is 
an awful thing.
  Mr. KLINK. If the gentleman will yield further, then it goes even 
deeper. The gentleman hit the nail so squarely on the head. It even 
gets worse than that.
  I have heard from doctors in my area who say, in their forties, ``We 
are walking away from the practice of medicine. We are going to go do 
something else. Not because we made so much money, but because we 
cannot afford, with the education that we have, to continue to work at 
this profession.
  ``Not only that, we are in this healing profession because we believe 
in it, we think it is a calling, it is an art, it is a healing art, it 
is a science. We would like to encourage other young people, the best 
and the brightest coming up through high school, to go to college, and 
those in college, go to medical school, become healers.'' They can no 
longer in good conscience recommend to the young people coming up to do 
that.
  I am saying this: We are in danger of losing a generation and a half 
of what would potentially be our finest healers in this Nation. They 
are walking away from the field of medicine, or not even getting in it.
  Mr. PALLONE. The other thing the gentleman mentioned that I wanted to 
bring up is this whole issue of cost, because we know that those who 
are against the managed care reform and the patient protections keep 
talking about costs.
  We have numerous studies that show that legislation like the 
Patients' Bill of Rights will not result in any additional costs. To be 
honest, even if it did cost an extra dollar or two a month, which is 
probably the most it would cost, I do not think the average person 
would even care. But, interestingly enough, these same health insurance 
executives that are out there talking about the costs of managed care 
reform are the ones that are benefiting so much and getting these huge 
salaries.
  It will not take too much time, but I had this document given to me 
that was put out by Families USA, called Corporate Compensation in 
America's HMOs, and it is long, but I just wanted to give you some of 
the summary here.
  It says in keeping with the industry's extenuated focus on costs, 
this report analyzes the very different facets of

[[Page H4307]]

managed care cost, namely the costs associated with compensation for 
high-level HMO executives. The report examines 1996 executive 
compensation for the 20 for-profit publicly traded companies that own 
HMOs with enrollments over 100,000.
  These were the key findings. The 25 highest paid executives in the 20 
companies studied made $153.8 million in annual compensation, excluding 
unexercised stock options. In 1996, the average compensation for these 
25 executives was over $6.2 million per executive. The median 
compensation for the 25 was over $4.8 million.
  Of the 25, the one with the largest unexercised stock option package 
in 1996 had stock options valued at $337.4 million. The average value 
of unexercised stock options for these 25 executives was $13.5 million.
  The last thing it says, in conclusion, which I thought was 
interesting, it says that publicly traded for-profit managed care 
insurance companies are considerably more cost conscious when they 
oppose the establishment of consumer rights than when they approve 
compensation for their top executives. For a publicly traded managed 
care company, remuneration in annual compensation and unexercised stock 
options for top executives routinely reaches millions of dollars; 
indeed, for many, reaches tens of millions of dollars. The managed care 
insurance industry's protestations about costs appear to be highly 
selective. While they argue they will need to raise premiums to be able 
to provide basic protections for consumers, their top executives make 
millions of dollars each year.
  I am not trying to begrudge anybody making $1 million. The economy is 
good, so be it. But in the case of the managed care organizations, the 
bottom line is more and more of the premiums are going to pay for 
profits and for top executives' salaries, and the squeeze is coming in 
terms of the quality of care provided. So they have no business 
complaining about costs, which I do not think are really going to go up 
anyway. But it is interesting, I think, the selectivity and the way 
they go about it.
  I yield to the gentlewoman from Texas.
  Ms. JACKSON-LEE of Texas. I thank the gentleman for yielding, and I 
thank the gentleman from Pennsylvania for his passion, but also his 
insight, into this extremely crucial issue. I appreciate his 
leadership.
  As well, I do believe that we are, in essence, doing important work, 
for I think we must cease and desist the trend of moving away from 
health care and basically providing Americans with tolerance care.
  In our community, sometimes we have a phrase that is used not so much 
as it will sound tonight. Sometimes mothers will say it about their 
children, or a child that has gone astray, or sometimes someone will 
say it about an incident that has occurred. But I am going to say it 
tonight. Managed care for Americans will be the death of us. Sometimes 
someone says this incident or this child's behavior, or 
something happens, it is going to be the death of me.

