[Congressional Record Volume 144, Number 128 (Wednesday, September 23, 1998)]
[Senate]
[Pages S10819-S10823]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        PATIENTS' BILL OF RIGHTS

  Mr. KENNEDY. Mr. President, I was over in my office earlier in the 
afternoon. I heard the quorum calls. Now again we are wasting time in 
the middle of the afternoon. We are talking about a Wednesday afternoon 
at about quarter of 5. The Senate is in a quorum call when we could be 
debating the issue of the Patients' Bill of Rights.

[[Page S10820]]

  I have taken the opportunity at other times to remind the Senate 
about the importance of that debate. Last week, we had the Republican 
leadership effectively close down the Senate for 5 hours, by 
essentially prohibiting Members of the U.S. Senate to speak at that 
time on the issue of the Patients' Bill of Rights. And, as has been 
pointed out by our Democratic leader, Senator Daschle, the Republican 
leadership shows an unwillingness to debate this issue during the 
evening times, which would allow us to do the country's business and do 
the people's business.
  I rise again today to talk a bit about this issue, and the importance 
of it, because it is of such compelling importance to millions of 
Americans--more than 160 million Americans.
  Every time I go back to Massachusetts--and I think it is generally 
true with others as they travel across the country to their States--I 
run into the people who have faced the kinds of situations that I will 
mention in just a moment or two. These are situations that cry out for 
action. Still we don't take the action.
  We have considered other pieces of legislation that have some 
importance. But I daresay that none of the recent pieces of legislation 
that we have considered, I believe, rise to the importance of the 
debate and discussion on the Patients' Bill of Rights.
  Mr. President, I want to include in the Record today the testimony 
and the comments of some leading American citizens who are very 
concerned about ensuring adequate protections for consumers of mental 
health services--protections that are included in the Patients' Bill of 
Rights, which has been introduced by Senator Daschle, and are not 
included in the Republican proposal.
  In the forum that was held this afternoon, 36 groups--representing 
patients, families, psychiatrists, psychologists, social workers, and 
others who are concerned about quality of health care for people with 
mental illness--begged the Senate to act to pass the Patients' Bill of 
Rights. With every day that passes, these patients and their families 
are suffering because of abuses by the managed care systems. In too 
many instances, the stories they told were tragic. They involved 
suicide, spousal abuse, anxiety attacks inflicted on a Vietnam veteran, 
and successful courses of treatment cruelly interrupted because 
insurance companies are putting their bottom line first and their 
obligations to patients last.
  One of our speakers, the president of the National Alliance for the 
Mentally Ill, NAMI, focused on an important provision of our 
legislation that has not received as much attention as some of the 
other issues--access to needed prescription drugs that are not on a 
health plan's approved list. For mental patients, the last few decades 
have seen a significant growth in the number of new medicines that can 
treat their diseases. For many patients, these new drugs represent 
genuine medical miracles and opportunities to resume lives that have 
been devastated by these cruel diseases. But too often managed care 
plans have said ``no'' to these patients and their doctors. They say: 
``The new drugs are too expensive. You will have to make do with older, 
cheaper drugs that are on our approved list. If they don't work for 
you, that is just too bad.'' That should be unacceptable to every 
American.
  Our legislation will guarantee that no family with a mentally ill 
member will ever be subjected to this kind of abuse again.
  Mr. President, I ask unanimous consent to have printed in the Record 
the statement of the Mental Health Liaison Group.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                  Mental Health Liaison Group,

