[Congressional Record Volume 144, Number 129 (Thursday, September 24, 1998)]
[Senate]
[Pages S10889-S10893]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                         THE HEALTH CARE SYSTEM

  Mr. GRAMM. Mr. President, about an hour ago, our dear friend, Senator 
Kennedy from Massachusetts, came on the floor to talk about health care 
and, like Goliath of old, challenged us to respond to his cry to allow 
him to dramatically change our health care system. Since it appears 
that there is a break in the legislative action,---I see no one 
standing around waiting to speak or amend--I thought I would make 
Senator Kennedy's day, so-to-speak, by coming over and responding to 
him.
  Mr. President, there are several points I want to make and I will try 
not to belabor any of them. First of all, there is something to be said 
about having an institutional memory. I would like to take our 
colleagues, at least those who are now eager to remake our health care 
system in their ideal image, down memory lane, and remind them that it 
was only in 1993 that President Clinton and Senator Kennedy told us in 
a debate, which lasted for 18 months in the Senate, that they knew how 
to solve our health care problem.
  Our health care problem, in 1993, according to President Clinton and 
Senator Kennedy, was an access problem, that 40 million Americans did 
not have health insurance, and their solution was to have the 
Government take over and run the health care system and create one 
giant HMO that I think they called a ``health care purchasing 
collective.'' All Americans were going to be forced into one giant 
Government-run HMO, and the benefit we were going to get from it was 
that everyone

[[Page S10890]]