  I think managed care as it is now presently structured in America is, 
frankly, going to be the death of us. Although that declaration may 
sound a little bit far stretched, let me share with you that it is 
actually not.
  It is comforting, yet it is distressing, to find so many physicians 
in my community raising their voices about managed care. No matter what 
community they serve in, each one says repeatedly, I cannot treat my 
patients.
  We are in a country where we were used to the friendly doctor that 
came to our homes. He may not have or she may not have had all of the 
most extensive technology and science at their fingertips, but we knew 
when we called Dr. Jones or Dr. Smith, Dr. Jackson, Dr. Pallone, any 
manner of doctor, that they would come and give us the very best that 
they could. If we needed admitting to a hospital, we would get that.
  I do not know if those doctors of early years filled their pockets 
with dollars. Some of the accusations that are made, doctors are the 
most wealthiest or wealthy population; every doctor is not. I know good 
doctors who are in county hospitals in rural communities, and they are 
not raking in the dollars. They truly took the oath because they 
believed in being nurturers and healing people and helping people to 
fulfill the good health promise of their life. Managed care now stands 
not as the gatekeeper, but the actual block to good health care in 
America.
  I think I read a report that my good friend from Pennsylvania might 
have mentioned, or the gentleman was also commenting on. We have in 
this country good science. We have in this country good medical 
technology. In fact, every day someone is discovering some new medical 
technique in order to make us better. But I was listening to a late 
night television program where a physician was saying the reason why 
our health care system is not competitive as it relates to other 
countries around the world is because we have the technology and the 
medical research, but it does not translate to care for Americans.
  Why? Because there is a block. And the block now has gotten stronger 
and uglier with HMOs. Constantly physicians are having to ask the 
bureaucrats lodged somewhere, where no one knows where they are, 
whether or not she can stay an extra day in the hospital, whether or 
not this mother with a C-section can stay 72 hours to 4 days or 5 days 
because of complications. There is no longer the decision to be made by 
that patient and physician relationship.
  I had a member of the Federal staff say to me that they had to leave 
and fly down to Florida where their father was discharged from a 
hospital. He was under managed care. That person was calling long 
distance here in Washington trying to make arrangements for the care 
for their parent. The only thing they could get was we are sending him 
home out of the hospital in a taxi. We are giving him a walker and 
sending him home to his trailer.
  That person had to fly down to Florida simply to ensure that that 
father had the kind of day-to-day care that was necessary, because the 
HMO sent him out of the hospital, threw him out, literally, if you 
will, did not provide him with any home care, did not provide him with 
the kind of physical necessities that he needed for someone who was 
suffering from a broken hip. Simply a walker, a taxi ride, and dropped 
off.
  What about the elderly person who was in need of staying the extra 
days in the hospital? Yet because of their attitudes about not being in 
hospitals when the physician came, the elderly person said ``Oh, I do 
not need any more care.'' What was written down hastily? ``Refused 
service.'' Out of that refusal of service came a dastardly ailment that 
could have been detected if someone said, I am not governed by the HMO, 
I think this person needs more testing.
  So we have to find a way to fix this broken system. We are one of, or 
at least considered, the richest country in the world, the United 
States of America, one where physicians have the best training. And I 
agree with my good friend from Pennsylvania, we may be discouraging a 
generation of nurturers, because they cannot practice their trade and 
their talent.
  I believe that we have to fix the managed care system. It is long 
overdue. We must put the physician and patient relationship, as Humpty 
Dumpty, back together again. Otherwise, we are going down, down, down, 
and managed care will in fact be the death of us.
  I think the legislation that we are looking at at this point, I would 
say to my good colleagues that managed care and good health and good 
managed care, if you will, is a bipartisan issue. Helping out 
physicians is a bipartisan issue. Dealing with senior citizens who 
cannot help themselves, children who cannot help themselves, people 
needing transplants who cannot help themselves, needs good bipartisan 
leadership.
  So I would thank the gentleman for this special order and for his 
leadership, and ask my colleagues in the House to join unanimously, if 
you will, to raise their voices to get the managed care legislation 
that would fix a broken system, so that we could save more lives, and 
not be known as a country that has a system that is the death of those 
of us who are attempting to make a better quality of life.
  Mr. PALLONE. I want to thank the gentlewoman again. I know that she 
has spoken out on this issue many

