[Congressional Record Volume 144, Number 130 (Friday, September 25, 1998)]
[Senate]
[Pages S10972-S10975]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PATIENTS' BILL OF RIGHTS
Mr. KENNEDY. Mr. President, here we are, Friday at 11 o'clock. Most
Americans are out working the fifth day of the week, and the Senate is
in a quorum call while we have important business to attend to. None is
more important, I think, than the consideration of the Patients' Bill
of Rights. I took time yesterday on the floor of the Senate when we had
a long quorum call, asking why we weren't debating the Patients' Bill
of Rights, as I did the day before. And here we are midmorning on a
Friday--a workday for most Americans--just going through the motions
before recessing, with a cloture vote scheduled late Monday afternoon.
We could debate this issue all day today, could debate the issue all
day on Monday, and we could have some resolution to the kinds of
protections that we are talking about in the Patients' Bill of Rights.
We have written these protections into legislation and we have
described these protections on the floor. We have challenged our
friends on the other side, the Republican leadership, to permit us an
opportunity to debate and vote on the kind of protections that are
outlined in the legislation introduced by Senator Daschle.
However, we have been denied the opportunity to bring up this
legislation, and to debate these various protections. Instead, we have
continued in the Senate to move forward on other pieces of legislation
which, as important as they are, don't measure up to what I think most
families are concerned with--and that is ensuring the protection of the
health of themselves, their children, and their parents.
Endorsements of various groups and individuals are important in some
instances, less so in other instances. But I daresay that in this
particular instance virtually all of the leaders in the health debate--
certainly the doctors, nurses, and patient coalitions--have endorsed
our proposal. We have been asking the Republican leadership for the
names of the organizations that endorse their program. And we are still
waiting to hear from the other side which medical professional groups
have endorsed or supported the Republicans in this debate. I do not
think there are any leading groups that support their plan, while
virtually all support our legislation. Still, we are denied the
opportunity to debate these issues.
Now, yesterday Senator Gramm took the floor for an extended period of
time to attack our plan. He said that the Republican solution was a new
kind of insurance policy called medical savings accounts. The fact is
that our bill takes medical decisionmaking out of the hands of the
insurance company accountants and puts it back where it belongs, with
the patients and the doctors. The Republican program is a sham and it
gives the appearance of reform without the reality.
I was struck by the fact that my friend, Senator Gramm, accuses the
American people of wanting something for nothing, of wanting a ``free
lunch.'' I object to this characterization of the patients who want
protections from the health insurance company abuses. That is what we
are basically talking about. What is at the heart of the legislation
that we support is ensuring that medical professionals--doctors,
nurses, and the trained medical professionals--make medical decisions.
Those who are opposed want to maintain the status quo. They want to
permit, in too many instances, insurance company accountants to make
medical decisions.
Now, a number of HMOs work well. Managed care in its best form can be
good for patients. There are even a number of HMOs that support our
particular proposal. And portions of our legislation are drawn from
standards adopted voluntarily by some plans. But the problem is the bad
apples that reach their medical decisions not on the basis of what is
necessary from a medical point of view, but what is necessary from a
bottom line point of view or the profit point of view of the HMO. That
is the fundamental, basic issue. That is it.
The good HMOs are complying with the kinds of protections that we
have here. But a great many of other HMOs are not. We want to make sure
that the patients are going to get what they pay for and what they are
entitled to, and that their medical decisions are made by medical
personnel and not accountants for insurance companies.
Now, that fact is not understood by the Senator from Texas. What he
has basically done in his presentation yesterday is accuse the American
people of wanting something for nothing--I use his words: ``a free
lunch.'' Those are the words the Senator used. Mr. President, I object
to the characterization of patients who want protection from health
insurance company abuse as patients who want a free lunch.
