[Congressional Record Volume 145, Number 86 (Thursday, June 17, 1999)]
[Senate]
[Pages S7203-S7208]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      THE PATIENTS' BILL OF RIGHTS

  Mr. KENNEDY. Mr. President, I will take just a few moments this 
evening to address the Senate on an issue which our leader, Senator 
Daschle, and others, have spoken to the Senate about in the period of 
these last few days. I would like to urge that the leadership here in 
the Senate set a firm time for the consideration of legislation, which 
I believe is of central concern to families all over this country, 
known as the Patients' Bill of Rights.
  We have taken advantage of the opportunity in the Senate to make a 
case for the consideration of this legislation. We are very mindful 
that there are appropriations bills that have to be addressed, but I 
think this is a matter which is of central importance and concern to 
all of the families of this country. It does seem to me that we ought 
to address this question and at least establish a timeframe for which 
the Senate could debate and finalize its actions on this legislation.
  I know there are probably Members wondering why there are several of 
us who are bringing this to the attention of the Senate again this 
evening. I would like to just review for the Senate membership what the 
timeframe has been in the consideration of this legislation since the 
introduction of the original Patients' Bill of Rights more than 2 years 
ago.
  When we introduced legislation in the Senate over 2 years ago, we 
thought we would have an opportunity to address it, at least in the 
final months or weeks of the last session. We were unable to do so. At 
the very end of the session, the majority leader, at that time, 
indicated this would be a priority item for the consideration of the 
Senate.
  I thought I would just review briefly tonight the key parts of this 
legislation and why so many of us are anxious that we have the 
assurance by the leadership that this matter will be considered by a 
date certain. If we secure a date, then members will know about it, and 
the American people will understand it. They will be able to focus on 
this extremely important health measure, which effectively, when all is 
said and done, will guarantee that medical decisions in this country 
are going to be made by the trained professionals and the patients they 
are treating and not be made by accountants in the various HMOs and 
insurance companies. When you get right down to it, that is what this 
legislation is all about.

  The Patients' Bill of Rights was introduced over 2 years ago. It was 
never scheduled in the last Congress, despite our repeated efforts to 
bring it before the Senate. This year's track record is equally 
troubling.
  On January 19, the majority leader said on the floor of the Senate 
that it was a priority. On January 27, in an address to the U.S. 
Chamber of Commerce, the majority leader announced that he expected the 
bill to come up in May. On March 18, our Health, Education, Labor and 
Pensions Committee

[[Page S7204]]

passed a bill on a party-line vote, but a report has just filed today. 
We passed the legislation out of our committee on March 18. Now we have 
April 18, May 18, June 18 coming up tomorrow.
  On April 15, the majority leader issued a list of bills to be 
completed by Memorial Day. The Patients' Bill of Rights was not even on 
that list. On May 19, the majority leader told the National Journal 
that he hoped to bring up the bill in June, that he had ordered the 
Finance Committee to move its portions of the bill. But that committee 
has held 30 hearings this year, not one on the Patients' Bill of 
Rights, and no markup is scheduled.
  Then on May 27, just as the Memorial Day recess was starting, the 
majority leader said at a press conference that he hoped it could be 
brought up by the summer.
  So we have gone from an announcement in January that it is a priority 
to a possible scheduling in May, to a possible scheduling in June, and 
now it is something that might come up this summer. And just today, the 
Republican leader said flatly that if we asked for a reasonable number 
of amendments, the answer was no. That is a quote from the majority 
leader in today's publication of Congress Daily.
  We can say, well, what is this really all about? Why should we be 
giving this consideration? We had the opportunity in the Health, 
Education, Labor and Pensions Committee to actually mark up a Patients' 
Bill of Rights in March of this year. It was reported out over the 
opposition of a number of us on some very important measures.
  I will review very quickly with the Members of the Senate in the time 
that I have tonight--how much time remains?
  The PRESIDING OFFICER (Mr. Bennett). The Senator has 3 minutes 8 
seconds.
  Mrs. BOXER. You can take 5 minutes from me.
  Mr. KENNEDY. I yield myself the 3 minutes then.
  Mr. President, listed in this chart are the protections in the 
Patients' Bill of Rights. First of all, the legislation that we favor 
covers all 161 million Americans with private health insurance. Those 
on the other side, whose legislation primarily favors so-called self-
funded programs, don't protect anyone in HMOs. But that's the issue 
here. HMOs are making decisions on the basis of the bottom line rather 
than the interests of the patients. We want to protect families. The 
Republican proposal doesn't even cover those individuals in HMOs, 
because HMOs are not self-funded.
  One amendment would allow the Senate to show whether we are really 
interested in providing protection for all Americans who need it or 
just for one-third? It seems to me that could be an issue that wouldn't 
take a great deal of time to be able to understand.
  We heard very considerable debate on complicated issues here this 
afternoon and were able to make resolutions of those measures. 
Certainly we ought to be able to make a decision on the floor of the 
Senate whether we are interested in covering all Americans or whether 
we are interested, as our friends are on the other side, in only 
covering about a third of those.
  So these issues on the chart are the principal differences between 
the Republican proposal and the Democratic bill. We would make sure we 
are going to cover all the patients. We would make sure that we are 
going to guarantee that all patients, including children, are able to 
get the specialists that are needed to deal with their needs.