would be covered. The cost of it, obviously, was that we would lose our 
right to choose.
  Now, in that program, no one had the right to sue the Government 
based on poor medical treatment. They had the right that you have under 
current law to sue an HMO if they violate their contract. But we were 
told in 1993 that the problem was access to health care, and that the 
right to choose your own doctor, the right to choose your own hospital, 
and the right to sue was not important. What was important--in the 
words of Senator Kennedy and the President, which still ring in our 
ears --was ``access.''
  Now, here we are 5 years later and we are now being told that the 
problem is not access, the problem is not that 40 million Americans are 
having trouble paying for health insurance, and that in fact we should 
take action to make millions more unable to pay for their health 
insurance; we are now being told that the problem is that HMOs limit 
choice.
  Now, Mr. President, I can't help but be struck by the fact that the 
same people who, 5 years ago, said the problem is access and we should 
sacrifice choice by putting everybody into one giant Government-run HMO 
called a ``health care collective,'' and that we should limit the 
ability of people to sue in the name of access--those same people are 
now saying that the problem is that HMOs limit choice. Specifically, 
they are saying the problem is that, under current law, you can't sue 
an HMO.
  The only point I want to make--and I think it is a very important 
point--is that, 5 years ago, the President and Senator Kennedy loved 
HMOs. They loved them so much they wanted to put every American into 
one, regardless of their circumstances, and not allow anyone, under 
punishment of law, to buy health care outside the system. They wanted 
to have everyone in one giant Government health care HMO called a 
``health care collective.''
  Now, they don't love HMOs anymore. Then they cared about people 
having health insurance, and now they don't care about people having 
health insurance. In fact, under their bill, even under the most 
conservative estimates, hundreds of thousands, millions of families 
will lose health insurance. Suddenly, they don't like HMOs, and they 
want to protect people from the very same health care system that they 
wanted to impose on the Nation on a mandatory basis just 5 years ago.
  Now, what is their real objective? We all know their real objective 
because, one thing about them--and they are not trying to hide it--is 
that they really believe the Government ought to run the health care 
system. We know what their ideal plan looked like; we had it 5 years 
ago. By the way, it looked very menacing. We had about 70 Members of 
the Senate who were cosponsoring these Government-run health care 
collectives. It looked like a 20-foot tall giant until, finally, a few 
Members of the Senate went up and stuck a pin in its big belly and it 
deflated. People realized that when their mama got sick, she was going 
to have to talk to a bureaucrat instead of a doctor, so we killed the 
Kennedy-Clinton health care plan.
  Well, they are back. Since we are not going to let them run the 
health care system, they have decided they are going to tell the 
private sector how to run it.
  Let me address the problems with HMOs. Let me say that, unlike the 
President and Senator Kennedy, I never was in love with their idea of 
an HMO. I was opposed to forcing people, on a mandatory basis, to go to 
a Government-run HMO. I want people to have choices. Now, Senator 
Kennedy says these HMOs are bad, but he doesn't want to give people the 
power to fire them, which I want to do. He wants to give people the 
ability to sue them.
  I want to give people the ability to have real choices. That is what 
our bill is about.
  Let me try to define the problem. I want to define it generically, 
and then I want to talk about the problem as people see it. Then I want 
to talk about Senator Kennedy's solution and then about the Republican 
solution.
  Here is the real problem. HMOs have grown like wildfire because of 
exploding medical costs. Under our old medical system, which we all 
loved and which was wonderful, except for one thing--nobody could 
afford it--with fee-for-service medicine and low-deductible health 
insurance policies, we all bought health care where somebody else paid 
for it.
  Under our old health care system, if you went to the hospital, 
somebody else paid 95 percent of your bill. Sometimes that was private 
health insurance; sometimes it was Medicare; sometimes it was Medicaid; 
sometimes it was indigent care. But the bottom line was, under our old 
fee-for-service health care system where Americans with Medicaid, 
Medicare, and private health insurance had a third party paying, when 
you went to the hospital somebody else paid 95 percent of your costs.
  Can you imagine if we had grocery insurance, so that when we went to 
the grocery store 95 percent of everything we put in our basket was 
paid for by our grocery insurance? We would all eat differently, and so 
would our dogs. Grocery stores as we know them wouldn't exist. They 
would have 20 times as many people working at the supermarket as they 
have now. They would have all kinds of luxury foods and prepared foods. 
And we would all love the grocery store, and we would all hate our 
grocery insurance bills.
  That is the situation we were in. Government, as usual, did nothing 
about it. In fact, Government policy made all those problems worse. 
Then the private sector started to move to solve the problem. And one 
of the innovations was the development of the HMO. People have gone 
into HMOs, through their jobs, by the millions because they are 
cheaper, because they exercise more judgment in spending and because 
they make health care more affordable.
  But there is a problem. The problem is that the way the HMOs control 
cost is by exerting influence over the health care you consume. Here is 
the problem with our national psyche. The problem is, we all want the 
benefits of cost control, but we don't want to bear the burden of 
having the cost control imposed on us and our family. We want the lower 
rates of the HMOs. We want to make the HMOs give us whatever we want, 
but we don't want them to charge us more to pay for it.
  In other words, as usual, we want a free lunch. We want something for 
nothing. But that can never be, because one of the things God decided a 
long time ago is, you can't get something for nothing. If you drive up 
costs, you have to pay for it ultimately.
  Here is Senator Kennedy's definition of the problem, and here is his 
solution.
  His definition of the problem, which millions of Americans identify 
with--and so do I--is when you go to see your doctor and you are a 
member of an HMO, when you go into the examining room, the HMO has its 
gatekeeper in the examining room, in essence, making decisions with 
your doctor as to what you need.
  We don't want somebody else in our examining room. When we go into 
the examining room with the doctor, we want to be alone with the 
doctor. The problem is, with HMOs, one of the prices we pay for lower 
cost is having a gatekeeper involved in our health care, which almost 
literally means having a third person in the examining room.
  What do Americans want, and what does Senator Kennedy want?
  Americans want to get the gatekeeper out of the examining room. They 
want to be alone with their doctors. What Senator Kennedy says is, 
``OK, you do not like having a gatekeeper in your examining room. So 
what we will do is this.''
  If you will adopt Senator Kennedy's bill, he will bring into the 
examining room a Government bureaucrat, whom he will choose, who will 
be there to regulate the gatekeeper and your doctor. And then you will 
get to hire with your money a lawyer, who can be there to watch the 
doctor and the gatekeeper and to be there to sue them on your behalf.
  I thought it would be instructive to take a simple medical device, 
the stethoscope, invented by the ancient Greeks and used to this day to 
listen to people's hearts, and demonstrate graphically what Kennedy-
Care looks like. What Kennedy-Care looks like is this stethoscope.
  When you go into the examining room, under Senator Kennedy's program, 
you are at this end--this part