I don't think a cancer patient who needs access to a specialist or a
cancer treatment center wants a free lunch. I don't think that a family
with a child experiencing seizures is asking for a
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free lunch when they want to rush their child to the nearest emergency
room, and their HMO, in an emergency, requires instead that they go all
the way across town to another emergency room. That type of response
can risk the life and the health of that particular child. I don't
think those parents who are saying, ``Why can't I take my child to the
nearest emergency room?'' are asking for a free lunch. I don't think a
woman whose doctors say she needs to stay in the hospital after a
mastectomy, even though her insurance company wants to send her home in
pain, with tubes still dangling from her body, is asking for a free
lunch.
All of these examples I am using are examples we have presented to
the U.S. Senate day in and day out over the period of the past many
months. All of those particular situations are addressed in our
Patients' Bill of Rights.
I would have hoped that the Senator from Texas at least would have
urged the Republican leadership to permit us to debate this and let the
Senate resolve these particular issues. That is where we would have the
opportunity to make our respective presentations and call the roll on
these matters, as to whether these requests amount to ``free lunches.''
Let him make his presentation, and those of us who are strong
supporters of the Patients' Bill of Rights can respond and make a
presentation to the Senate. Then let the Senate make a decision as to
whether those individuals are trying to have a free lunch.
I don't think a doctor who is penalized for telling patients about
the best available treatment is asking for a free lunch. In too many
HMOs, when doctors make that kind of judgment and tell that patient
they ought to have a treatment that is not on the plan's list, is that
they are effectively fired, or they are not rehired at the end of the
year. The insurance companies and Republicans can say this isn't a gag
rule. But the fact that they are not hired back when they are dismissed
is effectively a gag rule. That is what is happening in too many
circumstances. I don't think that the patient who is getting the best
advice from that doctor, at the risk of that doctor's employment, is
asking for a free lunch.
I don't think an individual suffering from terrible mental illness,
like schizophrenia or clinical depression, who wants effective
pharmaceutical products to treat the illness rather than the older,
ineffective, but cheaper medication that happened to be on the plan
listing, is asking for a free lunch. That is happening in America today
and will continue today and tomorrow, and it will continue day after
day in the future unless we address that issue here.
This isn't just my opinion or the opinion of our cosponsors. We have
the strong support of the leaders of the medical organizations,
doctors, psychiatrists, psychologists, social workers, nurses, and
others who know firsthand that the various HMOs are doing these things.
We have heard from countless patients who have been told, ``You can't
get the good kind of medications that are necessary to meet your
particular health care needs until you use these other ones and
demonstrate to us, not just once, but twice, that they just don't
work.'' This puts a patient's health at risk. That is happening today.
Look right here on the chart, Mr. President--``access to the doctor
prescribed drugs.'' But the Senator from Texas says, well, that
particular patient is just looking for a free lunch. These Americans
don't want something for nothing, and it is insulting of the Senator
from Texas to suggest that they do. They have faithfully paid their
premiums and they deserve quality care.
These companies don't mind going out and representing that they have
a whole range of different quality programs to get individuals into
their HMO. But, too often, insurance companies then deny the
individuals the kind of health quality protections they need when they
get ill. That is what is happening.
That is where there is bureaucracy; the bureaucracy is in that HMO
that refuses to give the best in terms of health care to the patient.
All we are requiring is that they just give the patient what they paid
for, what HMO represented in terms of quality health care. They are not
doing it. They are not doing it in the ways listed on this chart, Mr.
President.
These are not just made up categories of care; these have been
recommended by the President's nonpartisan commission, and by Congress
for the Medicare program. These are recommendations that have come from
State insurance commissioners. These are recommendations that have been
made by the health plans themselves. They are the ones who made these
recommendations. We didn't just pull this out of the blue.
These are protections that those who know the condition of what is
happening in America have recommended to us. That is what this debate
ought to be about.
Mr. President, the American consumer has faithfully paid for their
premiums. They deserve quality care. The characterization of it by the
Senator from Texas is typical of the attitude that the Republican
leadership has taken toward this issue. They want to allow insurance
companies to continue to put the profits first and patients last--all
driven by the bottom line.
