[Congressional Record Volume 144, Number 138 (Tuesday, October 6, 1998)]
[Senate]
[Pages S11540-S11543]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                    PRIORITIES OF THE 105TH CONGRESS

  Mr. DORGAN. Mr. President, one of the items up for consideration as 
we

[[Page S11541]]

finish this 105th Congress is H.R. 10, the so-called financial 
modernization bill. In fact, we have gone through a cloture vote on the 
motion to proceed to that bill. H.R. 10 is a piece of legislation that 
apparently has fairly wide support, I am told, in this Congress. I do 
not happen to support it, but I assume we will go through a period this 
week of debating and voting on a series of procedural motions dealing 
with H.R. 10.
  It is a 600-page bill, and it will make the most sweeping changes to 
the financial sector and particularly the banking and other financial 
industries since the 1930s. This piece of legislation repeals the 
Glass-Steagall Act, which restricts the ability of banks and security 
underwriters to affiliate with one another.
  The bill creates a new category of financial holding companies. The 
structure will allow for a broader range of financial services now to 
be done in one affiliated area--commercial banking, insurance 
underwriting, merchant banking.
  I do not know whether most people have forgotten the lessons of the 
1930s, but in the 1930s it was thought that perhaps we ought not to 
merge or marry in any way inherently speculative activities with 
banking because banking requires the perception--even just the 
perception--of safety and soundness to survive and do well. Safety and 
soundness is critical.
  When you bring into the realm of banking activity that is inherently 
speculative, such as underwriting securities, insurance underwriting, 
merchant banking, and a whole range of other activities, it seems to me 
we have just forgotten the lessons of the 1930s. And we are told that 
we must do this is the name of financial modernization. In order to be 
``modern,'' we must decide to step forward and change the structure of 
these financial institutions.
  This country learned tough lessons the very hard way decades ago 
about marrying banking activities with other activities that are 
inherently speculative. I know they say, gee, we have created these 
affiliates with firewalls, all that sort of thing. I have heard that 
all before. I heard that with the Saving and Loans. The taxpayer got 
stuck for $500 billion bailing out the S&L mess.
  I think this bill represents a huge step backwards for this country. 
For that reason, I do not support the legislation. I will speak more 
about it at some point later.
  But the thing I find interesting is this rush to complete H.R. 10 
right now. The big shots want financial modernization and the halls are 
filled with people who are working to get H.R. 10 done because the big 
economic interests in this country want financial modernization.
  But what about school modernization? I have been on the floor of this 
Senate talking about school construction, I guess maybe 10 times in 
this Congress. I have told about a young second grader at the Cannon 
Ball elementary school. Let me just talk about this issue again, 
because school modernization does not seem to be a priority. 
Apparently, second graders are not big shots. They do not have the same 
clout with this Congress.
  The school in Cannon Ball, just on the periphery of an Indian 
reservation, is a public school. It is open today. Those little kids, 
mostly Native Americans, are in their crowded classrooms. There are 160 
students and staff in that school with only one water fountain and two 
bathrooms. Part of the school that is now being used had previously 
been condemned. It is an old, old, old building in desperate disrepair.
  One of the rooms they use for music is in the downstairs area. They 
more than occasionally cannot use it because the stench of sewer gas 
comes up and fills that area, and they have to evacuate that area. And 
a little second grader came up to me when I toured that school, and 
asked, ``Mr. Senator, will you build us a new school?'' Well, the 
answer is, modernization of a school building does not apparently have 
the same priority to this Congress as modernization of our financial 
system.
  Instead of financial modernization, how about modernization of the 
Cannon Ball school so that little girl, Rosie, age 7, can walk into a 
second grade classroom that we can be proud of, where you can hook a 
computer to the Internet, a classroom that is not going to have to be 
evacuated because of seeping sewer gas, a classroom that has a bathroom 
outside or a water fountain close by. What about her needs? What about 
the needs of all those kids?
  Or maybe we can talk about the Ojibwa school. The kids there go to 
school in trailers that are overcrowded and unsafe and classrooms that 
have been condemned--and this Congress knows it. There is going to be a 
desperate accident there some day. There is going to be a fire spread 
across those trailers with their wooden fire escapes. My deep concern 
that somebody is going to die unless somebody takes action first.
  Study after study after study shows that school to be unsafe, but 
there is no money to modernize that school. Those little children on 
the Turtle Mountain Indian Reservation go to the Ojibwa school in 
conditions that, in my judgment, should not give any of us pride that 
we send our children through its doorway.
  We can do something about it. We can modernize those schools. We have 
had proposals on the floor of the Senate for school construction, but 
guess what? The funds to modernize those schools is not nearly as 
important as modernizing our financial system because H.R. 10, the 
financial modernization bill, has all kinds of folks in dark suits 
standing out here lobbying for it.
  They have a lot of clout, a lot of resources. When they say, 
``Jump,'' we have people saying, ``How high?'' But what about the 
second graders? What about the Cannon Ball school? What about the 
Ojibwa school? I could go on talking about the school construction 
needs in our country and in my State, and especially on Indian 
reservations, about which we ought to do something.
  I know the Senator from Massachusetts wanted to make this point with 
respect to the Patients' Bill of Rights. Talk about modernization, what 
about modernization with respect to the delivery of health care? Is it 
modern to have a health care system in which people do not get the 
medical care they need?
  The Senator from Massachusetts has been talking about the Patients' 
Bill of Rights. We cannot even get a vote on it. It is very simple. It 
says that, when you are sick, you ought to be able to have a doctor or 
a health care plan that tells you all of your treatment options, not 
just the cheapest. And yet today all across this country people find 
HMOs saying, ``We will only tell you what the cheapest option is, not 
all of your options, as a patient.''
  Mr. KENNEDY. Would the Senator yield for a question?
  Mr. DORGAN. I would be happy to yield.
  Mr. KENNEDY. I have before me--and I will include in the Record--an 
excellent letter written by representatives of 30 different 
organizations representing women. I would like to ask if the Senator 
would agree with me that this issue involving the Patients' Bill of 
Rights has special importance to women. It does--as I will mention in 
just a moment--to those who have been afflicted with breast cancer. 
And, of course, the nurses in this country are all in support.
  But would the Senator agree with this letter, which is sponsored by 
the 30 organizations? I will include it in its entirety.