                               Alexandria, VA, September 23, 1998.
     Hon. Trent Lott,
     Senate Majority Leader,
     Capitol Building, Washington, DC.
       Dear Senator Lott: The undersigned members of the Mental 
     Health Liaison Group (MHLG) are writing to urge the Senate to 
     pass meaningful legislation protecting consumers now enrolled 
     in managed care before the end of the 105th Congress. If 
     Senate passage is accomplished in an expeditious manner, 
     ample time remains to initiate a conference committee with 
     the House and achieve final passage of this important 
     legislation.
       Our community has a large stake in timely consideration of 
     consumer protection legislation. Today, over 160 million 
     Americans receive their mental health care from a mere 
     handful of managed care plans. Virtually every organization 
     signing onto this correspondence has received reports of:
       Consumers being denied access to emergency services despite 
     being in psychiatric crisis.
       Health care plans applying rigid utilization review 
     criteria that radically reduce the availability of 
     outpatients mental health services.
       Treatment plans, diagnoses and related clinical decisions 
     being reviewed by health plan personnel with no prior medical 
     or mental health training whatsoever.
       HMO drug formularies insisting upon the lowest-cost 
     psychotropic medications, which may be clinically 
     inappropriate for individuals with more serious mental 
     disorders.
       Procedural disputes should not inhibit free and fair debate 
     of consumer protection legislation on the floor. Key issues 
     like access to specialists, medical necessity, point of 
     service, legal accountability and related matters should now 
     be considered by the full Senate. The starting point for 
     debate could involve any of the wide array of comprehensive 
     bills now pending, including the measures endorsed by the 
     House and Senate Republican leadership.
       In our view, at this time, the only bill that represents 
     meaningful reform is S. 1890, the Patients' Bill of Rights 
     Introduced by Senator Daschle.
           Sincerely,
         American Academy of Child and Adolescent Psychiatry; 
           American Association for Marriage and Family Therapy; 
           American Association for Psychosocial Rehabilitation; 
           American Association of Children's Residential Centers; 
           American Association of Pastoral Counselors; American 
           Association of Private Practice Psychiatrists; American 
           Board of Examiners in Clinical Social Work; American 
           Counseling Association; American Federation of State, 
           County and Municipal Employees; American Family 
           Foundation.
         American Group of Psychotherapy Association; American 
           Nurses Association; American Occupational Therapy 
           Association; American Orthopsychiatric Association; 
           American Psychiatric Association; American Psychiatric 
           Nurses Association; American Psychoanalytic 
           Association; American Psychological Association; 
           Anxiety Disorders Association of America; Association 
           for the Advancement of Psychology.
         Association for Ambulatory Behavioral Healthcare; 
           Association of Behavioral Healthcare Management; 
           Bazelon Center for Mental Health Law; Child Welfare 
           League of America; Children and Adults with Attention 
           Deficit Disorder; Clinical Social Work Federation; 
           Corporation for the Advancement of Psychiatry; 
           International Association of Psychosocial 
           Rehabilitation Services; National Alliance for the 
           Mentally Ill; National Association for Rural Mental 
           Health.
         National Association of Protection and Advocacy Systems; 
           National Association of Psychiatric Treatment Centers 
           for Children; National Association of School 
           Psychologists; National Association of Social Workers; 
           National Council for Community Behavioral Healthcare; 
           National Mental Health Association.

  Mr. KENNEDY. Mr. President, we heard today from Jackie Shannon. She 
is the president of the National Alliance for the Mentally Ill, NAMI, 
and the mother of a son with schizophrenia. I would like to read from 
her very, very moving testimony. This passage refers to a woman named 
Pam Childs from Miami, Florida and her problems with manic-depressive 
illness:

       Pam was a Ph.D. psychologist who specialized in treating 
     children and adolescents . . . Repeatedly, Pam's HMO told her 
     that the treatment being recommended by her doctors were 
     ``not part of the plan.'' On several occasions, doctors who 
     made progress in treating Pam were later told that they were 
     ``being taken off the plan.'' Pam Childs never got the 
     treatment she needed, and this story did not have a happy 
     ending. On July 2 of this year, at 34 years of age, Pam took 
     her own life by leaping from the window of her father's 15-
     story apartment.

