[Congressional Record Volume 144, Number 101 (Friday, July 24, 1998)]
[Senate]
[Pages S8989-S8993]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        PATIENTS' BILL OF RIGHTS

  Mr. FRIST. Mr. President, I rise today to speak on the Patients' Bill 
of Rights, a bill that was introduced last week by my colleague from 
Oklahoma, Senator Don Nickles, and members of the Senate Republican 
Task Force on Health Care Quality, our distinguished majority leader, 
Trent Lott, with a total of 47 cosponsors.
  I am really quite pleased with this particular bill. I have had the 
opportunity to work on the task force because it is a product of months 
and months of very thoughtful discussion, vigorous debate among 
ourselves. I think, as most people know, on the task force were some of 
our most conservative members and some of our most moderate members 
within our caucus. It really is a consensus proposal to improve health 
care quality. As a practicing physician, I am absolutely convinced that 
health care is delivered best when that relationship between the doctor 
and the patient is given the very highest priority. My goal in this 
debate, the debate that we will have over the coming weeks, is to do 
everything possible to empower patients and doctors to be that focal 
point, to be that place where ultimately the quality of care is 
decided.
  Much of the debate will center around who is practicing medicine 
today. Is it bureaucrats in Washington? Is it bureaucrats in health 
maintenance organizations? Is it bureaucrats in the U.S. Congress? 
Ultimately, I think that we can address this issue, if in coming 
together in a bipartisan way with a reasonable, timely voice, with a 
reasonable thought, come back to that central premise that the doctor 
and the patient or the nurse and the patient, at the level where that 
really very intimate interaction is carried out, where one's problems 
are professed and treatment plans and diagnoses are generated, if we 
keep coming back to that as being the central focus of the Patients' 
Bill of Rights in everything that we do over the next several weeks, we 
will be doing a great service to the public, to all Americans.
  Now, our proposal that has been put forth is grounded on a Patients' 
Bill of Rights. It offers a number of protections for individuals, for 
patients, for potential patients, and that is No. 1, by guaranteeing 
full access to information as to what is in one's health plan.
  If you ask your typical Tennessean or American, you say, what really 
does your plan cover and what does it not cover, most of us, including 
me, throw up our hands and say, ``I don't know.'' If you, going back to 
my own field, develop a cardiomyopathy and a sick heart, it 
deteriorates over time and you need a heart transplant, does your plan, 
I could ask any of my colleagues, cover heart transplants? And they 
will probably say, ``I don't know. I understand it is very expensive. I 
also understand it could save my life. But I don't know the answer to 
that question.''
  We need to guarantee full access to everybody. Whether it is a health 
maintenance organization, a managed care plan, any type of plan, we 
need to guarantee that patient full access to that information. We do 
that in our bill.
  Secondly, we do need to make sure that patients receive the necessary 
emergency care, and it really does boil down to the fact that if a so-
called prudent lay person, meaning somebody with average intelligence, 
common sense, develops chest pain, they don't know whether it is 
indigestion or a massive heart attack. They go to the emergency room. 
They should be able to walk into that emergency room and be taken care 
of without fear that coverage will be denied for that particular 
service. We address that right up front. We allow patients to keep 
their doctor during a pregnancy or extended illness even if their 
doctor for some reason leaves a plan or is terminated from a plan, so-
called continuity of care. We allow individual patients direct access 
to that pediatrician without having to go through a gatekeeper or to 
that obstetrician or gynecologist without having to go through a 
gatekeeper first.
  The great fear I think that all of us in America have today, and I 
think it is the fear that, again, drives much of the debate, is that 
our health plan will not be there for us if we get sick. If my young 
11-year-old son develops a heart murmur, a virus, will there be 
somebody there to help him? Will that health plan respond to those 
needs? Or will my HMO deny me seeing the doctor who I feel is the very 
best person to take care of my son, who I know and people have told me 
is a better doctor. Will I be denied the opportunity to see that doctor 
by my health plan?