You can solve these issues and problems by having the decisions
affecting the quality made by the doctors. There is not a great mystery
about what the solution is.
But no. We do not hear that from the opponents. They want to allow
the insurance companies to continue to put the profits first. That is
why they have offered a sham bill. That is why they won't allow the
Senate to have a chance to debate and vote on this issue. That is why
they are trying to change the subject to medical savings accounts. They
don't want to debate this issue. They refuse to debate this issue. They
want to debate another issue and divert attention away from the real
issues in this discussion.
They do not want to talk about clinical trials and their importance
for women with breast cancer. They do not want to talk about the
ability to have the pediatric specialist for children with dread
diseases. They don't want to debate those issues. They don't want to
debate the question about giving the family the right to be able to go
to the nearest emergency room rather than across town. They don't want
to debate that issue. Which of these do they not want to debate? We
challenge the Republican leadership to tell us.
But day after day we go on with the charade of trying to get cloture
to prohibit any kind of amendments and any kind of debate on these
issues--day after day, issue after issue. That is wrong. It is
absolutely categorically wrong.
We are committed to trying to have this kind of debate and discussion
on, as Senator Daschle has said on many occasions, a reasonable way to
proceed. But, quite frankly, we see day in and day out the Republican
leadership attempting to do to the U.S. Senate what many of these HMOs
are doing to their patients--gagging their doctors so they can't give
them the right kind of health advice. The Republican leadership is
gagging the Senate by saying: We will only permit you to bring this up
if we have one vote--one vote--and do it now with no debate.
Why aren t we debating this on Friday at 11 o'clock this morning, or
this afternoon, or on Monday when millions of Americans are going back
to work? Why aren't we debating these issues? Why aren't we, Mr.
President? It is silence on the other side. It is silence on the other
side. They are trying to gag us from debating these issues. They are
trying to protect the profits of those HMOs that refuse to provide the
right kind of treatment by refusing us the opportunity to address these
issues. They are basically protecting those various special interests
and denying to virtually every major consumer group, and every major
medical professional group their voice here in the Senate on these
points. They refuse to let us even debate these issues. And the
American people understand it.
The American people want Congress to pass strong and effective
legislation to end the abuses of HMOs, managed care plans, and health
insurance companies. They want us to pass the Patients' Bill of Rights,
which was introduced by Senator Daschle and Senate Democrats, to
provide the needed and long overdue antidote to these festering and
growing abuses.
Our goal is to protect the patients and to see that insurance plans
provide the quality plan they promise but, too
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often, fail to deliver. Our bill has been on the Senate calendar since
March. An earlier version of the legislation was introduced more than a
year and a half ago, but the Senate has taken no action because the
Republican leadership has been compounding the HMO abuses by abusing
the rules of the Senate to block meaningful reform. This record of
abuse should be unacceptable to the Senate. It is certainly
unacceptable to the American people.
We held a forum Wednesday in which a letter was released from 36
groups representing patients, families, psychiatrists, psychologists,
social workers, and others concerned about quality health care for
people with mental illness. As I discussed in a floor statement
yesterday, these groups begged the Senate to act to pass a patients'
bill of rights, because with every day that passes, patients and their
families suffer needlessly because of abuses by managed care plans.
The stories they told were tragic--they involved suicide, spousal
abuse, anxiety attacks inflicted on a Vietnam veteran, successful
courses of treatment cruelly interrupted--all because insurance
companies are putting the bottom line first and their obligations to
patients last.
This forum was just the most recent one in which we have heard
patients and doctors and nurses pleading with the Republican leadership
to act on real managed care reform. In my statement yesterday, I
reported on an earlier forum in which we heard from Dr. Charlotte Yeh,
an emergency room doctor representing the American College of Emergency
Physicians. Dr. Yeh described tragic cases in which patients had been
denied the care they needed because of managed care penny-pinching.