[[Page H4308]]

times and how important it is to her, and I appreciate her joining us 
again this evening.
  The gentlewoman mentioned the bipartisan nature of this. We have an 
example here on the other side of the aisle, the gentleman from Iowa 
(Mr. Ganske), who is a physician, who has been outspoken on this issue 
of the need for patient protections. I would like to yield to him at 
this time.

                              {time}  2130

  Mr. GANSKE. Mr. Speaker, I appreciate joining my colleagues from 
Texas and from New Jersey on this important issue. As the gentlewoman 
mentioned, this should be a bipartisan effort. This is not something 
for Republicans or Democrats. It cuts across every segment of our 
society. Everyone needs health care.
  What we are dealing with right now is that about 5 percent of the 
people who receive their insurance from their employer are now in 
managed care organizations. Very frequently, they are not given a 
choice. They are simply told by their employer, here it is. This is our 
plan. It is the cheapest we could find on the market. Take it or leave 
it.
  So when I hear from my colleagues about, well, just let the market 
work out the problems in this, I just have to say, you know, the market 
is not working. There is a disconnect between who buys the insurance 
and who uses the insurance.
  When you are only offered one choice from your employer, then it 
turns out that your only choice for health insurance may be that you 
have to quit your job and find a different one.
  I am reminded of the fact that there is a very popular movie going 
around the country now. It is As Good As It Gets. In this movie, we had 
a waitress, Helen Hunt, who had a boy with asthma. She was in an HMO. 
She was not getting the proper care, having to take her child to the 
HMO all the time. Her appeals for specialist care were denied.
  So in the movie, Jack Nicholson, who is an elderly gentleman who is 
squiring this waitress, very kindly gets her an appointment with a 
private physician to find out what is wrong with her son with asthma.
  The physician says, well, what were the results of his skin tests? 
Standard procedure to find out what may or may not be causing asthma. 
Helen Hunt's face is blank. She says, well, it was not authorized. The 
doctor kind of looks at her, and then it is like a light bulb goes on. 
She gives a string of expletives about her HMO.
  All across the country, this happened in Des Moines when I saw the 
movie, people cheer and clap. It is the most amazing phenomenon. I have 
never seen it in another movie.
  Why would that be? Why would you get that type of universal response 
to mismanagement by managed care? It is because the public is realizing 
that there are some serious problems that need to be fixed in managed 
care. As an example of that, humor, which needs a universal medium, is 
being applied to HMOs.
  Here is a cartoon that was in a newspaper. Here we have a medical 
reviewer for an HMO. The medical reviewer is on the telephone taking a 
call from somebody phoning in with a problem from the HMO.
  The medical reviewer says, Kuddlycare HMO. My name is Bambi. How may 
I help you?
  You are at the emergency room, and your husband needs approval for 
treatment?
  Gasping, writhing, eyes rolled back in his head? Gee, does not sound 
all that serious to me.
  Clutching his throat, turning purple, uh-huh. Have you tried an 
inhaler?
  He is dead. Well, then, he certainly does not need care, does he?
  Then she finishes up after she has hung up by saying: Gee, people are 
always trying to rip us off.
  Does that seem overly harsh to you? Let me give you a real-life 
example. This is a woman who is 28 years old who was hiking in the 