  Many people fear that they will be denied the benefits they have even 
paid for and that they have been promised. Others are absolutely 
convinced today that their health plan cares much more about cost, 
cares much more about profits, cares much more about the

[[Page S8990]]

bottom line than about quality. And that is because of the focus on 
cost and saving money.
  We in this body talk about how we have to slow the cost of health 
care, we have to reduce health expenditures because of all of those 
pressures. HMOs have been allowed to go too far. They have not been 
held accountable. Our bill takes that focus and puts it right on 
quality, on quality. I say that because you can list 10 rights, and you 
can list 400 mandates, and you can say we have licked the problem. 
Unless you come back to focusing on quality, you have made yourself 
feel good. We have responded to the public sentiment of let's bash the 
HMOs, but you have done nothing for that next generation, nothing for 
the overall health care system unless you come back to those two 
principles: The doctor-patient, the primacy of that doctor-patient 
interaction, No. 1, and, No. 2, focus on quality.
  Therefore, you will see in the bills that are before us--and there 
are basically two bills, one from each side of the aisle, although I 
hope that both sides will end up to some degree through debate coming 
to a bipartisan agreement, but the bills are very different, and I 
think that is where the debate is going to have to play out because 
every day you are exposed on this floor and through press conferences 
to ``Let's kill the HMOs, capture that sentiment, put these mandates on 
the people and we fix the system.''
  What we have to do as a body is figure out really how to fix the 
system with the help of the American people, recognize that our health 
care system is changing and changing dynamically, and what we define as 
quality is changing dynamically. And thus whatever we do we cannot 
establish a system through well-intended mandates which rigidify this 
system and destroy the dynamism that is inherent in the public 
marketplace, in the private marketplace, in private industry, in 
Government-run programs today which recognize that quality is a new 
science, it is an evolving science, it is dynamic, it is energetic, 
everyday breakthroughs are made on how we determine quality. So let's 
be very careful and make sure that we, through well-intended mandates, 
don't come and box in this dynamism which is so important to the future 
of health care delivery.
  Our bill focuses on quality. Now, any physician today--and I am a 
physician. I have worked with managed care before coming to the 
Senate--any physician will tell you that managed care--and we use the 
word ``HMOs'' and everybody needs to recognize that managed care is a 
broad spectrum of entities. But a physician will tell you, anybody who 
has worked with an HMO, HMOs have gone too far. Not all of them. HMOs 
too often control the whole issue of what service is covered and what 
is not, regardless of what that physician may feel is in the best 
interest of the patient. And that same physician will very quickly tell 
you that what coverage you are allowed to give that patient ultimately 
defines the care and the outcome of that patient.
  Therefore, I don't blame my fellow physicians coming forward and 
saying, listen, I am being held accountable for decisions that I am not 
even allowed to make, whether it is coverage or admission to a hospital 
or the number of days in a hospital. I am not making that decision, yet 
I am held accountable.
  Well, our bill hits this inequity head on. Basically, it says it is 
not fair. That is inequitable. You, physician, you should not be held 
accountable. The HMO should be held accountable.
  We need to fix the system. The critical measure of this bill that we 
have put forward is to hold the health plans accountable for the 
coverage decisions they make and to take the whole essence and the 
power of denial of care out of the hands of the HMOs and place it in 
the hands of the way we fix the system--a strong appeals process 
internally and a strong external appeals process where decisions can be 
made by medical experts--yes, physicians--medical experts independent 
of the plan.
  Our bill requires that health plans make coverage determinations 
rapidly, quickly, not weeks later or months later or years later. We 
put some time specifically, actually in the bill; we say it must be 
made sometime but definitely not later than 72 hours after the request. 