[[Page S10891]]

right here where they put that right up against your heart. So that is 
where you are. Then your doctor has one set of earpieces so that he can 
listen to your heart and determine if something is wrong with you.
  Then the problem everybody is concerned about is, the HMO has a 
gatekeeper there with his stethoscope next to your heart listening to 
your beat, second-guessing your doctor.
  What you would like to do is cut this part of the stethoscope off. 
That is what every American who is a member of an HMO would like. But 
what does Senator Kennedy do? He adds another stethoscope for the 
Government bureaucrat that he is going to choose. So the Government 
bureaucrat is going to be listening to your heartbeat, second-guessing 
the HMO, and second-guessing your doctor, and trying to tell them both 
what to do.
  In addition, Senator Kennedy lets you hire a lawyer to come, and 
gives him another stethoscope.
  So here you are. What you wanted was to be alone with your doctor. 
But now, under the Kennedy plan, you are in the examining room not only 
with your doctor and the HMO gatekeeper, but also with a bureaucrat 
chosen by Senator Kennedy, and a lawyer, whom you pay for. So there you 
are, and there are four people in the examining room with you, three of 
whom you don't want.
  It is Senator Kennedy's solution to the problem.
  You wanted to get rid of the gatekeeper. But he keeps the gatekeeper, 
because he doesn't give you the ability to fire the HMO, but he sends 
his bureaucrats in and then takes your money to hire you a lawyer. 
Suddenly, you have four people in the examining room with you and you 
are three times as unhappy as you were before.
  That is not the solution that most Americans have in mind.
  What is the solution they have in mind? The solution they have in 
mind is what I call ``medical savings account care.'' Under our 
program, which is embodied in the Republican alternative, this is what 
the stethoscope looks like--again, exactly like the Greeks designed it.
  Here you are. The doctor is listening to your heart. Here is the 
doctor. But you have gotten rid of the HMO gatekeeper. You didn't have 
to hire Senator Kennedy's bureaucrat. You didn't have to hire Senator 
Kennedy's lawyer. What you have is simply you and your doctor.
  That is what people want.
  How do we do it?
  I conducted an interesting experiment the other day and I want to 
show you a chart and share the results with you today. I took a page of 
medical providers out of the Yellow Pages. I called up, and asked them 
if they were part of the largest HMO in Washington, Kaiser HMO. Then I 
asked if they were part of the largest preferred provider organization. 
That is Blue Cross, PPO. Then I asked them about the Republican 
solution, which is based on medical savings accounts, and I will 
explain more about them in a minute.
  The Republican bill--I want to congratulate our leader, Don Nickles, 
and the members of our task force who put together an excellent bill 
that deals with the legitimate concerns that Americans have about HMOs. 
But we do more on that to try to deal with HMO abuses, because we give 
people the power to fire their HMO--something Senator Kennedy does not 
do. He gives you the power to have a Government bureaucrat oversee your 
HMO, gives you the power to have a lawyer to sue them, but he doesn't 
give you the power to fire them.
  Now, in addition to dealing with the legitimate concerns about HMOs, 
we did something so much better, and that is we brought freedom into 
the Patients' Bill of Rights. What are the Bill of Rights about if they 
are not about the right to choose. So we create real medical savings 
accounts, and here is how they work. Let's say I have two children, 
which I do, and I have a wife. And I am grateful for the children and 
my wife. I buy the standard option Blue Cross/Blue Shield, and it costs 
my employer about $4,000 a year. Now, I could buy that same coverage, 
if it had a $3,000 high deductible, for just $2,000 a year. That is 
because the first $2,000 of medical costs are prepaid medical expenses 
rather than insurance.
  So under our bill, people would have the right--no one would make you 
do it, but you would have the right to choose a medical savings 
account. What it would mean, especially for young couples with a 
moderate income, is that you could at a low cost buy a high-deductible 
policy to protect your family in case something really bad happened and 
yet you could still afford it.
  The way it would work is your company, which is currently buying you 
a $4,000 Blue Cross/Blue Shield standard option, low-deductible policy, 
would instead buy for $2,000 the high-deductible plan and then deposit 
the $2,000 it saves into your medical savings account. With that 
$2,000, and the $1,000 you would normally spend on both health premiums 
and out of pocket medical expenses, your medical savings account would 
have $3,000 to pay for all your health care expenses up to $3,000. Any 
further medical expenses above $3,000 in a year would be covered by 
your high-deductible insurance.
  Now, there are two reasons why this is important. One, at the end of 
the year, if you had not spent that $3,000 in your medical savings 
account on medicine, it is your money. If you go to the doctor and you 
say, I have a terrible headache, and the doctor looks at you, examines 
you, and he says, look, you probably have a headache and you have two 
options: One, I can give you two aspirins and it will probably go away, 
or I can give you a brain scan that will cost $1,000. If you take the 
two aspirins and it doesn't go away, you can come back tomorrow and I 
can give you the brain scan. With the medical savings account, since 
you get to keep that $1,000 if you don't spend it on a brain scan, you 
will see more rational economic decisions. You will probably ask the 
doctor what he really thinks, and in all probability, you re going to 
take the two aspirins and come back tomorrow if the headache is not 
gone.
  On the other hand, under Senator Kennedy's plan, if you have low-
deductible insurance, you will say, well, does this brain scan hurt? 
And they will say, no, it doesn't hurt at all. In fact, it is very 
interesting. You can actually watch it. You might say, great, let's 
have the brain scan.
  The point is, if I am spending my money I behave differently than if 
I am spending someone else's money. But under the medical savings 
account, at the end of the year, if all I had was a headache, I am 
$1,000 better off in my pocket--to send my children to Texas A&M or to 
go on a vacation or buy a refrigerator--if I went with the two aspirins 
and I didn't need the brain scan. But the most important thing about 
our medical savings accounts is I get to choose.
  Now, let me get back to my experiment. I took a page out of the 
Yellow Pages. In my Yellow Pages test on the Kennedy health care plan 
and the Republican health care plan, I decided to give him the benefit 
of the doubt and assumed that everyone was in the biggest HMO in 
Washington. Many people won't be. Or let's say everyone went with the 
most popular preferred provider organization, the Blue Cross/Blue 
Shield PPO. So what we did was, starting with Ginsberg, Susan M. 
Ginsberg, M.D., at 106 Irving Street, NW, 723-4015, we went through and 
called each of these physicians and we asked them three questions: One, 
Do you participate in the Kaiser HMO?
  Ten of them did. So if I were a member of the Kaiser HMO, I could see 
one of their doctors. If I could get to see somebody under the Kennedy 
plan, I would even have a Government bureaucrat in the examining room 
with me sharing my intimate experiences, along with a gatekeeper at 
Kaiser, but only 10 doctors of the 28 on this list would see me under 
the Kaiser HMO plan.
  Now, if I had the Blue Cross PPO, 17 physicians that are listed on 
page 1017 of the Yellow Pages, 17 of the 28 physicians would take Blue 
Cross/Blue Shield. But then we asked them another question. We asked 
these physicians if they would take a check from a medical savings 
account. Golden Rule is a just one company that offers these MSA 
checking accounts. When you go to the doctor, you simply pay with your 
MSA check.
  Then you have, through Mellon Bank with MasterCard, a MasterCard 
medical savings account. The way it works is you don't call up any 
gatekeeper. You don't say, do you take my preferred provider? Or, do 
you participate