  Mr. President, Jackie Shannon also told us about the problems the 
mental health community faces in terms of access to various 
prescription drugs. The prescription drug formularies used by insurance 
companies limit access to the newest and most effective medications. I 
would like to read from her testimony:

       Over the past decade, the most far-reaching advances in the 
     treatment of brain disorders such as schizophrenia and manic-
     depressive illness have all been in the area of prescription 
     drugs. These new medications are highly effective in treating 
     severe symptoms, without many of the disturbing side effects 
     associated with older medications. While some of these 
     medications may cost more at the front end, they deliver 
     significant long-term savings through fewer and

[[Page S10821]]

     shorter hospitalizations, and, more importantly, a higher 
     quality of life for consumers.
       Unfortunately, managed care plans too often use 
     formularies--restrictive lists and bureaucratic rules--to 
     limit access to the newer, more effective medications. What 
     kind of rules? A 1997 survey of managed behavioral health 
     plans by NAMI revealed widespread use of policies such as 
     prior authorization, and what they call ``twice-fail'' 
     requirements as parts of the formulary.
       These ``twice fail'' rules are especially offensive to the 
     NAMI members. Our survey found that some managed care plans 
     actually require patients to fail on older, cheaper 
     medications multiple times before being able to access the 
     newer medication. NAMI believes that psychiatrists and their 
     patients should be able to select the medication that is 
     right for them based on clinical effectiveness, not on a 
     managed care plan's financial bottom line. The best treatment 
     available should be the treatment of first choice.

  Do we understand that, Mr. President? The best treatment available 
ought to be the treatment of first choice. The Democratic version of 
the Patients' Bill of Rights guarantees that. It would allow the 
doctors to overrule a plan's restrictive drug formulary when it is in 
the patient's interests. The Republican bill would not.
  Now, Mr. President, this is an issue of particular importance to 
persons with mental illness who need these newer drugs. We hear case 
after case of patients who would be helped if they had access to the 
newest and most effective medications. We heard of one young person 
whose plan required him to use the cheaper drugs and demonstrate their 
failure not just once, but twice, before they would even be eligible 
for the right drugs. This is one of the reasons that we provide this 
kind of protection in our Patients' Bill of Rights. We believe it is 
important to ensure that the doctor can to say, This is the kind of 
prescription drug that is necessary to deal with your particular health 
need and that the plan will cover it, if the plan offers drug coverage.
  That is a very important protection. We would like to debate that 
issue. If the Republican leadership does not believe that we ought to 
provide that kind of protection, they should come to the floor of the 
Senate and let's call the roll. This is not a complicated issue. It is 
not a very complicated issue. But it is one of the very important 
protections that exist in our bill and which does not exist in the 
Republican bill.
  The American people have been effectively denied--with the various 
proposals that have been offered by the majority leader in terms of the 
debate of the Patients' Bill of Rights--from seeing where the Senate 
stands on these important issues. The leadership has said, in reference 
to their proposal, You can either take it or leave it. They are 
attempting to gag not only the doctors in this country from giving the 
best advice on health care needs, but they are also attempting to gag 
the Senate from having any kind of debate or discussion on these 
issues, let alone a vote on them. That is very, very important, Mr. 
President. The National Association of Mentally Ill feel that access to 
prescription drugs is of enormous importance to their membership. Their 
view is shared by all of the leading mental health organizations. That 
is why the 36 different groups have indicated strong support for the 
Democratic Patients Bill of Rights.
  Mr. President, I refer right here to this chart that compares our 
Patients' Bill of Rights, which puts patients before profits, and the 
Republican legislation. Right here, No. 11--access to doctor prescribed 
drugs--the question is whether you will be able to get the kind of 
prescription drug--new or old, perhaps somewhat more expensive--that 
your doctor recommends, or be forced to take only those medications 
that are listed on the HMO plan and just do not work for you.
  Mr. President, this forum that we had was just the most recent one in 
which we heard patients and doctors and nurses pleading with the 
Republican leadership to act on real managed care reform before the end 
of the year.
  At today s forum, I spoke about a particularly tragic set of 
circumstances surrounding the case of a man who died because his plan 
denied necessary treatment. In this case, however, like too many 
others, the plan was not held accountable for its abusive actions. Let 
me just tell you, Mr. President, about this very tragic case.
  Richard Clarke of Haverhill, MA, was struggling to deal with a 
serious problem of substance abuse. His health plan clearly covered 30 
days of inpatient rehabilitation. But when Mr. Clarke's doctor admitted 
him to a detoxification program, the plan provided only 5 days of 
treatment. His treatment was cut short, and his pattern of abuse and 
inadequate treatment continued. Shortly after the first 
hospitalization, his doctor again tried to admit him. But his HMO 
approved just 8 days of inpatient rehabilitation. And 24 hours after 
this discharge, Mr. Clarke attempted suicide. Again, he was referred 
for additional inpatient treatment, but this time the HMO refused to 
pay for any additional services--even though his policy clearly should 
have covered 17 additional days.
  At this point, a judge committed Mr. Clarke to a State correctional 
center. Mr. Clarke was abused in that center and received only minimal 
treatment. Tragically, just a few weeks after being discharged from the 
correctional center, Mr. Clarke committed suicide at age 41. He left a 
widow and four children and 17 days of inpatient rehabilitation 
coverage on his insurance policy--17 days that were not used, 17 days 
that were repeatedly denied by the HMO. And he took his life.
  His widow took the insurance plan to Federal court. But Judge William 
Young had no choice but to reluctantly dismiss the case because the 
Federal law protected the HMO from accountability for its actions.
  Judge Young was frank in his opinion:

       Federal law has evolved in a shield of immunity that 
     protects health insurers. . . and other managed care entities 
     from potential liability for the consequences of their 
     wrongful denial of health benefits. The Federal law thwarts 
     the legitimate claims of the very people it was designed to 
     protect.

  There it is, Mr. President, an example of an individual who needed 
help, consolation, rehabilitation, and attention, but was denied it by 
the HMO. A tragic, tragic ending, with the HMO responsible--I believe, 
just from a reading of these facts--or certainly contributing to the 
anxiety and ultimately to the untimely death, and the loss of this 
father of four children. And, under current law, the HMO is able to 
stand back and say, no, we can't be sued. And they cannot be, Mr. 
President.
  That particular issue is addressed in our legislation. Right here on 
the chart where we say ``ability to hold plans accountable.'' But it is 
not in the Republican legislation. We looked through their bill. It is 
not there, but it is in ours. Another issue to debate. Another issue to 
discuss. Another issue to vote on. It is not very complicated. Are you 
going to hold a plan accountable when its decisions result in the death 
or serious injury of an individual who may be the breadwinner for a 
family? Are you going to deny a family the opportunity to hold 
insurance companies responsible if a loved one has been the recipient 
of negligent treatment?
  We ought to be able to vote on that. It is not very complicated. But 
no, no, we cannot even bring that up. We cannot even debate it. It is a 
crucial matter, certainly, to the Clarke's or any other family in this 
situation. It is a crucial matter to millions of other families.
  Mr. President, there are millions of Americans who have that kind of 
protection today, but it is not guaranteed to over 120 million 
Americans who receive their insurance through employers in the private 
sector. It is not guaranteed. It is effectively excluded. Mr. 
President, more than 40 million Americans can hold their HMOs 
accountable, but more than 120 million others cannot. The others 
cannot. Why not, we might ask? Because the power of the special 
interests will not permit us to get to this legislation, to consider 
it, debate it, and call the roll on it.
  Mr. President, this forum was just the most recent one in which we 
have heard the patients and doctors and nurses pleading with the 
Republican leadership to act on real managed care reform. Several weeks 
ago, we heard from Dr. Charlotte Yeh, an emergency doctor from Boston 
who also is a leader in the American College of Emergency Physicians. 
In fact, we have had the leaders of many of these professional groups 
appear in these forums--representatives of from many of the more than 
180 different groups of patients and doctors, nurses, health 
professionals that support our legislation.