On behalf of the college, she endorsed our legislation, and she
denounced the Republican leadership alternative as worse than
inadequate. Only with a full and fair floor debate can we pass real
protection for patients who need emergency care or who should be
allowed to go to the nearest emergency room when the symptoms of
serious illness strike.
On July 24, we heard from cancer patients and their doctors who
explained how critical the provision of the Patients' Bill of Rights
was in assuring patients access to quality clinical trials. These trial
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 their patients to
participate or to pay these costs.
We understand. When patients are in a clinical trial there isn't a
significant increase in terms of the costs to the HMO. It is just the
routine doctor costs and hospital costs that they would pay anyway. The
trial itself pays for the kinds of additional attention and
prescription drugs that are given to these patients. But the insurance
companies won't even cover the minimal payments.
Our bill requires them to respond to this need--but the Republican
bill does not, and the Senate leadership does not want a debate on this
issue.
Fourteen leading organizations of cancer patients, representing the
eight million Americans surviving with cancer and the 1.5 million
Americans who will be newly diagnosed with cancer this year, have
spoken out strongly on the need for this amendment. These are
organizations that patients and physicians alike look to for guidance
on cancer issues. They include the National Coalition for Cancer
Survivorship, Cancer Care, Incorporated, the Candle-
lighters Childhood Cancer Foundation, the Susan G. Komen Breast Cancer
Foundation, the National Alliance of Breast Cancer Organizations, the
North American Brain Tumor Coalition, US TOO International, the Y-ME
National Breast Cancer Society, the American Society of Clinical
Oncology, the Alliance for Lung Cancer Advocacy, Support and Education,
the Friends of Cancer Research, the Leukemia Society of America, and
the Oncology Nursing Society--all groups that speak out for patients
who have cancer. They have made their recommendations. They support our
legislation. But we are being refused and denied the opportunity to
even debate it.
Here is what the combined cancer groups say about this:
Clinical trials represent the standard of care for cancer
patients. Patient care in clinical trials is no more
important than standard therapy. Cancer will strike roughly
one in three Americans during their lifetimes. Even those who
escape the diagnosis will have friends and family touched by
the disease. Any patient rights or quality care legislation
will be a shallow promise for people with cancer if it does
not include provisions ensuring access to clinical trials.
That is what we are talking about--clinical trials for individuals
who have cancer. Why can't we debate that on the floor of the U.S.
Senate on a Friday at noontime? Why can't we call the roll for those
who believe, as the cancer organizations do, that clinical trials are a
critical aspect of treatment, and that most Americans believe when they
sign those HMO contracts that they are going to get the best in terms
of American health care? And they do with a better HMO. But there are
too many that are denying that care. Too many that are risking their
lives because they are being denied the opportunity for clinical trials
that may offer new hope and opportunity of survival for an individual
member of a family. That is unbelievable. But that is happening--
denial. Too often the insurance companies offer a shallow promise. But
our program ensures these protections. The Republican plan does not.
Mr. President, we see that not one, not a single group that is
concerned about the survival of cancer has supported the Republican
program. But virtually every major cancer group supports our
legislation and believes it is essential to protect American families.
Why can't we debate that on the floor of the U.S. Senate? What is it
about? Hard-working Americans--more than 160 million working Americans
who are going to work today on Friday at noontime.
Why aren't we debating that in the Senate? Why aren't we debating it
at 2 o'clock or 5 o'clock or on this coming Monday morning or
afternoon? We are prepared to debate these issues. But, no, the
Republican leadership refuses to debate them. We are effectively seeing
the manipulation of the Senate rules in such a way as to deny the
opportunity for full consideration of something that is of core concern
and importance to every American family, and that is the quality of
their health care.
So, Mr. President, I just want to again reiterate my strong support
for our Democratic leader, Senator Daschle, who has indicated that we
are going to still, even in the final days of this session, continue to
pursue this. There are those who say, well, we haven't got enough time.