[[Page S10892]]

in this HMO? You simply call up and say, do you take MasterCard? And 
through the medical savings account at Mellon Bank you can get a 
MasterCard for participating in the program. And then there is Health 
Value, which has a medical savings account through Visa.
  I performed an additional experiment. After we had asked them, Do you 
take Kaiser HMO, and 10 of the 28 did; Do you take Blue Cross preferred 
provider, and 17 of the 28 did. Then we said, Do you take Visa? Every 
one of the 28 took Visa. Do you take MasterCard? Every one of them took 
MasterCard. If I have identification, do you take a check? Every one of 
them took a check.
  Now, there is the power of real freedom of choice. The freedom of 
choice is you do not have to go to an HMO. You do not have to go to 
some preferred provider. You do not have to appeal to an outside 
appeals board. You do not have to file a lawsuit. You do not have to 
have a Government bureaucrat. All you have to do is pick up the phone 
and call the doctor or the specialist you want and say, ``Dr. Goldbaum, 
do you take MasterCard?'' If he takes MasterCard, you don't care 
whether he is on somebody's preferred provider list or whether he is a 
referral specialist. He is your primary care physician, if he takes 
MasterCard.
  What our proposal does is set people free to choose. Senator Kennedy 
and the President hate medical savings accounts. They respond to 
medical savings accounts the way vampires react to a cross. And the 
reason is simply this: They understand that medical savings accounts 
empower people. And once somebody has a medical savings account, they 
do not want a Government bureaucrat. They do not need a lawyer. And if 
they need one, they can go into court and hire the lawyer. They do not 
have to fool around with gatekeepers. They just simply pick up the 
phone and dial William D. Goldman, Pediatrics-Adolescent Medicine. He 
could be a referral doctor for Kaiser or Blue Cross/Blue Shield. But 
they call up Dr. Goldman, and they have one simple question for Dr. 
Goldman: ``Dr. Goldman, do you take Visa?'' If Dr. Goldman takes Visa, 
they are in. We set them free to choose.
  Now, Senator Kennedy and the President understand that if we ever 
have medical savings accounts that will work, their idea of having the 
Government taking over and running the health care system of America is 
dead. It will never be brought back to life. So they do not like this 
provision in our bill. But the wonderful thing about it is we do not 
make people buy medical savings accounts. Many people love HMOs. My 
mother-in-law participates in an HMO and loves it, and she ought to 
have the right to choose it. Many people love preferred providers. All 
we do is make it possible for people to have real choice so if their 
baby is sick and they want to get in to see a specialist, if they want 
to see William D. Goldman, pediatrics and adolescent medicine, they 
don't go to a gatekeeper; they just pick up the phone and say do you 
take MasterCard? He does? They are in.