We want to protect patients, before harm occurs, by setting up a 
process that is not present in many--I don't know whether to say most 
or not--but it is simply not present in many of the HMOs today. But it 
is a process for patients and their families to get an immediate answer 
over what is covered and what is not covered and, if there is a 
disagreement, resolution right then and there, not a year later or 5 
years later or 2 years later, after whatever potential for harm may 
occur.
  Furthermore, we require health plans to provide quick internal 
grievance, as well as these independent, external, appeals processes in 
areas where there might be some question, like: Is a particular 
procedure or use of a device investigational or experimental? The whole 
point is, we need to hold the plans accountable. And we do it by fixing 
the system.
  Our bill provides protections for patients who rely on health plans 
that States do not. This will be another issue, but our bill basically 
says that there are a group of people who are unprotected today. Yes, 
the purpose of our bill, and where we see the Federal responsibility as 
being, is to protect the unprotected, the people who, by law, are not 
being protected by an entity. That is the group that we focus on. We 
fix the system where it is broken, without this whole issue--which has 
really captured the attention of the press and really taken focus away 
from the quality issue, which is the really important issue--this issue 
about lining the pockets of trial lawyers in the process of the bills 
that are discussed today.
  We do demand that all 125 million Americans have this strong internal 
appeals process, grievance process, as well as external appeals 
process. We want the questions answered up front, when it really 
matters, and not years later by a trial lawyer.
  Our bill guarantees patients the right to access their own medical 
information. It gives them the right to make modifications and to amend 
their medical information if they find something that is incorrect. In 
addition, we require health plans to inform you of the plan's practices 
with regard to confidentiality of medical information, with regard to 
privacy of your medical record. We require health plans to establish 
safeguards to protect that confidentiality, to protect that privacy, to 
protect that security of your health information.
  As you can tell, I just believe the heart of the problem that we have 
today with HMOs is that they focus too much on cost, on the bottom 
line, without anybody coming in and demanding that they look at 
quality--quality. Our bill, more than any other bill, focuses on this 
issue of quality.
  Some believe that quality can be legislated today. It is a subtle 
issue, but it is a point that I have a real obligation to make because 
I have been so intimately involved. That is, the science of quality and 
understanding what quality is today in health care is a relatively 
young science. It is a science that is maybe 10 years old. I think you 
can crystallize that by asking yourself, What is quality today? How did 
I choose my doctor? Did I choose my doctor because I knew that he was a 
better doctor than the doctor across town? If you feel your doctor is 
pretty good, step back and ask yourself, Do I really know he is a good 
doctor? Or is he just a nice guy? Does he just answer the telephone 
when I call? What are the standards that we, as a society, have to 
compare one doctor to another doctor? We are entrusting our lives to 
them for a heart transplant or heart surgery. How do we judge them? The 
information is not there. The answer is: We don't have the answer.
  Therefore, we as a body have to be very careful before we come in and 
mandate what quality is, because we don't know what quality is. We are 
learning about it, but it is an evolving science. It is something we 
are learning about on an ongoing basis. It is important because one 
approach mandates quality, the other says let's support and figure out 
what quality is. That is the Federal responsibility: Let's pull 
together the private entities, the public entities; let's take 
advantage of state-of-the-art information systems; let's coordinate 
this information and determine what quality is and then disseminate 
that information out so we

[[Page S8991]]

can educate people broadly so they can answer that very basic question, 
``Do I have a good doctor or do I not have a good doctor?'' Or, ``Is 
that plan a good plan for me and that one a bad plan for me?''
  Mandating data collection: Right now, there are plans being proposed 
on both sides in the House and Senate that just say let's collect more 
data, let's have all information from a health plan--demographics and 
age and gender and outcome and results and patient satisfaction 
surveys--let's just collect all that data and send it to the Secretary 
of Health and Human Services. It sounds pretty good, if we knew what it 
meant, if it didn't mean that a doctor is going to have to sit down and 
talk to a patient and then go take a piece of paper and fill out a 20-
point questionnaire and then give it to a bureaucrat, whom he has had 
to go out and hire to sit in his office to compile it for a health care 
plan that has another whole system, to send it to the Secretary of 
Health and Human Services, who gets this data from millions and 
millions of doctor-patient interactions. And what are we going to do 
with it? Let's invest in the science of figuring out what we do with it 
before we mandate the collection.