       Few issues resonate as profoundly and pervasively as the 
     need for quality health care, and women have a particular 
     stake in the changes in our health care delivery system. 
     Women are the primary consumers of health care services in 
     this country, and we have unique health care needs. Women 
     also take care of the health care needs of our families, from 
     children to elderly relatives. Because of the great impact 
     any patient protection bill will ultimately have on women, we 
     ask that you support real reform that will truly improve 
     women's health.
       The Patients' Bill of Rights Act (S. 1890) takes the needs 
     of all consumers seriously, and it pays particular attention 
     to the needs of women. The genuine and often unique concerns 
     of women are woven into the fabric of this bill. S. 1890 
     recognizes that women's health can only be improved by 
     comprehensive reform.

  I am just wondering if the Senator would agree, first of all, as a 
strong supporter of the legislation, that he believes that the 
Republican leadership is derelict in its duty by failing to bring up 
legislation that can have that kind of importance to the mothers and to 
the wives, to the sisters, to the daughters, of families in this 
country?

[[Page S11542]]

  This is supported by 30 organizations that represent women, children, 
and families.
  Does the Senator not agree with me that the Republican leadership has 
been derelict in failing to give us an opportunity to address these 
issues which are central to the concern of women in our society and 
their health care needs?
  Mr. DORGAN. I agree that there has been a concerted attempt to 
prevent legislation of this type from coming to the floor of the Senate 
under regular order.
  It is apparently not a priority. In fact, not only is this apparently 
not a priority but they have also deliberately attempted to prevent us 
from having the opportunity to enact HMO reform, the Patients' Bill of 
Rights, school modernization, and so on, because it is not something 
they want to do.
  I think this is a misplaced set of priorities.
  Mr. KENNEDY. Will the Senator agree that is one of the most important 
issues before families in this country? We believe, as supporters of 
the Patients' Bill of Rights, Senator Daschle's bill, that doctors 
ought to be making decisions with regard to the health of women in our 
society. That is the key underlying difference between the Patients' 
Bill of Rights and other substitutes, but this is a matter of urgency, 
a matter of importance.
  The PRESIDING OFFICER. The time of the Senator from North Dakota has 
expired.
  Mr. DORGAN. Mr. President, I ask unanimous consent for 2 additional 
minutes.
  Mr. CRAIG. May I inquire how much time remains in morning business 
under the order?
  The PRESIDING OFFICER. The remaining time is about 18 minutes, until 
11:30.
  Mr. CRAIG. The Senator from West Virginia and I would also like some 
of that time if at all possible prior to 11:30. If you would take that 
under consideration, I would not object.
  The PRESIDING OFFICER. The Senator has 2 more minutes.
  Mr. CRAIG. I require no more than 10 minutes.
  Mr. DORGAN. Mr. President, I appreciate the indulgence of the Senator 
from Idaho.
  Let me make one final point, and if the Senator from Massachusetts 
wishes to make a final point in the form of a question, I will yield.
  The point is that health care decisions ought to be made in a 
doctor's office or in a hospital room, not by some insurance company 
accountant 500 or 1,000 miles away. That is the point the Senator from 
Massachusetts is making. That is the point that is made in the 
underlying legislation dealing with a Patients' Bill of Rights. It is a 
critically important point.
  We ought to have been able to debate fully under regular order the 
piece of legislation called the Patients' Bill of Rights. I regret we 
have not been able to debate that.
  I yield to the Senator from Massachusetts.
  Mr. KENNEDY. Mr. President, to conclude, I ask unanimous consent to 
have printed in the Record the correspondence from various women's 
groups, including the No. 1 consumer group in terms of protection of 
women, the Breast Cancer Coalition, 450 organizations that support this 
legislation, and the American Nurses Association, who strongly support 
the legislation.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:
                                                    July 29, 1998.
       Dear Senator: The undersigned organizations work on a range 
     of issues that are important to women, including women's 
     health, and together we speak for millions of women around 
     this country. As women's organizations, we understand the 
     needs and concerns of women. We urge you to support the 
     Patients' Bill of Rights Act (S. 1890) because it is the only 
     bill that provides comprehensive and genuine patient 
     protections for the millions of Americans enrolled in managed 
     care plans.
       Few issues resonate as profoundly and pervasively as the 
     need for quality health care, and women have a particular 
     stake in the changes in our health care delivery system. 
     Women are the primary consumers of health care services in 
     this country, and we have unique health care needs. Women 
     also take care of the health care needs of our families, from 