But our Republican friends must think we do have enough time because
they are continuing to resist our efforts. They must assume we do have
enough time. It is amazing how quickly this body can act when we want
to act on important pieces of legislation, and we do have time. So, Mr.
President, we will continue to press these issues forward.
I see other of my friends and colleagues in this Chamber. I will
continue to address this issue at another time, but it is important to
note that we have seen one more week go by and a denial of the request
of our Democratic leader to at least have a reasonable period of time
to debate these issues and resolve them in a way that would respond to
the central concerns of every major medical professional group and
society in our country. I am not aware of a single medical society or
patient group that supports the Republican plan--not one. We have been
waiting to hear one. They can't come up with one. In contrast, more
than 180 groups support our particular proposal.
Now, we may not have it all right, and we are interested in
discussing adjustments that we may have to make. But 187 groups in our
country, representing the cancer societies, the medical professionals,
the nurses, the patient groups, working families, and others
effectively support our proposal.
Every major children's health organization in our society has
endorsed this proposal because they know how important this is for
children. Every major breast cancer group in our society that cares
about women and understands the enormous possibilities of breakthroughs
in terms of the new
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modern miracle drugs supports our proposal. Every major group that
represents persons with disabilities in our country--individuals who
are challenged mentally and physically every single day--supports our
proposal. And still, because of the manipulation of the Senate rules,
we are denied a full debate and discussion and ultimate resolution as
to what this body would say to families of this country on such a
matter. It is wrong, and we are going to continue to press our case.
I yield the floor.
Mr. BYRD. Mr. President, will the Senator yield?
Mr. KENNEDY. I am glad to yield.
Mr. BYRD. Mr. President, the distinguished Senator from Massachusetts
can always be counted upon to stand up for the things in which he
believes. He is constantly supporting legislation that is calculated
and dedicated to bring better health care to the American people. I
support his Patients' Bill of Rights. ``Constancy, thou art the
jewel.'' He is always constant in this efforts.
I have been hearing some ads on the radio, and these ads are talking
about the ``Kennedy Bill of Rights.'' I don't recall their ever telling
us what is wrong with it. They may have been doing it; I have missed
that. But I continually see these ads on the television: ``Write your
Congressman, write your Senator, write your representative, and urge
them to defeat the Kennedy Bill of Rights, the health care bill of
rights.''
Tell me, has the Senator seen those ads, and what are we talking
about?
Mr. KENNEDY. Mr. President, it is very interesting. I have seen those
ads, but I believe they are going to be pulled very soon because what
has happened, according to the most recent study by Bob Blendon at
Harvard and the Kaiser Family Foundation, is that support for our bill
has gone up, quite in conflict with the intentions of those who
sponsored the ads that have been critical of the Patients' Bill of
Rights. And so now the insurance companies and corporations that oppose
the Patients' Bill of Rights are reviewing their television strategy
because their campaign has had the reverse effect. They are sort of
going back to the drawing board.
But quite clearly, as the Senator implies, their ads certainly were
not a fair representation of the legislation that we have introduced.
As I mentioned, virtually every one of these proposals in our bill has
either been suggested by the President's commission--which was
bipartisan and reported its recommendations unanimously--as important
for all patients, or included in Medicare at the present time and used
in protecting our seniors, or have been embraced by the state insurance
commissioners--which are the 50 commissioners around this country,
Republicans and Democrats--or adopted voluntarily by the HMOs
themselves through their trade association.
This legislation reflects the best judgment of those groups that know
this issue best. That is why we have a sense of confidence in this
legislation. It has the strong support of those professionals who treat
families and understand the kinds of protections that are necessary to
give the best of health care to American families.
Mr. BYRD. Mr. President, I thank the Senator for enlightening this
Senator in response to the question I asked. I again commend him for
his unceasing effort in behalf of this legislation, the Patients' Bill
of Rights.
Mr. KENNEDY. I thank the Senator.
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