  We are going to guarantee coverage for routine costs in certain 
clinical trials. I believe that the next century is going to be known 
as the century of life sciences. We are committed here, I believe, in 
the Senate to doubling the research budget in the NIH. Why? Because of 
the promises of breakthroughs in lifesaving drugs for cancer and 
Parkinson's disease and Alzheimer's and other conditions. But to get 
these breakthrough drugs, you have to provide clinical trials. Clinical 
trials are a key element in terms of bringing the brilliance of our 
researchers from the laboratory to the bedside.
  We want to make sure that individuals who are afflicted with a 
disease for which traditional treatments offer very little hope for 
their survival have access to the breakthroughs that can be achieved by 
clinical trials. If the medical doctor that is treating that patient 
recommends a clinical trial, we are committed to making sure that 
clinical trial will be available for that mother, for that daughter, 
for that child, for whomever it might be in the family that can benefit 
from it. That is one of the very important aspects in this debate.
  It doesn't make a lot of sense on the one hand to be voting for 
billions of dollars to support research at the NIH to discover 
breakthrough therapies, but on the other hand not be able to use them. 
We want to make sure that there is going to be a law, a guarantee, that 
encourages access for certain patients.
  So, we will take the time in the Senate to go over a few of these 
issues each day and spell out exactly the kinds of protections that we 
think are needed in a real Patients' Bill of Rights. There are not a 
lot of them.
  When the minority leader indicated there would be probably 20 
amendments or so needed on our side, it is no secret what many of those 
amendments would be. You can look right over this list and see the 
protections that are guaranteed in our Patients' Bill of Rights and the 
failings of the one that will be proposed by the opposition.
  The bottom line is that over 200 organizations in this country, made 
up of the best of the medical profession, the best doctors, the best 
nurses, the patients' organizations, working families and others, 
universally and uniformly support our proposal. And the other side does 
not have one, not one organization. There isn't a single medical 
organization in our country that supports their program. But 200 
leading groups support ours. Not because it is Democrat or Republican. 
It is because ours protects patients.
  The PRESIDING OFFICER. The time of the Senator has expired.
  Mrs. BOXER. Mr. President, if I could, I ask unanimous consent to 
engage my friend on my time in a couple of questions, reserve the 
remainder of my time, and then ask the Senator from Illinois if he 
would go, and then I will close.
  The PRESIDING OFFICER. Is there objection? Without objection, it is 
so ordered.
  Mrs. BOXER. I thank the Chair.
  The PRESIDING OFFICER. Under the previous order, the Senator from 
California is recognized.
  Mrs. BOXER. Mr. President, we thought there was a breakthrough from 
our majority leader. We believed we were going to have this Patients' 
Bill of Rights before us soon. I know we did that with the gun bill. I 
just want to know where we stand on this. I was listening to my friend. 
Is it my understanding it is the position of the majority leader that 
he would not agree to scheduling this Patients' Bill of Rights if we 
would just offer 20 amendments to it? Is that it? Did he put out a 
number of amendments he would accept?
  Mr. KENNEDY. The Senator is quite correct, according to this 
morning's edition of Congress Daily. The leader was here earlier this 
evening and has not refuted it. The Democratic leader has restated 
it. Here it is. He says, ``If they are still insisting on 20 
amendments, the answer is no.'' Then he says, ``We don't have but 2 
weeks before the Fourth of July.''