[[Page S10822]]

  Dr. Yeh described cases where HMOs denied treatment that patients 
needed because of managed care penny-pinching. She indicated she was 
appearing at the forum ``representing the concerns of 20,000 emergency 
physicians, on behalf of 90 million patients we see every year.'' She 
went on to say, ``For emergency physicians protecting patients is not 
just a job, it is our lives.'' They are strongly in support of our 
legislation. They strongly believe that we ought to have an opportunity 
to debate this legislation. They are strongly opposed to Republican 
leadership, and are concerned about the leadership s refusal to let us 
have an opportunity to debate the legislation. This is what Dr. Yeh 
commented on:
       For the last several years, the tactics of the managed care 
     industry with respect to coverage of emergency care has 
     become a national issue.

                           *   *   *   *   *

       We've all heard the stories.
       In Detroit, a 46-year old woman collapsed in her husband's 
     arms and was rushed to the hospital by ambulance. She died of 
     cardiac arrest after a failed resuscitation attempt. 
     Unbelievably, her managed care plan later denied payment for 
     her treatment because she did not call for prior approval.
       In Boston, a boy's leg was seriously injured in an auto 
     accident. At a nearby hospital, emergency doctors told the 
     parents he would need vascular surgery to save his leg and a 
     surgeon was ready and available in the hospital.
       Unfortunately, for this young man, his insurer insisted he 
     be transferred to an ``in-network'' hospital for the surgery. 
     His parents were told if they allowed the operation to be 
     done anywhere else, they would be responsible for the bill. 
     They agreed to the move. Surgery was performed three hours 
     after the accident. But by then, it was too late to save his 
     leg.
       These are not episodes from the TV program, ``ER''. These 
     are not anecdotes. They are real people with real lives.
       A bipartisan majority in the Congress has called for 
     enactment of standards that will put an end to episodes like 
     the ones I just described. Last year, the Congress adopted 
     the prudent layperson standard and other protections for 
     Medicare and Medicaid patients seeking emergency 
     care. Millions of Medicare and Medicaid beneficiaries have 
     these protections, but not the 160 million people outside 
     of those programs. They do not have these protections.

  She continues:

       We thought there was consensus on this issue. . . . But we 
     are very disturbed about the way in which the emergency 
     service protections were drafted in the Republican ``Patient 
     Protection Act.'' As a physician, it seems that a little 
     unnecessary surgery was performed on the ``prudent 
     layperson'' standard to the point where barely recognizable 
     as the consumer protection we envisioned.

  Mr. McCAIN. Will the Senator from Massachusetts yield?
  Mr. KENNEDY. Yes.
  Mr. McCAIN. Just for a question. The Senator from Massachusetts, I 
know, wants to indulge his colleagues. We have Senator Inhofe on the 
floor on an amendment on pending legislation, and Senator Roth to 
follow him. So if he could perhaps very quickly allow the amendment 
process to proceed, I would appreciate it very much. I thank the 
Senator from Massachusetts.
  Mr. KENNEDY. Seeing Senators are here and ready to move ahead, I will 
just make some few concluding remarks on this issue and then get back 
to it at another time. I think we could have been debating this, rather 
than just filling in the time with the quorum calls, which we have been 
doing frequently. So I indicate to colleagues, I will make some 
concluding remarks for just a few more minutes and then yield the 
floor. Again, from Dr. Yeh's testimony:

       What's the difference between the real ``prudent 
     layperson'' standard included in the Balanced Budget Act and 
     the Democratic Patients Bill of Rights and the imposter that 
     has been included in the GOP Patient Protection Act?
       The GOP Patient Protection Act would establish a weaker 
     coverage standard for privately insured patients than what 
     exists for Medicare and Medicaid patients.

