[Congressional Record Volume 144, Number 75 (Thursday, June 11, 1998)]
[Senate]
[Pages S6133-S6134]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        PATIENTS' BILL OF RIGHTS

  Mr. TORRICELLI. Mr. President, last month the Senator from 
Massachusetts, Mr. Kennedy, came to the floor to urge the Republican 
leadership to allow the body to consider reform of managed health care 
in our country. Today, I also want to join his plea that this 
institution be allowed to consider the consequences for American 
families of the managed health care system in our country.
  The simple truth is health care in America is in a state of crisis--
not a crisis of competence or technology. Most assuredly, it is a 
crisis of confidence. Confidence in health care in many respects is as 
important as the quality of the providers or the level of our 
technology. I have rarely in my life seen an issue where so many 
Americans are of a similar mind with such a depth of concern regarding 
the availability and quality of health care under the HMO system.
  I realized myself the depth of these feelings when, only a few 
months, ago I joined with my colleague, Congressman Pallone from New 
Jersey, in a field hearing in our State. During the hearing, families 
told me about their own experiences in attempting to care for their 
children, gaining access to the best health care providers, and the 
enormous frustration and feeling that the costs of operations were 
being placed before the health of their children.
  Perhaps the best example came from a single family in New Jersey, the 
Bolingers. Their daughter, Kristin, is 15 years old, and lives in 
Spotswood, NJ. She has experienced the frustration of managed care that 
has been visited upon many American families. As an infant, Kristin 
developed unexplained intractable seizures which left her in need of 
very specialized care and expensive diagnostic tests. Five years 
before, Kristin's parents had enrolled themselves in an HMO. But 
because of the rules of the HMO, Kristin could no longer see the 
pediatricians and the specialists who had been treating her for her 
entire life. Those who had the experience with Kristin, had seen her 
symptoms and knew her case, were now separated from her treatment, and 
in their place the HMO on its list of available doctors made a 
pediatrician available who was not qualified, who had no experience 
with her condition, and did not know her or how to treat her.
  Her family then was left in an extraordinary position. In caring for 
their 15-year-old daughter, do they absorb all of the financial costs 
which they are unable to bear when treating their child or do they go 
to doctors who, on their face, were not qualified to deal with the 
case?
  The family was left in a desperate financial position. The HMO 
refused to pay many of her medical bills deeming them ``not medically 
necessary.'' The case only gets worse.
  In 1994, scoliosis, caused by Kristin's condition, required the use 
of a back brace. The HMO gave her a back brace which was inferior and 
not usable.
  Last year, Kristin had to undergo corrective spinal surgery. Her 
physician prescribed home nursing care and physical therapy. For a long 
time the HMO refused to pay for the physical therapy or the home care. 
They would pay for nothing. After they started to pay, the physical 
therapy was only half complete when payments stopped.
  This, of course, leaves Kristin Bolinger's family with a question 
that they will ask themselves all their lives. The bills were not being 
paid, the family had to make these sacrifices in spite of the fact they 
were paying an HMO all of this time on time in full. The finances 
aside, the Bolinger family for the rest of their lives is left with the 
question: How much did their child suffer, and how much of her 
condition might have been reversed if she had gotten the right care at 
the right time?
  Obviously, Mr. President, Kristin Bolinger and her family are not 
alone. She is one of 4 million people in my State of New Jersey and 50 
million in our country who have absolutely no protection from the 
judgments of their health maintenance organizations. They live at the 
whim of whatever decisions may come from the officials who manage these 
health care organizations. That is true, even though I am very proud 
that in New Jersey we probably have the best patient protection system 
for those in managed care of any State in the Nation. But it doesn't 
work. State protections don't work because only 25 percent of those in 
health maintenance organizations in New Jersey can be covered by State 
protections. The other 75 percent, who like Kristin Bolinger are in 
ERISA-based plans, are left to their own devices to fight their 
insurance companies for their rights because State protections cannot 
shield them.
  It is no wonder that more than half of all Americans who are enrolled 
in health maintenance organizations are significantly dissatisfied with 
the quality of their care.
  Fifty-one percent of Americans believe that health maintenance 
organizations are eroding the quality of health care for their 
families. Fifty-five percent fear that if they become ill while in a 
managed health care plan, those who administer their plan would have 
their highest priority in saving money rather than caring for their 
patients. And if that is not bad enough, the worst indication may be 
that this lack of confidence of those who are enrolled in the plan is 
mirrored by health care professionals themselves. Forty percent of all 
physicians who work in these very plans every day watching these 
judgments believe that the quality of health care and of the judgments 
made by health care professionals is eroding and prevent them from 
making the best medical judgments for patients.
  I cannot tell you that the movement in America to managed health care 
plans has not had benefits. The truth is the spiraling upward costs of 
health care in America are being contained. I do not believe we ever 
could have developed the current Federal budget surplus without managed 
care. It has been of enormous benefit to the American economy as 
corporations have contained costs, but there is a loss of balance. If 
we are achieving the controlling of these costs, but the price is that 
families and physicians do not have confidence they can get the care 
they are purchasing, we are paying a very high price for this 
efficiency. What is required is to restore the balance between the 
efficiencies of delivering care and ending the upward spiral of rising 
health care costs, but assuring quality and access and balance of 
judgments.
  The truth is this loss of balance is not necessary. Patients should 
have access to health care professionals who are qualified to treat 
their conditions and not forced to accept people without