  Senator Kennedy tells us that he wants to vote on health care. I find 
it very interesting that we have offered him the ability to present to 
the Senate his plan, change it any way he wants to change it--put two 
Federal bureaucrats in every examining room, hire five lawyers, 
whatever works for him--develop the best system he can develop for 
America, we will not try to change it. We will not try to be 
mischievous and offer an amendment to it. He tells us how to fix the 
health care system. And then the Republican Task Force, of which I am a 
proud member, will present our alternative and what will happen is we 
will let people choose.
  Senator Kennedy, knowing we are in session for 10 more days--I ask 
unanimous consent for 5 additional minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. GRAMM. Senator Kennedy, knowing we are in session for only 10 
more days, wants to do all these amendments. He wants to amend our 
proposal. We do not want to amend his proposal. All we want to do is 
give people a choice. We think we have a better way. He, obviously, 
thinks highly of his plan. It is much closer to the world as he sees 
it.
  What we are saying is, if he really wants to vote on his plan, we can 
have a vote this afternoon. But what we want to do, instead of getting 
into all these games with only 10 days left where we try to amend each 
other's plan and mess it up and end up with something nobody in the 
world wants, what we have offered, and very generously offered as the 
majority--I don't ever remember it happening when we were the minority 
on a major bill--we have offered to Senator Kennedy, you take your 
health care plan and you write it exactly as you want it and you offer 
it and we will vote on it. And if you get 50 votes, you can get the 
Vice President to come over, break the tie, and you are in. You can put 
a Government bureaucrat in every examining room, you can have people 
hire lawyers, you can do it however you want to do it. But we think we 
have a better way.
  What we would like to say to Senator Kennedy is, we will give you a 
vote on your plan, and then you give us a vote on our plan. If we win 
and you do not, then we go forward with our bill. If you win and we 
don't, we go forward with your bill. But I am afraid there is a growing 
suspicion--I would never say this because I try to never be suspicious 
of people's motives--but there are some people who believe all of this 
discussion about health care is political. There are some people who 
believe that Senator Kennedy does not really want his bill voted on 
because he knows it is not going to pass. Some suspect he knows some of 
the Democrats are not going to vote for it. And I believe he suspects 
our proposal would pass.
  But the point is, if we really want to vote on health care with just 
10 days left, let's stop all the games; let's let the Democrats sit 
down in a room and write the best plan they can write and we will not 
try to amend it. We will not try to stall it. We will let them bring it 
forward, tell us why it is the right idea, and we will vote up or down. 
Then we would like to have the same right on our plan, and if we are 
successful then we can go to the House very quickly, work out our 
differences, and let the bill go to the President. If we really want to 
do something about health care, that is what we need to do.
  Finally, before my time runs out, I want to simply say that I believe 
that a lot of work has gone into this issue. I will congratulate 
Senator Kennedy and others for raising the issue. I think we have a 
better way, as Republicans. I think our bill is better. I think it 
gives more choice. I congratulate Doug Badger, who has been the staff 
director who, through some 25 meetings, has helped us put together, 
with Senator Nickles' leadership, what I believe is an excellent 
program. I would be happy for our program to become law.
  But we have 10 legislative days left. If we want to have any 
opportunity to do something about health care, there is only one way: 
the Democrats put together their best bill. If that is Senator 
Kennedy's bill, that is fine. If they want to change his bill, we are 
not going to interfere because we are not trying to make mischief. But 
we have a better way which we think will improve health care in 
America. We think it will make HMOs more responsive. We think it deals 
with legitimate concerns without denying millions of people access to 
health care because they will not be able to afford it, and it gives 
people the freedom to choose.
  Remember the Yellow Pages test. On the Yellow Pages test, if the 
Republican plan passes and you want a medical savings account--you can 
have one, but nobody makes you get one. You can do a HMO, you can do 
Blue Cross/Blue Shield, you can do whatever you want to do. But if you 
want to choose for your family, we put you in a position so when you 
call up Seth Goldberg--who is ear, nose, throat, facial plastic 
reconstructive surgery--you don't have to go through a gatekeeper, on 
the Republican plan. You just call up Dr. Goldberg and say, ``Dr. 
Goldberg, I wanted to come see you but I had to ask you a question.''
  So Dr. Goldberg gets out his big file and he figures we are about to 
ask him do you participate in the Joe B. Brown HMO, and he is going to 
look it up and see if he does. We just simply say, ``Dr. Goldberg, will 
you take a check?''
  He is going to say, ``Yes.'' And when he says yes, if your baby has a 
throat problem, you are going to get to see a specialist and you are 
not going to have to go through a gatekeeper.