  Our legislation promotes quality improvement by supporting research, 
to give patients and physicians better and more useful information to 
judge quality. Our Patients' Bill of Rights establishes an agency. We 
call it the Agency for Health Care Quality Research, AHQR. I hate to 
use those initials, but by the time this debate is finished, I hope 
everybody in America knows what AHQR is. Its purpose is to foster 
overall improvement in health care quality through supporting pertinent 
health sciences research, then disseminating that information through 
public and private partnerships--pretty simple, pretty straightforward. 
I believe it is the fundamental problem we have today with managed 
care, with HMOs, with focusing on dollars, with focusing on the bottom 
line, because nobody is focusing on quality.
  Some of my colleagues will come forward and say, ``You mean as a 
Republican you want to create a whole new Federal bureaucracy and 
agency?'' The answer is no. We don't do it very well, I think, in 
Washington. But when we go in one direction, I think it is important to 
build on the past, and we have done just that. The agency that we 
propose is built on the platform of a current agency which I feel is 
doing a very good job. But we take that agency, called the Agency for 
Health Care Policy and Research, we refocus the agency on quality, 
because quality is the issue today. It may have been ``cost'' 5 years 
ago, but it is ``quality'' today. Then we enhance that agency to become 
the hub and the driving force of all of the many quality efforts that 
are going on in Federal programs today.
  There are many different agencies all across this country, Federal 
agencies, that do focus on health care. They all have--not all of them, 
but many of them have programs and a little subdivision devoted to 
quality. Our Agency for Health Care Quality Research will help 
coordinate all of those many very positive efforts. We will focus on 
not just HMO quality, where so much of the debate and anger is, but we 
will focus on quality on the managed care setting, the urban setting, 
the rural setting, the setting of the solo private practitioner. This 
agency will have, as its mission, improving quality, and the 
disseminating of that information to everybody in health care today.
  Thus, if we agree that this fundamental issue on our debate is that 
HMOs have, to some extent--I don't want to sort of categorize them 
because I don't think that is fair--but if the debate is that HMOs have 
ignored quality because of an almost obsession with cost, then let's 
hit the problem; let's go after how we, as a nation, can improve 
quality and what is our Federal responsibility. If we are talking about 
a Patients' Bill of Rights, the ones that we have in our bill are very, 
very important. But I think the most basic right for a patient is that 
right to quality health care. That is what our bill, like no other 
bill, addresses.
  This particular agency has a role that is not to mandate. It is not 
to mandate a national definition of ``quality,'' but, rather, it is to 
support the science that is necessary to provide information to 
patients so they will know whether or not they are receiving good 
quality of care, to provide information to physicians so they can 
compare what they are doing to the next physician and modify their 
behavior, so they will know what good quality is and modify their 
behavior so they can deliver better care to all of their 
patients, information to enable employers and individuals to become 
wise purchasers or wise shoppers of health care based not on cost, or 
not on cost alone, but on cost and quality.

  The agency will stimulate public-private partnerships to advance and 
share what we learn about quality. Quality just means different things 
to different people. It is constantly being refined. As I said, it is 
just a few years old as a science; therefore, in collaboration with the 
private sector, the agency will conduct and will coordinate health 
science research that really will accelerate our understanding of what 
quality means to clinicians and to patients, how to measure that 
quality and how to use this information to improve your own health and 
your own quality of life.
  This agency will have as a major purpose and objective the sharing of 
this information. We have medical advances that are made daily. We see 
them in the newspaper; we see them on the news each night when we go 
home. In truth, many of these discoveries do not make it out into the 
general practice of medicine for too long. We need to do a better job 
in narrowing the gap between what we know and what we do, and this 
agency will accomplish that.