Shenandoah Mountains. She fell off of a 40-foot cliff. She fractured 
her skull, was comatose, broke her arm, broke her pelvis. This is a 
picture of her just before she is airlifted to a hospital. She is taken 
to the hospital where she is in the intensive care unit, comatose, for 
weeks.
  When she finally gets better, she is presented with a $12,000 bill by 
her HMO. They refused to pay for her care. Can you guess why? Because 
she did not phone for prior authorization. I mean, can you believe 
that? What was she supposed to do? Wake up from her coma when she is 
lying at the bottom of that cliff, reach into her pocket with her 
nonbroken arm, pull out a cellular phone, and make a phone call to an 
HMO a thousand miles away, say, oh, by the way, I just fell off a 40-
foot cliff? I broke my skull, my arm, and my pelvis, will you authorize 
me to go to the hospital?
  Then the HMO would not pay later on because they said that she did 
not give them timely notice when she got to the hospital. She was in 
the ICU on a morphine drip for weeks.
  This is the type of problem that affects real people. These are not 
just anecdotes. The reason that this issue resonates with so many 
people is because almost everyone has had either a family member or a 
friend who has had an outrageous denial of treatment or delay in 
treatment or other problem related to their HMO.
  Here is an anecdote. This is a woman who is no longer alive today 
because her HMO denied her the care that she needed. Talk to her two 
children and her husband about how she is just an ``anecdote.''
  I mean, I am reminded of a scene from Shakespeare where a character 
says, ``Do these anecdotes not bleed if you prick their finger?''
  This is a real problem that we are facing in this country, and I am 
very glad to be able to join my colleagues on this. There are two bills 
before Congress right now. One is called the Patient Bill of Rights, 
and the other is called the Patient Access to Responsible Care Act. 
Both of them are very similar in many regards, and they are both 
bipartisan bills. Yet, we have a situation where, as my colleagues have 
outlined earlier tonight, we cannot get these bills to the floor, even 
though one of them has more than enough votes just from the sponsorship 
to pass.
  Let me tell you about a bill that I have had for 3 years; 3 years I 
have had a bill in this House that has nearly 300 cosponsors, 
bipartisan bill, dealing with an aspect of managed care that would ban 
gag clauses.
  Do you know what gag clauses are? These are contractual arrangements 
that HMOs have on provider contracts that say, before you can tell a 
patient what their treatment options are, you first have to get an okay 
from the company.
  Think about that. Let us say that a woman has a lump in her breast. 
She goes in to see her doctor. He has got a gag clause in his contract. 
We know that these clauses exist all across the country, because we had 
congressional testimony before our committee on this.
  So the doctor does her history and physical exam. She has got three 
options, one of which might be more expensive than another, but he has 
got a gag clause in his HMO contract. What does he have to do? He has 
to say, excuse me, leave the room, get on the phone and find out if it 
is okay with the HMO if he tells that lady all of her treatments.
  That is an infringement upon first amendment rights. It is also a 
terrible infringement on doctor/patient relationships. Patients need to 
trust their physicians that their physicians are going to tell them the 
whole story, not just what their HMO wants them to tell the patient. 
Doctors should be patients' advocates. They should not be the company 
doctor.