  This is not Senator Daschle or myself making this statement, this is 
a leading member of the American College of Emergency Physicians--
doctors who deal with this problem every single day--talking about how 
the GOP Patient Protection Act is a fraud.
  She continues along. I ask unanimous consent to have her full 
statement printed in the Record.
  There being no objection, the statement was ordered to be printed in 
the Record, as follows:

   Testimony of Charlotte Yeh, MD, FACEP, Chair, Federal Government 
      Affairs Committee, American College of Emergency Physicians

       Thank you very much. I am Dr. Charlotte Yeh, a practicing 
     emergency physician at the New England Medical Center in 
     Boston, MA. I am here today representing the concerns of 
     nearly 20,000 emergency physicians and on behalf of the 90 
     million patients we see every year. For emergency physicians, 
     protecting patients is not just a job, it's our life.
       For the last several years, the tactics of the managed care 
     industry with respect to coverage of emergency care has 
     become a national issue. I'm pleased to be here today as we 
     try to enact meaningful patient protections that will ensure 
     that patients get not only the care they deserve, but that 
     they also get the coverage that their managed care plan 
     promised them.
       We've all heard the stories.
       In Detroit, a 46-year old woman collapsed in her husband's 
     arms and was rushed to the hospital by ambulance. She died of 
     cardiac arrest after a failed resuscitation attempt. 
     Unbelievably, her managed care plan later denied payment for 
     her treatment because she did not call for prior approval.
       In Boston, a boy's leg was seriously injured in an auto 
     accident. At a nearby hospital, emergency doctors told the 
     parents he would need vascular surgery to save his leg and a 
     surgeon was ready and available in the hospital.
       Unfortunately, for this young man, his insurer insisted he 
     be transferred to an ``in-network'' hospital for the surgery. 
     His parents were told if they allowed the operation to be 
     done anywhere else, they would be responsible for the bill. 
     They agreed to the move. Surgery was performed three hours 
     after the accident. But by then, it was too late to save his 
     leg.
       These are not episodes from the TV program, ``ER''. These 
     are not anecdotes. They are real people with real lives.
       A bipartisan majority in the Congress has called for 
     enactment of standards that will put an end to episodes like 
     the one I just described. Last year, the Congress adopted the 
     prudent layperson standard and other protections for Medicare 
     and Medicaid patients seeking emergency care. We thought 
     there was a consensus on this issue!
       Just a few weeks ago, we were delighted to see that 
     Republican Task Forces in both the House and Senate had 
     decided to include the ``prudent layperson'' standard in 
     their respective patient protection measures.
       But we are very disturbed about the way in which the 
     emergency services protections were drafted in the Republican 
     ``Patient Protection Act.'' As a physician, it seems that a 
     little Unnecessary surgery was performed on the ``prudent 
     layperson'' standard to the point where it is barely 
     recognizable as the consumer protection we envisioned.
       What's the difference between the real ``prudent 
     layperson'' standard included in the ``Balanced Budget Act'' 
     and the Democratic ``Patient's Bill of Rights'' and the 
     ``imposter'' that has been included in the GOP ``Patient 
     Protection Act?''
       The GOP Patient Protection Act would establish a weaker 
     coverage standard for privately insured patients than what 
     exists for Medicare and Medicaid patients.
       The Democratic bill would provide the same protections for 
     all patients.
       The GOP Patient Protection Act establishes a two-tiered 
     test for coverage of emergency services and guarantees 
     coverage only for a ``screening examination.''
       The Democratic bill would require that health plans cover 
     all services necessary to evaluate and stabilize the patient 
     to anyone who meets the prudent layperson standard--no 
     questions asked!
       The GOP Patient Protection Act sets no limits on the amount 
     of cost-sharing the managed care plans would be allowed to 
     charge patients who seek emergency services from a non-
     network provider.
       The Democratic bill would protect patients who reasonably 
     seek emergency services to protect their health from being 
     charged unreasonable co-pays and deductibles.
       The GOP Patient Protection Act provides sets no guidelines 
     for the coordination of post stabilization care, making it 
     impossible for emergency physicians to coordinate and obtain 
     authorization for necessary follow-up care with the managed 
     care plans.
       The Democratic bill would require health plans to adhere to 
     new federal guidelines that require managed care plans to be 
     available to coordinate post stabilization care, instead of 
     just permitting the managed plan to turn off the phone at 
     5:00 o'clock.
       Obviously, we are very troubled by the changes to the 
     ``prudent layperson'' standard in the ``Patient Protection 
     Act.''
       Our assessment is that this legislation--Will provide less 
     protection for privately insured patients than for Medicare 
     and Medicaid patients; Will lead to more coverage disputes, 
     not less; Will create even more barriers, not fewer; and Will 
     create new loopholes for managed care plans to deny coverage 
     of emergency services.
       In four years, we have come so far, but we cannot support 
     these provisions in their current form. We will do everything 
     in our power to ensure that the ``prudent layperson'' 
     standard that is enacted will be consistent with the 
     meaningful protections that Congress enacted for Medicare and 
     Medicaid beneficiaries. Hard-working Americans who pay their 
     premiums deserve no less.