  We need to get the science that we know is good science quicker to 
the American people by sharing this information among public entities 
and private entities, and this effective dissemination will be a major 
purpose of the agency.
  In addition, the agency will develop evidence rating systems to know 
what a good doctor is, what a good plan is, whether or not the 
treatment that has been recommended for your diabetes is an effective 
treatment.
  This agency will play a vital role in facilitating innovative 
inpatient care in this whole area of new technologies and assessment of 
new technologies. As chairman of the Science, Technology, and Space 
Subcommittee of the Commerce Committee and the Public Health and Safety 
Subcommittee of the Labor Committee, we held hearings and people came 
before us again and again about new technologies and the confusing 
methodologies that our Federal Government has set up, that each agency 
has set up, hoops through which they need to travel before that new 
technology is disseminated or shared with the American people.
  The agency that we are setting up will establish a consistent 
methodology with coordination across Federal agencies so that people 
will know what guidelines they must follow in a consistent way to have 
technologies evaluated and then appropriately disseminated.
  In its mission to promote and facilitate quality and quality 
development, this particular agency will have a focus on improved 
information-based computer systems which are so necessary for quality 
scoring and which will facilitate informed decisionmaking by providers, 
by physicians, by nurses, and by patients. The agency will aggressively 
support the development of these state-of-the-art information systems 
for health care quality which then can be shared both by the public and 
the private sector. The setting is important. Again, as I mentioned 
previously, so much of the discussion today, as we talk about bills of 
rights, is focused just on health maintenance organizations.
  I think it is important for our colleagues to realize that our bill 
goes beyond just health maintenance organizations and looks at quality 
in all different settings. Quality improvement applies to the care that 
is given in that solo private practitioner's office in the managed care 
setting or at the health maintenance organization. This agency will 
understand that part of its mission will be to specifically address 
quality in rural areas in underserved areas, using such technologies as 
telemedicine and other long-distance-type technologies.
  Our bill addresses the fact that patients do want to know if they are 
receiving good care, but compared to what? Statistically accurate, 
sample-

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based national surveys will efficiently provide reliable and affordable 
data without the other approach, which is excessively mandated, overly 
intrusive, potentially destructive mandatory reporting requirements, 
which as I have described previously, in the long run take away time 
from that doctor-patient interaction.
  You simply do not need to have a doctor, after every patient 
interaction, fill out a questionnaire at every visit and then send that 
information to Washington. It can be a waste of physician time, taking 
time away from the patient, and will ultimately drive up what patients 
have to pay for the care they receive. Our approach is very different.
  As I mentioned, they are sample-based national surveys. We expand the 
current Medical Expenditure Panel Survey to require that outcomes be 
measured and reported to Congress so that as a nation--as a nation--we 
can better determine the state of quality and the cost of quality in 
our Nation's health care.
  The role of the Agency for Health Care Policy and Research is not to 
mandate national standards of clinical practice. Definitions and 
measures of quality, as I said, are an evolving science, a science that 
is critically important to our ability to make educated, informed 
decisions.
  Another aspect of our bill that is important for our colleagues to 
understand is a part of the bill--because it is a very important part 
of the bill--is the strong focus on women's health issues. As a nation, 
it is time that we focus on diseases and health issues that are faced 
by women. In our bill we specifically emphasize women's health research 
and prevention activities at the National Institutes of Health and at 
the Centers for Disease Control and Prevention. The goal is to support 
the critical role that our public health agencies--the NIH and the 
CDC--play in providing a broad spectrum of activities to improve 
women's health. That includes research, screening, prevention, 
treatment, and education.
  Among others, these provisions in women's health promote basic and 
clinical research for the aging process in women, for osteoporosis, for 
breast cancer, Paget's disease, for ovarian cancer. We expand our 
research efforts in the important area of cardiovascular disease. Many 
people--in fact, I am sure many of our colleagues--do not realize that 
the No. 1 killer, cause of death for U.S. women is cardiovascular 
disease. We need to expand our research efforts there. We do that in 
our bill.