  But, as I understand it, there are some 52 or 53 amendments that are 
now pending on the legislation we are calling up tomorrow, dealing with 
the State Department authorization. So 52 amendments are OK for the 
State Department authorization, but our 20 amendments are not OK for 
the Patients' Bill of Rights.
  Here they are, effectively, on this chart. There is no secret about 
what we are generally interested in addressing. There may be some 
changes in some of the language. I think one of the ones that might be 
missing is something on ``drive-through mastectomies,'' which is not 
spelled out here. But there is no secret here.
  Mrs. BOXER. Mr. President, so that people in this country understand, 
when it comes to the State Department, which deals with other 
countries, there doesn't seem to be any problem of the leadership with 
having 50-plus amendments. But when it comes to the reality and 
everyday life of our people who are not getting the quality health care 
they deserve, who want to see HMOs held accountable,

[[Page S7205]]

who want to be able to go to a specialist, who want to make sure they 
have the information as to what all the possibilities of treatment are, 
who want to make sure, if they are, for example, a woman and they go to 
an OB/GYN and all of those points on there, we can't have that. They 
would add up to 20, 21 amendments, but we do not have agreement.
  I think the American people ought to understand what is going on 
here. I have to say, in my heart of hearts, as my friend points out, 
every responsible organization that deals with health care supports 
this Patients' Bill of Rights--the Democrats' version. So one can only 
conclude it is the special interests on the other side that are 
blocking this proposal from coming to the floor. I can't come up with 
any other answer. I wonder if my friend can.
  Mr. KENNEDY. The Senator is quite correct. I mentioned a moment ago--
but it bears repeating--that we had the assurance by the majority 
leader on January 19 and January 27 that this would be a priority, and 
we expected the bill to come up in May. On March 18, we acted in our 
Health and Education Committee and reported out what I consider to be a 
``Patients' Bill of Wrongs.'' It doesn't provide the protections 
American patients need. But we ought to have whatever is going to be 
used out here so we can debate it. The bill from our committee was just 
filed today. They have had half of March, all of April, May, and half 
of June--3 months. That gives an indication of what the attitude and 
atmosphere is here in terms of acting on something that is of central 
importance to protecting families across this country.
  And then, finally, as we heard today, it isn't just to the Senator 
from California, or from Illinois, or the Senator from Massachusetts, 
but they are saying no to the families in this country: No, you are not 
going to be able to have those protections considered. No, you are not 
going to be able to bring this up. We heard last year from those on the 
other side of the aisle that we are not going to let you decide what 
the agenda is going to be.
  All we are trying to do is the people's business. It is the business 
that has been supported by virtually every single major medical and 
patient organization. It is their business, and their treatment. It is 
each family's business. That is why I wonder whether the Senator from 
California, like myself, is troubled by the fact that we can't get this 
legislation up, why we get a refusal to consider this proposal.
  If I could ask the Senator, does the Senator remember that the 
Democratic leader indicated that, as far as speaking for the Democrats, 
we could go on sort of a dual track. If it was the judgment of the 
Republican leadership that we could do their agenda, I know I would be 
here through the afternoon tomorrow and through the afternoon on 
Saturday, or in the evenings, of course, next week. We could certainly 
get a debate and discussion on the various 20 or so amendments needed 
to pass a good bill. And I am wondering if the Senator from California 
or the Senator from Illinois remembers when that proposal was put 
forward. I have been here a number of times when we have followed that 
procedure.