     children to elderly relatives. Because of the great impact 
     any patient protection bill will ultimately have on women, we 
     ask that you support real reform that will truly improve 
     women's health.
       The Patients' Bill of Rights Act (S. 1890) takes the needs 
     of all consumers seriously, and it pays particular attention 
     to the needs of women, The genuine and often unique concerns 
     of women are woven into the fabric of this bill. S  1890 
     recognizes that women's health can only be improved by 
     comprehensive reform. Some of the provisions in S. 1890 that 
     will improve women's health include: letting a patient's own 
     trusted health care professional make important treatment 
     decisions like how long a patient stays in the hospital; 
     ensuring and streamlining access to specialty care, including 
     access to non-network specialists (at no additional cost) 
     when the plan can't meet the patient's needs; giving women 
     the option of having direct access to ob-gyn services or 
     choosing an obstetrician/gynecologist as a primary care 
     provider; ensuring access to clinical trials that may save 
     women's lives; ensuring that pregnant women can continue to 
     see the same health care provider throughout pregnancy if 
     either their provider leaves the plan or their employer 
     changes plans; allowing health care professionals to 
     prescribe drugs that are not on the plan's predetermined list 
     when such drugs are medically indicated; providing a fast, 
     fair, consumer-friendly independent appeal whenever a 
     plan's decision to deny or limit care jeopardizes life or 
     health; having an internal quality improvement system that 
     measures performance on health care issues that affect 
     women; collecting data (and providing a summary of it to 
     enrollees) that allows plans to evaluate how they are 
     meeting the health needs of women; incorporating gender-
     specific medicine when developing the plan's written 
     clinical review criteria; and ensuring that providers and 
     patients are not discriminated against on the basis of sex 
     or other characteristics.
       The other health reform bill that the Senate may soon 
     consider, the Senate leadership's bill (S. 2330), does not 
     include the patient protections listed above. It attempts to 
     address a few of these issues (ob-gyn services, continuity of 
     care, appeal procedures), but in each case the provisions 
     fall considerably short of S. 1890. As a result, the bill 
     does almost nothing to correct the problems that insured 
     women encounter every day with their health plans--the very 
     point of enacting patient protection legislation.
       The bill's sponsors tout Title V of the bill (entitled 
     ``Women's Health Research and Prevention'') as responding to 
     the needs of women. But this title consists mostly of routine 
     reauthorizations of research and public health programs that 
     Congress must attend to as part of the usual course of 
     business. Initiatives such as these have bipartisan support, 
     but have stalled in committee for 18 months. Now that these 
     proposals have the backing of the leadership, we hope they 
     can be passed swiftly. But let's not be fooled--these 
     provisions, regardless of their obvious merits, do not turn 
     S. 2330 into a patient protection bill that meets the needs 
     of women.
       Only S. 1890 offers the range of common-sense patient 
     protections that women need. We need to invest in women's 
     health research, but not as a substitute for comprehensive 
     patient protections. We urge you to support S. 1890 and not 
     S. 2330 when these bills come to the floor for a vote.
           Sincerely,
         National Partnership for Women & Families; American 
           Association of University Women; American Nurses 
           Association; Association of Women's Health, Obstetric 
           and Neonatal Nurses; Catholics for a Free Choice; 
           Church Women United; Coalition of Labor Union Women 
           (CLUW); Feminist Majority; MANA, A National Latina 
           Organization; National Abortion Federation.
         National Abortion and Reproductive Rights Action League; 
           National Association of Commissions for Women (NACW); 
           National Association for Female Executives; National 
           Association of Nurse Practitioners in Reproductive 
           Health; National Black Women's Health Project; National 
           Committee for Responsive Philanthropy; National Family 
           Planning and Reproductive Health Association; National 
           Organization for Women; National Women's Conference; 
           National Women's Law Center.
         NETWORK, A National Catholic Social Justice Lobby; Older 
           Women's League; Religious Coalition for Reproductive 
           Choice; RESOLVE, The National Infertility Association; 
           United Methodist Church, General Board of Church and 
           Society; Wider Opportunities for Women; The Woman 
           Activist Fund; Women Employed; Women's Institute for 
           Freedom of the Press; Working Women's Department, AFL-
           CIO; YWCA of the U.S.A.
                                  ____


