Congressional Record, Volume 144 Issue 73 (Tuesday, June 9, 1998)

[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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