  Mrs. BOXER. Yes, I just heard Senator Daschle propose again that we 
have a late shift. He said many Americans, after they work their day 
shift, work a late shift. Why don't we do it here in the Senate? Here 
we are, the Senator from Utah is in the Chair, and he is always ready 
to work; he is a great worker. We are here ready to work. The people 
want us to do the business.
  I will close my question this way. This happened once before on the 
minimum wage. I hope the Senate remembers the ending of that. When the 
Senator from Massachusetts decides to take all his energy and put it to 
an issue, and we come around and we put our energy and spirit behind an 
issue, what happens is that eventually the issue will be heard. We did 
it with the minimum wage. It was a horrible situation, trying to get 
that before the Senate. But I think we know how to do it. As the 
Senator from Massachusetts said, if this wasn't an important issue, we 
would fail in our effort. If this was a frivolous matter, we wouldn't 
win. But it is important every single day to people.
  I have case after case in California--and I hear them coming from 
around the country--where you have a little child who is your pride and 
joy. Suddenly, a terrible disease hits and an HMO says: You don't need 
a pediatric specialist; take him to our cancer specialist. They ask: 
Has the cancer specialist ever operated on a child before? The answer 
is: No, but he is good. They say: No; I want the best for my child. I 
want somebody who knows what it is to examine a little body. Children 
are not little adults; they are changing, they are growing, they are 
different. I, on the other hand, am a little adult, but a child is 
different and they need to have specialties.
  Under the bill the Democrats are supporting, that would be a fact. 
You would have the right to have someone who knows what they are doing. 
If you want to get a tooth pulled, you don't go to a foot doctor. If 
you want to treat a child, you go to a pediatric specialist. So this is 
serious.
  I am so happy to be part of this little trio tonight.
  Mr. KENNEDY. If the Senator will yield, the proposal advanced by our 
Republican friends is so bad that you can't even appeal the rights it 
purports to guarantee. If, for example, you had a child whose doctor 
recommended a cancer specialist--a pediatric oncologist--and the HMO 
rejected it, by saying, ``No, we are not going to allow you to see that 
specialist, even if the doctor recommended it,'' and the parent said, 
``Well, I want to appeal''; under the proposal reported out of the 
Labor Committee, that family has no right of appeal, because the right 
of appeal is defined to deal only with certain decisions and not with 
regard to individuals' access to specialists. So it effectively 
excludes from the appeal system a whole range of care and protection 
that it claims to provide. That is rather a technical aspect. That may 
take a little time to debate. We can certainly vote on that. But not 
only don't you get the specialist, you don't even have a right to 
appeal it even if the doctor says this is what your child needs.
  I can say, from a personal point of view, how important these 
provisions are. My son had cancer, osteosarcoma, and he was given 
little chance in terms of survival. They told him he needed a pediatric 
oncologist, and he was able to participate in a clinical trial that 
worked miracles for him and the other children who participated in it.
  Members of the Senate always have very good insurance. We can get 
into clinical trials, and we can have our specialists. It is always 
interesting to me that some Members can vote no on these protections 
when they have it themselves. Then some Members wonder why people are 
cynical about how they view Members of the Congress.
  As you well know, when you become a Member of the Senate, you fill 
out that little card so you can have the health care coverage that is 
available to Federal employees. You don't have to take it. But I bet 
there isn't a Member of the Senate who has refused it.
  Yet, they are prepared to deny Americans across the country the kind 
of protections we have, and that our families have. They don't want to 
debate this issue.
  The PRESIDING OFFICER. The Senator from Illinois.
  Mr. DURBIN. Mr. President, I am happy to join my colleagues from 
California and Massachusetts. We were on the floor about a month ago 
and decided that we would like to have the Senate debate the gun issue. 
I remember the day very well. The majority leader, Senator Lott, came 
to the floor and said: You will have your wish. In 2 weeks you will get 
a vote.
  Most people view that as a very historic debate, as America was 
literally emotionally wrenched over the Littleton, CO, tragedy.
  We, finally after a few weeks, addressed it on the floor of the 
Senate in a debate which culminated in the passage of sensible gun 
control legislation, when the Vice President of the United States, Al 
Gore, cast the deciding vote.
  We come to the floor this evening, as we have before and will in the 
future, to urge the leadership of the Senate to again address the issue 
which is on the minds of American families nationwide.
  Senator Kennedy made an excellent point. We are blessed as Members of

[[Page S7206]]