 Statement of Beverly L. Malone, President, American Nurses Association


          press conference on managed care and women's health

       Good afternoon. I am Beverly Malone, President of the 
     American Nurses Association.
       ANA is proud to be one of the signatories of this letter 
     urging members of the Senate to support S. 1890, the 
     Patients' Bill of Rights Act. It is the only bill that 
     provides comprehensive and genuine patient protections for 
     the millions of Americans enrolled in managed care plans, 
     protections that are of particular importance to women.
       Nurses have long been in the forefront of efforts to 
     recognize and provide for the distinct health care needs of 
     women. As patient

[[Page S11543]]

     advocates, most of whom are themselves women, and as health 
     care providers who focus on the health of the whole person, 
     nurses have a special concern for the well-being of women in 
     our society.
       ANA strongly supports the patient protections recommended 
     by the President's Commission on Consumer Protection and 
     Quality in the Health Care Industry and embodied in Patients' 
     Bill of Rights of 1998. As a member of the Commission, as a 
     nurse, as a woman, and as a representative of the millions of 
     registered nurses in the United States, I say without 
     reservation that the nursing profession's commitment to our 
     patients demands our commitment to legislation that will 
     provide true protection from the abusive practices of the 
     managed care industry.
       Nurses who are at the bedside when women undergo the trauma 
     of breast cancer and mastectomy are acutely aware of a broad 
     range of unsafe and insensitive practices that threaten the 
     health and safety of their patients. Certainly, requirements 
     by health plans that women undergo mastectomies as outpatient 
     procedures are unconscionable. But that practice is 
     symptomatic of more pervasive dysfunctions in the health care 
     system that impact women disproportionately and must be 
     addressed as well. It is not enough to address only one 
     instance of inappropriate interference in treatment 
     decisions. In fact, offering a token rather than a genuine 
     reform is shameful when there is such suffering in so many 
     other areas.
       My colleagues from the women's community who are here today 
     know that aging women suffer the effects of prescription drug 
     limitations that do not allow for their complex health 
     requirements, that the scourge of breast cancer requires not 
     only humane treatment but access to clinical trials so that 
     true progress can be made for future generations, and that 
     women who make health care decisions for themselves and for 
     their families must have full information on which to base 
     those decisions.
       The Americans Nurses Association believes that every 
     individual should have access to health care services along 
     the full continuum of care and be an empowered partner in 
     making health care decisions. We also believe that 
     accountability for quality, cost-effective health care must 
     be shared among health plans, health systems, providers, and 
     consumers. There is only one bill before the Senate which 
     will provide that kind of access and empowerment and 
     accountability for the women of our nation and their 
     families.
       Nurses at the bedside have learned what happens when frail, 
     older women receive inappropriate medications, or when 
     mammograms come too late, or when misinformation or 
     misunderstanding lead to dangerous delays in care. For the 
     nurses at the bedside, the need for patient protection and 
     patient advocacy is played out every day, and we urge every 
     Senator to support S. 1890, the Patients' Bill of Rights Act 
     of 1998.
                                  ____