[[Page S6134]]

the proper professional credentials simply because they are preferred 
by health care managers in these organizations. Insurance companies 
should not withhold the care that family physicians and specialists 
alike deem necessary. If a health care professional, a doctor believes 
a certain treatment is necessary, as a matter of right that doctor's 
judgment should prevail. Obviously, if a doctor believes that an HMO is 
making the wrong judgment for the health of an individual, there should 
be a fair and speedy appeals process to someone who can make the best 
judgment for the patient.
  Mr. President, this case is so obvious, it is so compelling, it comes 
as close to a consensus judgment as can ever be reached in a country of 
this size and complexity. It is at issue in every State, in millions of 
American families, borne out by the practical experience of people that 
Senators meet every day. It is true today. It was true yesterday. It 
was true last month. It was true last year.
  I join with the Senator from Massachusetts, Mr. Kennedy, in urging 
that this Congress this year deal with health maintenance organization 
reform. There is legislation before this Senate that is prepared. It is 
ready. It is comprehensive. It deals with the issue. Senator Daschle's 
legislation, S. 1890, would deal with the very issues that Kristin 
Bolinger had to face in her own life. Senator Daschle's Patients' Bill 
of Rights, consistent with the call of President Clinton in his State 
of the Union Address, would ensure that patients like Kristin would 
have (1) access to providers who are qualified to treat their 
conditions, including referrals to specialists when necessary; (2) that 
any Member of a health maintenance organization, wherever they are in 
America, wherever they travel, whatever community they are in, have 
access to emergency care in a hospital that is proximate to them when 
they are in trouble or in need; (3) have access to a fair and immediate 
appeals process.
  More than anything else, this would convince the American people that 
their interests and the needs of their families are being put before 
the profits of these organizations. It is obviously too late to deal 
with Kristin Bolinger's pain or the terrible financial plight of her 
family. Kristin's experience and those of millions of other Americans 
can be instructive to this Senate and remind us of our obligations to 
deal with the problems of health care in America. We can still 
acknowledge the enormous efficiencies of managed care and its benefits 
of ending the rising costs, helping with corporate efficiency and the 
predictability of health care costs. But simply because these 
organizations are working to add efficiency, does not attest to the 
fact that all families are being treated fairly as demonstrated by 
Kristin Bolinger's experience. Senator Daschle's legislation, his 
Patients' Bill of Rights, deals with that balance. I urge the majority 
leader, Senator Lott, to bring the Patients' Bill of Rights for managed 
health care reform before the Senate.

  I yield the floor.
  The PRESIDING OFFICER. The Senator from Missouri.

                          ____________________