the Senate. We are blessed by being considered Federal employees. As 
Federal employees, we have access to health care, which very few people 
in America have.
  Imagine this for a moment. Once a year, we have open enrollment. We 
get to make a choice of medical plans. What do we want for our 
families?
  There is a Congressman now who serves from the State of South 
Carolina in the House of Representatives who decided at age 60 that he 
wanted a lung transplant. He waited until open enrollment and enrolled 
in a plan which would cover a lung transplant for him at the age of 60. 
He signed up for it and went through the operation successfully, and 
still serves in the U.S. House of Representatives. This was 6 or 8 
years ago. But he was able to shop for his health insurance. What a 
luxury.
  How many Americans can do that? Those of us in the Senate and most 
Federal employees have that option. What we are talking about is giving 
this kind of protection and this kind of option to many different 
Americans when it comes to the quality of their own health care.
  When we asked the Rand Corporation how important this issue is, they 
told us that 115 million Americans either have had a problem with their 
managed care insurance, or a member of their family has had a problem. 
This is a real concern.
  Do you remember the movie ``As Good As It Gets'' with Jack Nicholson 
and Helen Hunt? She was so good in that movie and had a little boy 
suffering from asthma. There was this great scene in the movie where 
Jack Nicholson decides to pay for a specialist to come see her little 
boy at their apartment. They are sitting at the table, and Helen Hunt 
decides to give, in her own earthy way, an expletive definition of 
managed care. In every movie theater that I have been to where that 
movie is shown the people started applauding. She knows what she is 
talking about.
  Arbitrary decisions that are being made by bureaucrats and clerks in 
insurance companies are not good for you or your family.
  Senator Kennedy is talking about the Democratic Patients' Bill of 
Rights. Senator Boxer of California spelled out the difference between 
these two.
  It gets down to some fundamental things. When you look at it, think 
about this.
  An internist from my hometown of Springfield, IL, a town of about 
110,000 people with two excellent hospitals comes in to talk to me. We 
are in a conversation. He says: You know, I am treating more and more 
patients for depression. It is something that seems to bother a lot of 
people, and thank goodness we have many ways to treat it with drugs and 
therapies that work. He says: You know, a lot of my patients are 
concerned if it gets into part of their medical record that they have 
been treated for chronic depression. He says: Of course, they know that 
if they are in a position where they have to apply for health insurance 
in the future they may be turned down because they have ``a mental 
illness,'' a chronic depression, a very common malady among American 
people.
  Shouldn't we during the course of this debate on a Patients' Bill of 
Rights talk about this kind of prejudice and discrimination against 
people who have chronic depression? This is something that affects 
every family. It could.
  When we talk about access to health care--Senator Kennedy made this 
point, and Senator Boxer as well--the difference between the Republican 
plan and the Democratic plan is graphic. The Republican plan excludes 
more than 100 million Americans from protections we are talking about. 
They cover people that are in a self-funded employer health insurance 
plan, about 48 million Americans. But look who is left behind--15 
million Americans buying individual policies, 23 million State and 
local government workers, 75 million people whose employers provide 
coverage through an insurance policy, or an HMO, 75 million people 
written out of the Republican plan. They leave behind 113 million 
Americans.
  If we are talking about a real bill that addresses the concern of 
real American families, it should include all.
  Mr. KENNEDY. Will the Senator yield on that point?
  Mr. DURBIN. I am happy to yield.
  Mr. KENNEDY. Basically, the self-funded plans are primarily the 
largest businesses. Looking at this another way, you will find that 
people left out of the Republican plan are schoolteachers, police 
officers, social workers, and small business men and women. How many 
small businesses have self-funded programs? Virtually none.
  Mr. DURBIN. And farmers.
  Mr. KENNEDY. And farmers. These are the ones that aren't included in 
the majority's proposal. These are the ones that the statistics confirm 
what the Senator from Illinois has said. But when you look behind those 
statistics about who is covered and who isn't covered, you will find 
that it is the working families, the small business men and women, and 
the farmers and the workers who are the ones that aren't included. They 
certainly should be protected as well as everyone else.
  I thank the Senator.
  Mr. DURBIN. I thank the Senator from Massachusetts. His point is well 
taken.
  Before we end this debate, let's stop talking about health for a 
minute and let's talk about politics.
  If this is such an important issue, and the debate on this issue is 
really one where we could have some debates, why are we not considering 
it on the floor of the Senate?
  We spent 5 days debating protection for computer companies against 
lawsuits--5 days to protect these computer companies. It is an 
important debate. Can't we spend 5 hours talking about protecting 
American families when it comes to their health insurance? We are 
afraid of amendments, the Republicans say. We want to make sure that we 
have a limited number of amendments--no more than 20 on the side. In 
fact, that may be too many.
  As Senator Kennedy said, on the next bill we will consider there are 
over 50 amendments. We haven't disqualified that bill from 
consideration. We understand that it is important that we do our 
business and debate these things and vote on them.
  The bottom line here is that there are Members on the other side of 
the aisle who do not want to face votes on these issues. They don't 
want to have to go home and explain why they stood with the insurance 
companies and voted against the people they are supposed to represent--
the families, the consumers, those who are literally worried on a day-
to-day basis as to whether they have health insurance protection.
  I think, frankly, they have to face their responsibility on this side 
of the aisle as we do on our side of the aisle, a responsibility to 
face a tougher vote, make a choice, go home, and defend your vote. That 
is the nature of this government.
  For them to try to construct some sort of a strategy on the floor to 
protect themselves from criticism is at the expense of the families 
across America who do not have adequate health insurance and expect 
Congress to do something to protect them.
  Mrs. BOXER. Will the Senator yield?
  Mr. DURBIN. I am happy to yield to the Senator from California.
  Mrs. BOXER. I thank the Senator for his eloquence on this point.
  When he said we spent 5 days taking care of the computer industry, I 
come from the Silicon Valley. I love those people. They are good 
people. They are the best employers. As a matter of fact, I thought it 
was a bit insulting to them to think that they need to have all of this 
special help from us. I think they are going to take care of the 
problem and stand up to the challenge. They are wonderful people. We 
took care of them with days of debate. We took care of the steel 
companies. We just did that. Oil companies--just did that.