   Statement of Frances M. Visco, President, National Breast Cancer 
                               Coalition


                  Patients' Bill of Rights Act of 1998

       Once again, on behalf of the 450 organizations and tens of 
     thousands of individuals who are members of the National 
     Breast Cancer Coalition (NBCC), I would like to reconfirm our 
     support for the ``Patients' Bill of Rights Act of 1998'' (S. 
     1890). I applaud Sens. Daschle and Kennedy for introducing a 
     bill which offers real patient protections benefitting women 
     and the potential to help ensure effective, quality health 
     care.
       The NBCC is dedicated to the eradication of breast cancer 
     through action and advocacy: it seeks to increase the 
     influence of breast cancer survivors and other activities 
     over research, clinical trials, and public policy and to 
     ensure access to quality health care for all women. NBCC 
     recognizes that the evolving health care system affords us 
     the opportunity to define and focus on true quality of care 
     for women and their families. We cannot afford to let this 
     opportunity pass.
       The NBCC believes that breast cancer patients have 
     fundamental rights, including: the right to receive accurate 
     information about their health plans; access to the right 
     providers; involvement in treatment decisions that are based 
     on good science; confidentiality of their health information; 
     and coverage for routine health care costs associated with 
     participation in clinical trials. S. 1890 guarantees patients 
     these rights and offers women a legitimate ``Patients' Bill 
     of Rights.''
       Other bills being considered by the Senate that are being 
     marketed as women's health bills do not in fact give women 
     the substantive protections that they need. Instead, the 
     bills offer routine reauthorizations of research and public 
     health programs that Congress must attend to as part of the 
     usual course of business. While these provisions and efforts 
     to move them forward quickly are extremely important, they do 
     not transform proposed health reform legislation into a 
     women's health care bill. To ensure true quality health care 
     for women and their families, we need legislation, such as S. 
     1890, which offers comprehensive patient protections against 
     the problems that insured women encounter every day with 
     their health plans.
       One of the NBCC's most pressing concerns is that health 
     insurance and managed care plans are erecting barriers to 
     good science by increasingly refusing reimbursement for 
     routine patient costs when breast cancer patients participate 
     in approved clinical trials. This practice is preventing us 
     from finding desperately needed scientific answers about 
     breast cancer and severely affects the treatment breast 
     cancer patients receive. Only three percent of adult cancer 
     patients are enrolled in clinical trials--insurance 
     reimbursement is often a major obstacle to clinical trial 
     participation. In fact, one of our NBCC members who 
     participated in an NCI clinical trial five years ago, only 
     recently resolved her legal battles with her insurance 
     company over coverage of the costs associated with the NCI 
     trial. The Patients' Bill of Rights Act is an important first 
     step in ensuring third party coverage for the routine patient 
     costs incurred within a clinical trial.
       The NBCC is prepared to work with the Congress, and will 
     mobilize our nation-wide network of advocates to ensure that 
     meaningful legislation like the Patients' Bill of Rights Act 
     is enacted into law. We offer thanks to all of the leaders 
     gathered here today for their work to ensure that breast 
     cancer patients and all American women and families receive 
     quality health care.

                          ____________________