  Our bill reauthorizes the National Breast and Cervical Cancer 
Screening Program which provides crucial screening services for breast 
and cervical cancers to underserved women. Our bill supports data 
collection through the National Center for Health Statistics and 
National Program of Cancer Registries, which are the leading sources of 
national data on the health status of women. Support of these valuable 
programs will help ensure scientific progress in our fight against 
these diseases and will lessen the burden of these diseases on millions 
of women and their families.
  Another component of our bill which is not in any bill currently 
before the U.S. Senate except for ours--which is not a part of the 
Patients' Bill of Rights in the House of Representatives--it is a part 
of the bill, again, which I feel demonstrates that this piece of 
legislation is forward thinking; it fulfills our responsibility, I 
believe, of looking ahead and seeing what obvious challenges there are, 
challenges that could potentially disrupt the delivery of health care 
in this country--that is our responsibility--and to respond, and to 
respond now, before they become potentially debilitating, have a 
debilitating effect on health care in this country.
  This provision is one--and it is a right--it is one of the Bill of 
Rights, and it is a right that every woman and every man and every 
child should be free from the fear that an insurance plan or an HMO 
will discriminate against them because of a positive genetic test.
  The human genome project, a 15-year, very successful project, 
initiated by our Federal Government, being carried out in a wonderfully 
unique public-private partnership, by the year 2005, we will have 
defined over 3 billion bits of genetic information called DNA which 
comprise the human genome which explains in large part our genetic 
makeup--3 billion bits of information defined over this very successful 
program.

  We have learned tremendous scientific progress, but it has introduced 
the fact that once we link these genes to diseases and conditions--and 
we see it happening almost every day; there was an article in the 
Washington Post just yesterday about linking several genes with 
Alzheimer's disease and the onset or when Alzheimer's disease comes 
being linked to these genes.
  Again, tremendous science, yet it strikes right at the heart of this 
fear that the information in some way will not be used to help you but 
will be used to hurt you, that access to that information and the 
result of whether or not you have that gene will be used by an HMO or 
an insurance company to deny you coverage, to increase your premium, to 
use against you that fear in not getting a test, a potentially 
beneficial test. If you had a test which, with 80 percent 
predictability, said you were going to have breast cancer, wouldn't you 
want to know the result of that test? I would, because it means I might 
get a mammogram once a year instead of once every 2 years, or I might 
do a breast exam once a week instead of once a month, because we know 
the earlier diagnosis of best cancer, earlier detection, means earlier 
treatment, and earlier treatment means cure instead of delay, which 
means, many times, it cannot be cured.
  The promise of that test will be defeated unless we act, and we act 
today, to eliminate the fear of genetic discrimination based on genetic 
tests which are coming online at a rapid pace. Our ability to predict 
what diseases individuals may be at risk for in the future has caused 
grave concern that this powerful information--information that affects 
every one of us in the room; we all have this genetic information; we 
all carry it in our genes--the fear that that information might be used 
against you.
  I am really troubled when the Tennessee Breast Cancer Coalition tells 
me that genetic counselors right now are facing women every day who are 
afraid to even have these genetic tests performed. Women are avoiding 
genetic testing due to concerns that they will lose their insurance 
coverage even though that genetic test might be saving them. We must 
prohibit discrimination in health insurance against healthy individuals 
and their families based on genetic information.
  Think about it--3 billion of these little bits of information on a 
single human genome; we all carry genetic mutations that may place us 
at risk in the future for some disease, even if we are healthy today. 
Therefore, each of us is at potential risk for discrimination.