  I am sitting here thinking what about all these people who write us 
every day.
  I want to ask the Senator a question. Is it not his understanding--
because the Senator said this before, and I want the Senator to expound 
on it--that there are only two groups in America today who cannot be 
held accountable in a court of law? Could the Senator talk about who 
those groups are?

[[Page S7207]]

  Mr. DURBIN. Every one of us as individuals and businesses can be held 
accountable for our actions. That is understandable. You go out and 
drink too much, drive a car, get in an accident, and you might be sued. 
There are two groups, though, that are spared this: foreign diplomats 
and health insurance companies.
  Why in the world would we carve out this kind of protection from 
liability for this group of health insurance companies? If they make 
the wrong decision on coverage, and it is your child who ends up not 
getting adequate care, or getting a bad medical result, who should be 
held responsible--the doctor, the hospital, or the insurance company 
that made the basic decision? I think the insurance company should.
  Frankly, if they are held accountable, they will think twice about 
making the wrong decision. They will make certain that children have 
access to specialists they need, that people can go to emergency rooms 
close to home, and when there is a medical necessity there is a 
continuity of care. If your employer changes health insurance, you have 
an opportunity to keep that doctor who is so important to you.

  One of the most humbling experiences in my life--in the life of 
virtually anyone--is to sit in a waiting room in a hospital waiting to 
hear about the surgery on your child. Senator Kennedy has been through 
that. I have been through that. It is something I will never forget. 
You realize that everything you hold dear and close is in the hands of 
people you have to trust to be the very best specialists, well-trained 
medical technicians trying to save or improve the life of someone you 
love so very much.
  I think at those moments in our life when we are so vulnerable and 
pray that we have the very best and brightest helping our children and 
helping members of the family we love so much, to do the job and do the 
right thing and bring them home, we need to have the confidence that we 
have a system that works.
  Over 100 million Americans today question whether this system works. 
They question whether that doctor they want to trust can tell them 
everything they need to know. They question whether that hospital 
making a decision can make that decision without worrying about some 
insurance clerk in some faraway city.
  If we do nothing else in the 106th Congress, shouldn't we address 
this basic gut issue that American families worry about on a day-to-day 
basis? The 105th Congress came and went with a record no one remembers. 
This Congress has a chance to act. We may debate a lot of things on the 
floor of the Senate, but if we don't take up this very fundamental 
issue, we are missing our responsibility.
  This Congress should not be toiling in an atmosphere of partisanship. 
It shouldn't be afraid to face tough issues. It should come forward and 
vote for the Patients' Bill of Rights, as Senator Kennedy and Senator 
Boxer have said, to make sure families across America receive the 
protection they deserve.
  The PRESIDING OFFICER. The Senator from New York.
  Mr. SCHUMER. Mr. President, I will address the same subject that my 
senior colleague from Massachusetts and the Senators from California 
and Illinois have talked about: The Patients' Bill of Rights.
  Our health care system has been a remarkably successful system. We 
can't forget the fact that over the years the idea of people living 
longer and healthier has become a reality.
  When I was a little boy, all the kids in my neighborhood would come 
around and press their foreheads to the kitchen window because in our 
home sat a curiosity, in a certain sense. It was my great grandmother; 
she was over 80. In the neighborhood, everybody said she was the oldest 
lady in the world. They hadn't seen anybody over 80. It was a rarity.
  These days, of course, somebody who lives over 80 is, thank God, 
rather commonplace. In fact, on the ``Today Show'' they used to 
announce people who celebrated their 80th birthday; then they announced 
the 90th birthdays; and now they announce the 100th and 105th 