  Both of these bills have protections for patients in them that even 
some of the nonprofit HMOs have said are very good pieces of 
legislation and have called for Federal legislation.
  I would just like to enter into this discussion with my colleagues 
because I think we need to explain to our colleagues here why we need 
Federal legislation. Why can we not just leave this to the State 
insurance commissioners or the State legislatures? I wonder if my 
colleague from New Jersey would like to address that issue.
  Mr. PALLONE. Absolutely.
  Mr. Speaker, if I can comment on that, and one other thing that the 
gentleman said so eloquently, the reason is because when we talk about 
insurance plans that are basically for the self-employed, if you will, 
we have the ERISA preemption.
  Essentially what that means is that if the State, like my home State 
of

[[Page H4309]]

New Jersey, passes a patient protection act, if they will, which they 
did, I should say, is now law, it does not apply to the majority of 
people who have health insurance in the State because of the Federal 
preemption, so to speak.
  So if we do not pass a Federal bill like the two that you have 
mentioned, then the majority of people in New Jersey are not actually 
impacted by the State Patient Protection Act. So that is why we need 
Federal legislation.
  Mr. GANSKE. Mr. Speaker, I know my colleague from Texas is an 
attorney, and I wonder, is this not a result of prior Federal law that 
we have this exemption, this exclusion?
  Ms. JACKSON-LEE of Texas. Mr. Speaker, we have to correct it. Part of 
the additional reason, unlike my good friend from New Jersey, I am not 
sure of your State, Doctor, I like to call you doctor, because you have 
clearly outlined for us the real crux of the problem, my State as well 
has dealt with the question on a State level.
  I think the problem is and why this is raised to a level of a Federal 
need is, one, because there is a lot of interstate commerce, if you 
will, between HMOs. Frankly, there needs to be consistency on the 
Federal level as far as the problem that was mentioned by my good 
friend in New Jersey. But because we created a problem federally, we 
now have to fix it federally.
  It is much more apropos because, in many instances, our physicians 
are calling out of State for approval because they are under this HMO 
or that HMO. Many HMOs have put their offices in different States. Some 
have moved to the more popular States. But many times, they are calling 
out of State.
  To add to the consistency and not be subject to the individual State 
laws, we need the Federal correction of this problem, which is the 
problem of how you deal and protect the patient/physician relationship. 
It is key.
  Mr. PALLONE. Mr. Speaker, my understanding is that the self-insured 
that come under the Federal law are actually a majority in many cases. 
The gentleman can tell us a little more about that.
  Mr. GANSKE. Mr. Speaker, the problem that we have is that 25 years 
ago Congress passed a law primarily to deal with uniformity of pension 
standards that was then applied to health plans. An exemption from 
State insurance regulation was in that, that legislation.
  So what we have happen is we have had a large amount of our health 
care now delivered by health plans that are not under State insurance 
quality regulation, and there is no Federal legislation. So they are 
basically totally unregulated.
  That is why I and others who, in a bipartisan fashion, have supported 
this type of legislation, that 300 or so that are signed onto the 
Patient Right to Know Act which would ban gag clauses, are getting so 
frustrated with the leadership of this House and of the other body for 
not bringing this to the floor when it could pass overwhelmingly this 
type of legislation. It is why I think that it is very important that 
our constituents demand that Congress deal with this problem.
  We are not talking about something radical here. We are simply 
talking about some uniform quality standards so that, when you have 
insurance and you get sick, that it actually means something, that you 
can actually use it.
  I hear my colleagues say, just let the market work. Competition. I 
would liken this to buying an automobile. All of us buy an automobile 
that has Federal standards related to headlights, brakes that work, 
turn signals, seat belts. These are minimum safety standards that we 
know when we go out and buy a car, that is what we are going to have. 
Has that resulted in a nationalized auto industry? For heaven's sakes, 
no. There is tons of competition out there.
  It is just that you know, when you buy your car, you are going to 
have some minimum safety standards. The same thing should apply, 
doggone it, for health insurance when you have got health plans that 
are making life and death decisions. It may be even more important in 
some respects than safety standards for some of the other things that 
Congress has legislated on.
  Mr. PALLONE. Mr. Speaker, the reason that I was so impressed with the 
gentleman's comments earlier is because he was pointing out, really, 
how basic these patient protections are. I think that we cannot 
emphasize enough how this is really a floor. We are not doing anything 
radical here. These are basic patient protections that I think most 
people probably think are already there until they are faced with the 
reality of how to deal with the managed care organizations in certain 
circumstances.
  I loved the gentleman's analogy of the emergency room situation, 
because that is really so typical. I do not think people can imagine 
that, if they need a hospital or other kind of care in an emergency, 
that they have to get prior authorization.
  What we do in the Patient Bill of Rights, and I think that the Parker 
bill does the same thing, is to basically say that you use the prudent 
layperson standard. In other words, if I am in an emergency situation, 
I have to go to an emergency room, then the standard about the level of 
care that should be ensured is what the average layperson would think 
should be ensured in those circumstances.

