[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
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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.
____________________