birthdays. That is, in good part, because of our health care system.
  It is a good health care system, there is no question. However, over 
the last several years it has developed some problems that can be 
fixed. These are not the intractable problems of how we pay for the 
costs of new operations that cost tens of thousands and even hundreds 
of thousands of dollars.
  What happened is very simple. Costs were going up. We were basically 
involved in a cost-plus system. As a result, HMOs developed. HMOs had a 
good purpose. They were going to ``rationalize'' the health care 
system. They were going to keep costs down so that the providers could 
not raise costs willy-nilly and have a third party pay.
  For a while it worked. Costs did decline. It is one of the reasons 
that our budget is in better shape today than it has been.
  However, the pendulum swung too far. In a good effort to reduce 
costs, HMOs began to go too far. They started assigning important, 
often life-and-death decisions. They started taking those decisions out 
of the hands of physicians, out of the hands of hospitals, out of the 
hands of trained personnel, and putting them in the hands of actuaries.
  As a result, day after day after day, injustices are done. We hear 
stories such as the one I told on the floor a couple of days ago about 
the young nurse who can barely walk because her HMO would not provide 
her with an orthopedic oncologist. Instead, she went to a regular 
orthopedic surgeon. The surgery was performed not well. The tumor grew 
back. She had to go to an orthopedic oncologist.
  How about a simple case where somebody has cancer. The HMO says yes, 
that is covered. Because of the cancer, they cannot swallow; they 
cannot eat. The HMO's decision of no dietary supplements being allowed 
is a ridiculous decision.
  How about the times when people go to an emergency room and are told: 
You are not covered; go somewhere else.
  Or when woman after woman after woman is again turned away from going 
to an obstetrician or gynecologist. A woman is told that osteoporosis, 
a common woman's disease, is not covered by the HMO, even though 
diseases that would be just as frequent in men are covered.
  On issue after issue after issue, every day across America, scores of 
people--perhaps hundreds of people--are sitting there in awful 
situations and are told that not only do they have to deal with their 
illness but they have to deal with an unfair HMO.
  What we seek to do, led by the senior Senator from Massachusetts, is 
simply to redress that imbalance. This is not radical surgery. We are 
not trying to totally change the system. We are not even trying to 
eliminate HMOs. We are simply trying to put in place some basic rules 
of fairness that seem to most Americans to be called for. We are simply 
trying to say that the pendulum, which has swung so far over on the 
side of the actuaries, should move a little bit back to the middle. We 
are attempting to keep the best parts of HMOs, which deal with cost 
savings, and at the same time get rid of their most egregious 
violations. We are on the floor of the Senate simply asking for a 
chance to debate those issues.
  I have now been in the Senate close to 6 months. We had some historic 
moments in the first few months. Since then, it seems to me no issue is 
being asked to be debated more, to be discussed, to be legislated upon 
than this subject. Yet we are told we can't do it. It just does not 
make sense.
  So we must come to the floor of the Senate in the early hours of the 
morning or the later hours of the evening and make our case. We 
shouldn't have to. This is a deliberative body that has been known for 
its great debates, that has been known for the fact that, if a group of 
Senators feels strongly about an issue, they will get to debate it and 
vote on it. That has been the tradition for the 200-some-odd glorious 
years of this body. It is being thwarted on an issue of great 
importance.
  I am sure most of my colleagues in this body do not agree with every 
position I hold, and I don't agree with every position they hold on 
HMOs. How in the name of fairness can we refuse to debate the 
issue? How can we refuse that young nurse who really needs the 
orthopedic oncologist or that cancer victim who needs dietary 
supplements or that woman who needs help with

[[Page S7208]]

osteoporosis? How can we refuse, at least through their elective 
Representatives, to let their voices be heard?