                              {time}  2145

  Of course, the average person is not going to think that they have to 
have prior authorization or that they have to go to a hospital that is 
40 miles away, the example I used before. The average person would 
think that they would go to the closest emergency room, and they would 
just walk in and get the care, because it is an emergency. It is a 
pretty simple phenomenon. It is very basic. It is nothing really 
abstract.
  Those are the kinds of patient protections, the sort of floor, if you 
will, of patient protections that we are talking about here which make 
sense, I think, to the average person. That is why, I think, we are 
getting so much support from our constituents saying, do something 
about this, because it is not acceptable, what we have to face now.
  Ms. JACKSON LEE of Texas. If the gentleman will continue to yield, 
Mr. Speaker, the gentleman raises the obvious. That is what we hear 
when we go home. I just want to raise a Texas issue.
  Many of the Members are aware that there were fires burning in 
Mexico. There was the glaze that was reported in the news, I think the 
national news, a small glaze that was covering Texas, and it may come 
back again, with heavy air, and causing a lot of symptoms for our 
asthmatic citizens down there and our constituents down there.
  Under HMOs, the other point of their fiscal responsibility is to 
limit the number of visits one can go to a physician for during a 
certain period of time. There are certain regulations along those 
lines. You are then interfering, because of an environmental problem 
that was exacerbating those people with asthma or respiratory illness. 
They were filling up the emergency rooms. They were not heart attack 
cases, they were not accident cases, not the comatose case, which 
obviously rings a bell with everyone, but they were coming in because 
they were in a confined situation, a bad haze, and it was exacerbating 
their problem.
  In those instances, the questions of whether or not they would be 
accepted as having an HMO service because they were in there 
repeatedly, or they did not seem to be really an emergency case, this 
is what is happening around the country when we have a system that is 
not responsive to the physician treating the patient, the responsible 
physician treating the patient.
  My Indian doctors from India, doctors who treat a particular 
clientele in Houston, a very diverse community, have raised concerns 
about them being on an HMO list. I do not know if we have discussed 
that this evening, about the difficulty, sometimes, of physicians being 
able to get on a list, and particularly a lot of physicians in the 
inner city.
  These physicians who treat a certain patient clientele have had 
difficulty in maintaining their names on HMO lists so they can treat 
their patients and their patients can choose them; all kinds of 
problems that I believe reasonable men and women can come together and 
fix, so that the tragedies that the gentleman has mentioned, the

[[Page H4310]]