  Mr. KENNEDY. We heard from cancer patients, and their doctors, who 
explained that the Patients' Bill of Rights is critical to ensuring 
patients

[[Page S10823]]

access to quality clinical trials. These trials are often the only hope 
for patients with incurable cancer or other diseases where conventional 
treatments are ineffective. They are the best hope for learning to cure 
these dread diseases.
  Insurance used to routinely pay the doctor and hospital costs 
associated with clinical trials, but managed care plans are refusing to 
allow patients to participate. Our bill forces the insurance companies 
to respond to these needs, but the Republican bill does not. And they 
refuse to debate this issue. Here it is on the chart, ``Access to 
Clinical Trials.'' We provide this protection, and they do not.
  Yet, this is very important for women who are battling breast cancer. 
It is important for children--like my own son, Teddy, who was able to 
get into a clinical trial when he had osteosarcoma at age 12, and 
survive that dread disease. He is alive today because he was in a 
clinical trial.
  Mr. President, as I have pointed out before, these are the guarantees 
that are in our legislation. Under our proposal, the doctor, the 
medical professional, will make the decisions on medical treatment for 
the patient--be that you or your spouse or your child or your 
grandchild. Medical decisions will not be made by an insurance company 
accountant. That is what is at the heart of the differences between the 
two pieces of legislation.
  We welcome an opportunity to just say we will take 10 of the issues 
on this list, and vote on those measures and vote on the legislation, 
while permitting our Republican friends to have a similar number of 
amendments. But let us at least get about it in these final days. It is 
not too late. It must not be too late, or we would not see the kinds of 
activity to deny or delay action on this legislation by our Republican 
friends each day.
  Just in conclusion, earlier in the day--although this was not 
advanced, it was circulated by the majority--there was a unanimous 
consent that was going to be proposed on the Internet tax legislation. 
I will include the whole provision in the Record.
  This was circulated to see whether there would be any objection on 
the Democratic side. It basically allowed all types of amendments--
unlimited first and second degree amendments or amendments that are not 
relevant to the Internet tax issues in the underlying bill--but, and 
this is important, no health care amendments. Here is the text that 
would have been spoken by the Majority leader, ``I further ask that 
during the Senate's consideration of S. 442 or the House companion, no 
amendments relative to health care be in order.'' There you have it: 
One piece of legislation, with possibilities for all other legislation, 
except one--health care, the Patients' Bill of Rights, guaranteed 
protections for more than 160 million people. Under this proposal from 
the Republican leadership, we are permitting other kinds of amendments, 
but we are going to say no amendments relative to health care be in 
order.
  Thankfully, our Democratic leader rejected this, so it was not 
offered. But these are the tactics we are facing. We are as committed 
as ever to ensuring that we will have an opportunity to debate this 
issue--even if not on this particular measure. So we are going to 
continue to pursue it.
  I thank the Chair and I yield the floor.

                          ____________________