  So we debate tonight simply asking for some vital things. We ask for 
the ability of patients to be treated in the emergency room wherever 
that emergency occurs. We ask for the ability of people to get the 
specialists that are medically called for and that they need, not for 
excessive use, not for things they do not need, but for things they 
need. We ask, if that HMO makes an egregious and reckless mistake, for 
the ability to sue it, not out of malice but out of fairness, out of 
recompense, and out of a desire to correct an abuse that may have 
occurred.
  As I mentioned, these are not large demands in the grand scheme of 
things, but they are very important to millions of Americans who either 
have an ill loved one, or have an illness themselves, or who worry that 
they might.
  So I ask, and I am joined by so many of my colleagues, particularly 
those of us on this side of the aisle, I ask the majority leader to 
allow this issue to come to the floor, to allow a full and open debate. 
I do not know what the results will be, but I can tell you this: If we 
do that, we will be, indeed, fulfilling our obligation as the people's 
Senators, as the people's Representatives, and we will be living up to 
the fine and high traditions of this Senate.
  I yield the floor.
  Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative assistant proceeded to call the roll.
  Mr. DASCHLE. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DASCHLE. Mr. President, I hoped to get over here prior to the 
time my colleagues left the floor, but let me compliment Senators 
Kennedy, Durbin, Boxer, Schumer, and others who participated in the 
colloquy this afternoon on the Patients' Bill of Rights. We are very 
hopeful that over the course of the next two weeks the Senate can reach 
an agreement on proceeding to the bill, the Patients' Bill of Rights.
  We will be more than happy to enter into negotiations with our 
colleagues on the other side of the aisle with one understanding, that 
we have the opportunity to offer amendments. In fact, we have suggested 
at least 20 amendments to ensure that we have a good debate. We don't 
want to have a sham debate on something of this import. On a bill that 
we will take up tomorrow, the State Department authorization bill, both 
sides have agreed to consider 52 amendments. We passed the Defense 
authorization bill a month ago, and we agreed to over 100 amendments. 
We have reached an agreement on virtually every bill that has come to 
the floor. In fact, the juvenile justice bill had 35 amendments with 
over 18 rollcall votes.
  But I think the key question is, if tomorrow we can agree, as 
Republicans and Democrats, to consider 52 amendments on a bill that 
has, frankly, very little relevance to the day-to-day lives of every 
American, as important as it is for other reasons, then, my goodness, 
it would seem to me we could agree to 20 amendments on the Patients' 
Bill of Rights.
  One of the amendments we feel very strongly about offering is an 
amendment to expand the scope of the bill. I just want to talk briefly 
about that before I move to another issue. Probably the single biggest 
difference--I won't say the only big difference, because there are 
many--but one of the most important differences between the Republican 
bill and the Democratic bill has to do with what we call scope. By 
scope, we simply mean who is covered.
  By everybody's recognition, the Republican bill covers 48 million 
Americans. Those 48 million Americans fall into one category: those 
employed by large businesses that are self-insured. Those are the only 
American people today who are covered under the Republican bill.
  I have a chart. This is so important. This chart says it so well. 
This chart shows what the Republican bill does not do, and why we feel 
so strongly about offering amendments. Mr. President, 48 million 
Americans are covered through a plan that self-funds insurance within 
the company. Here are all the people who are not covered; 75 million 
Americans are not covered who have individual insurance policies or an 
HMO that is purchased but not funded by their employer. In other words, 
if you are an employee of a company with self-funded insurance, you are 
covered. If you work for an employer who contracts with an insurance 
company or an HMO, you are not covered.
  There are only 48 million people in that category--those who work for 
a self-insured employer. There are 75 million Americans who are working 
for employers who purchase their insurance through separately-funded 
insurance companies and HMOs. There are another 23 million Americans 
who have their insurance through their jobs in State and local 
governments, and then there are 15 million Americans who have 
individual insurance plans. All of those people are not covered in the 
Republican plan. Two-thirds of all of those with health insurance are 
not covered.
  I do not know why they would not be covered under the Republican 
plan. I am sure our Republican colleagues have a good rationale for not 
including all of these people. I have heard them say they are covered 
in some of the State plans. That is the problem.
  What if you move from one State to another? The average American 
family now moves three times in the life of the family as children are 
growing up. What if you move? What if you get transferred? You may not 
be covered. How do you know? Are you going to call the State capital 
and find out? We say: Cover them all. Cover all 75 million Americans 
who are working for companies that have insurance coverage. Cover all 
State and local government employees. Cover all people who have 
individual policies and, yes, cover everybody who is working for a 
self-insured company.
  That is just one of the many differences--and we want to talk more 
about that in the future--but it is why we ought to have amendments. 
Some suggest let's just have an up-or-down vote on the Republican bill 
and an up-or-down vote on the Democratic bill. That will not cut it. We 
will not have an opportunity to talk about issues like this.
  I really hope we will have the opportunity to have that debate in the 
next 2 weeks. We will have the opportunity, because if we cannot get an 
agreement, we will be forced then to offer it as an amendment to 
another bill.

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