[[Page S10893]]

  Senator Kennedy will let you sue if the gatekeeper says no, and he 
will have a Government bureaucrat there, with your child, if you ever 
get in to see the ear, nose and throat specialist. But the point is, if 
your baby is sick and your baby has a 104-degree fever, you don't care 
about suing. You want to go to see Dr. Goldberg.
  Our plan gets you in the door. Our plan gets your baby medical 
attention because it empowers you. Hallelujah.
  The PRESIDING OFFICER. The time of the Senator has expired. The 
Senator from North Dakota.
  Mr. DORGAN. Mr. President, I ask consent to speak in morning business 
for 3 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DORGAN. Mr. President, I will shortly offer an amendment to the 
FAA bill on the floor. But I could not help but listen to my colleague 
from Texas. I should not frame it that way, I ``could not help but 
listen to him.'' I was here and listened to him, and I couldn't help 
but have a desire, an urgency to respond to some of it. I shall not do 
that now, but reserve the time later.
  I notice he talked about the Kennedy plan. He is probably talking 
about the plan that is embraced by hundreds of organizations in this 
country, by the President, by the American Medical Association, and 
others who believe that health care ought to be practiced in a doctor's 
office or in a hospital room, not by some insurance accountant 500 
miles away, and who understand the stories we have told on the floor of 
the Senate about a little boy had cerebral palsy whose HMO says this 
boy only has a 50 percent chance of being able to walk by age 5, and 
that is insignificant, and therefore we will not give this young boy 
the kind of therapy he needs. That decision was not made by a doctor. 
The doctor of that boy recommended therapy. That decision was made by 
an accountant, and had everything to do with an HMO's bottom line, not 
health care. That is the issue.
  The issue is, do patients have a set of rights here? Do patients, 
when sick, and who present themselves to a doctor and hospital, have a 
right to know all of their medical options? Or do they have a right to 
know only the cheapest medical option?

  Does a patient have a right to be taken to an emergency room when 
they have just broken their neck? I will give you an example of 
somebody who broke their neck, went to the emergency room, unconscious, 
and the HMO said, ``We can't pay for that because you didn't get prior 
clearance.'' That is health care? That is a decision a doctor would 
make? I do not think so.
  That is why doctors across this country, health care professionals 
across this country, and increasing numbers of people who have been 
herded into these shoots called ``managed care,'' 160 million of them 
are now saying, there needs to be some changes here.
  Health care ought to be practiced in the doctor's office, in a 
hospital room. I understand there is great passion about this issue. I 
hope this Congress will address this issue. The Senator from Texas 
proposes a way to address it. ``We have a bill; they have a bill. We 
have a vote; they have a vote.''
  What about regular order? Why does the Senator from Texas propose 
that we not have regular order? Bring your bill to the floor--we have 
amendments, they have amendments--vote on the amendments one by one. 
How do you propose to deal with emergency care? What about the choice 
of specialists when you need it? What about the ability to know all of 
your medical options? What about the issue of bringing managed care to 
the floor of the Senate, a Patients' Bill of Rights--any version--and 
then having votes, amendment after amendment after amendment?

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