humor that the gentleman has mentioned, that does not make it funny, 
can stop.
  Because the question becomes, who are we as a Nation if we cannot 
provide the kind of health care to live up to our own reputation, with 
the excellent physicians? My own doctor, Michael DeBakey, traveled to 
Russia, and I think President Yeltsin is as fine and fit as I have seen 
him. That was a United States physician, trained in America, Dr. 
Michael DeBakey, who left here to supervise that open heart surgery. 
Today the President of Russia is considered healthy and robust 
physically, as Dr. DeBakey shared with me after his last check-up.
  I think it is extremely important that we do not diminish what we 
have here in this country. We have it. We have the ability to be 
fiscally responsible with health care, and I understand that is 
important, and at the same time using the resources that we have to 
make our country one of the healthiest around.
  What a tragedy, and the gentleman is a physician and he knows, that 
we have such a high death rate in certain instances because we are not 
getting the care and the technology and the expertise to the patient. 
If the doorkeeper is in there diminishing that access, that is why 
people cry out for universal access. They throw up their hands.
  Mr. GANSKE. Mr. Speaker, if the gentleman would yield further, let me 
relate another example. I recently had a woman pediatrician in my 
office. She left her medical practice, which involved running a 
pediatric intensive care unit, partly because she could no longer 
handle the types of things, the demands that were being placed on her 
from managed care. Let me give an example that she told me about.
  One day she had a 5-year-old boy come into her ICU. The boy was a 
victim of drowning, so he was attached to a ventilator. He had his IVs 
running. All the medicines were being given. He had been in the ICU, 
been in the hospital, about 4 hours. This team of doctors and nurses 
and other health professionals were standing there, doing everything 
they could for this little 5-year-old boy, with the parents standing 
there.
  Think of how you would feel if this were your 5-year-old boy who had 
been in that hospital for about 4 or 5 hours. They were basically 
standing around the bedside holding hands, praying for a sign of life, 
and the telephone rings. It is an HMO reviewer from some distant place.
  So this pediatrician gets on the line and she tells this nonphysician 
reviewer what the situation is, and how it does not look very 
promising. Do you know what that reviewer suggested? The reviewer said, 
well, if the prognosis is so bad, have you thought about sending the 
child home on a ventilator in order to save money?
  Mr. PALLONE. That is incredible.
  Mr. GANSKE. That is an incredible but true story. It shows that that 
reviewer did not know what she was talking about, or he was talking 
about, I do not know which.
  But I know how it happened. This reviewer was sitting at a computer 
terminal, and she saw ``Respiratory distress''; moved up the algorithm, 
``Ventilator''; moved up the algorithm, ``Poor prognosis.'' The next 
question you ask is, have you thought about home ventilation?
  Let me tell the Members, that is a situation where this little boy's 
life was hanging in the balance. There is nobody that I know of, 
including myself or my wife, who is a physician, that could take a 
child in that situation home without all the technology that you would 
need in that intensive care unit and have a chance of that little boy 
surviving. Yet that is the kind of recommendations that we are getting 
from people that should not be giving the recommendations.
  That is why part of this legislation we are talking about says that 
if you are going to deny care, the denial of care has to come from 
somebody who is legitimate and qualified to understand the situation in 
order to deny the care.
  Then the legislation says that if you do not agree with that denial 
of care, you can appeal it, but the appeal has to be adjudicated on a 
timely basis, not 6 months from now, when, like this poor unfortunate 
lady, you may no longer be in this world.

  Mr. PALLONE. What the gentleman is bringing up again is so important, 
because we had a forum in New Jersey with Senator Torricelli and myself 
in my district, and the people that came and talked about the problems 
they had with managed care, their biggest concern was the bureaucracy 
of having to deal with a denial; in other words, denial of certain 
services, denial of certain equipment, and how they had to go about 
appealing that or finding someone who would hear their case.
  I just could not believe the hours and hours parents or a relative 
would spend trying to get through that bureaucracy to try to have 
someone hear their case on appeal, or whatever the grievance procedure 
is. I think that that is a very important part of the legislation that 
we are talking about here today, because how many people can do that? A 
mother maybe can do it for her child if she is not working, but most of 
the time you have to call during the day, and a lot of people just 
cannot take the time to go through the morass that has been set up in 
these organizations.
  Again, I just want to say to the gentleman from Iowa (Mr. Ganske) 
that the reason it is so valuable to have the gentleman here tonight if 
he is just pointing out how common-sense these patient protections are.
  The gag clause, again, I think most people would not believe that 
their physician is not allowed to tell them what the proper treatment 
should be or make recommendations because of some gag clause, or the 
circumstance the gentleman just described. We are only talking about 
things that I think most people would expect would be the norm, but 
unfortunately, they are not. That is the problem.
  Mr. GANSKE. If the gentleman will yield further, Mr. Speaker, we 
always hear from opponents to this that this legislation will cost so 
much. It is going to make premiums double.
  Phooey on that. As far as I know, there is one independent study that 
has been done by Coopers & Lybrand, a well-respected actuarial firm, by 
a nonpartisan group that has looked at the cost of a Patient Bill of 
Rights, exclusive of the liability provision, and the cost to a family 
for a year would be about $31. All sorts of surveys across the country 
have shown people would be willing to have their premiums go up more 
than that in order to have their insurance mean something.
  Mr. PALLONE. Mr. Speaker, I want to thank everyone for joining us. 
This was certainly worthwhile. We have to keep pressing to have patient 
protection legislation brought to the floor.
  Ms. JACKSON-LEE of Texas. I thank the gentleman. I think America 
deserves it.

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