  If I receive a genetic test that shows I am at risk for cancer, 
diabetes, or heart disease, should this predictive information be used 
against me or my family? The answer is no. That is a right. We address 
that right in our bill. I think it an important point because it shows 
our bill is forward looking, looking to the future, not a set of rigid 
mandates based on what we think we know about quality today, but we 
look to the future.
  I want to commend the Senator from Maine, Senator Snowe, whose 
original bill provided the framework and really the sound principles 
upon which this legislation is based. She has supported our task force 
effort and worked with us in a step-by-step way to craft this 
legislation. I also would like to mention Senator Jeffords, who had the 
foresight to include these provisions, since we are talking about basic 
rights.
  Our bill very specifically prohibits health insurers from requiring 
collection of the results of these predictive genetic tests. It 
prohibits them from using that information, if they do have it, to deny 
coverage. And it prohibits insurers from using that information, if 
they do have it, to adjust rates or to increase rates.
  Preventing genetic discrimination does have enormous implications 
that I will continue to come back to, and that is improving quality. It 
improves the quality of care to an individual patient. But also, if one 
is afraid to have the results of a genetic test released to somebody 
outside or participate in a large protocol, investigational protocol, 
that means that research overall

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into what these tests mean and how they might be beneficial will be 
slowed down, thus affecting the quality of health care for all 
Americans.
  Lastly, our bill enhances access and choice of health insurance 
coverage in a number of ways which we will debate on the floor, areas 
that increase access to and affordability of health care of several 
areas, that include provisions which I am very excited about, and that 
is to allow the self-employed individuals, for the first time, to fully 
conduct their health care expenses. It only makes sense. We have really 
been punishing self-employed individuals, not giving them the same tax 
treatment that somebody has if they are working for a large company. It 
doesn't make sense. What we want to do is level that playing field and 
allow these self-employed individuals to fully deduct their health care 
expenses, just like people who work for large companies. It addresses 
access, because it means that these self-employed individuals are more 
likely to go out and enter the insurance market.
  Our bill provides greater flexibility to employees who use the so-
called flexible spending accounts to pay for health care. Our bill 
gives individuals the opportunity to have control over the health care 
decisions and costs through medical savings accounts. Medical savings 
accounts allow a patient to access the physician of their choice and to 
choose the medical treatment that they want if they choose that option.
  As you can tell, our bill contains a lot. The reason that I wanted 
this afternoon to outline our bill is to make sure that our colleagues 
spend the next several days looking very carefully at the differences 
between the two bills that are before us, because the approach is very, 
very different. Both bills are well intended. I will say that I am very 
hopeful that we can pass a bill, a strong Bill of Rights. But that Bill 
of Rights needs to include a right to quality health care for all 
Americans. Our approach is very, very different. The intentions, I 
believe, of both bills are the same.
  I am hopeful that we can engage in this debate without too much in 
the way of rhetoric. There is a lot of rhetoric that has been thrown on 
the floor here and in press conferences, but I hope we can come back 
and say this is an important issue. It is not one, really, to play 
politics with. It is not one to defer to another Congress or to 
filibuster or to make a part of the next elections. It is the sort of 
issues that we, as trustees to the American people, have an obligation 
to address and to address in this Congress.
  Our Patients' Bill of Rights offers all Americans quality improvement 
based on the foundation of strong science. Our Patients' Bill of Rights 
offers all Americans patient protection, to access the care they need 
from the doctor they choose. Our Patient Bill of Rights offers all 
Americans trust in that doctor-patient relationship, that central point 
through which I believe quality needs to be defined and health care 
delivered. We reinstate that trust. Our Patient's Bill of Rights offers 
all Americans access to more affordable health insurance coverage. Our 
bill does represent a forward-looking approach to provide for 
continuous improvement in health care quality, and it meets our goal of 
assuring that the doctor and the patient define quality--not HMOs, not 
bureaucrats, not trial attorneys, and not the U.S. Congress.
  Mr. GORTON addressed the Chair.
  The PRESIDING OFFICER. The Senator from Washington is recognized.

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