[Congressional Record Volume 145, Number 90 (Wednesday, June 23, 1999)]
[Senate]
[Pages S7489-S7491]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                     EXTENSION OF MORNING BUSINESS

  Mr. NICKLES. I ask unanimous consent that each side have 20 minutes 
of additional time for morning business.
  The PRESIDING OFFICER. Is there an objection?
  Mr. REID addressed the Chair.
  The PRESIDING OFFICER. The time has expired in regard to the Senator 
from California.
  Hearing none, without objection, it is so ordered.
  Mr. REID. Mr. President, I ask through the Chair to the Senator from 
California, how much additional time does the Senator need?
  Mrs. FEINSTEIN. If I could have another 7 to 10 minutes at this time, 
I would appreciate it very much.
  Mr. REID. How about 7 minutes?
  Mrs. FEINSTEIN. I will do my best with 7 minutes.
  Mr. REID. Okay.
  The PRESIDING OFFICER. The distinguished Senator is recognized for 7 
minutes.
  Mrs. FEINSTEIN. I thank the Chair. I thank the Senator from Nevada.
  At an appropriate time, I will submit that amendment.
  Let me tell you some of the things we are increasingly told: That is, 
that doctors have to spend hours hassling with insurance company 
accountants and adjusters to justify medical necessity decisions--why a 
person needs another day in a hospital, why a patient needs an MRI, why 
a patient needs a blood test, why a patient should get a particular 
drug, this drug rather than that drug. Doctors increasingly say they 
have to exaggerate or lie so their patients can get proper medical 
care.
  In USA Today, an article was run saying that 70 percent of doctors 
interviewed said they exaggerate patients' symptoms to make sure HMOs 
do not discharge patients from hospitals prematurely. Seventy percent 
of doctors indicate that they do not tell the truth about a patient's 
condition so they can be assured that that patient gets adequate 
hospital care.
  Now, is this what we want? I don't think it is. I think the doctor's 
decision, based on an individual's condition, should be the overriding 
decision that determines medical necessity. The amendment I will 
introduce will ensure that that happens.
  In the HHS inspector general's report of June 1998, the following 
finding was made: Most doctors think working in a Medicare HMO 
restricts their clinical independence and that HMOs' cost concerns 
influence their treatment decisions. Mr. President, every patient is 
different and brings to a situation his or her own unique history and 
biology. Only a physician who is trained to evaluate the unique needs 
and problems of a patient can properly diagnose and treat an 
individual.
  A Los Angeles doctor by the name of Lloyd Krieger said:

       Many doctors are demoralized. They feel like they have 
     taken a beating in recent years. Physicians train years to 
     learn how to practice medicine. They work long hours 
     practicing their field. Under this health care system, that 
     training and hard work often seems irrelevant. A bureaucrat 
     decides how doctors are allowed to treat patients.

  Dr. Krieger says:

       When I tell someone he is fit to leave the hospital after 
     an operation, I am often given an accusing stare. Sometimes 
     my patient asks: Is that what you really think or are you 
     caving in to HMO pressure to cut corners on care?

  Here's another example: A California pediatrician treated a baby with 
infant botulism, a toxin that spread from the intestine to the nervous 
system so the child really couldn't breathe well. The doctor prescribed 
a 10- to 14-day hospital stay. That doctor thought that length of stay 
was medically necessary for that particular baby. The insurance plan 
cut it short, saying the maximum that baby could remain in the hospital 
was 1 week. That shouldn't happen.
  The amendment I will introduce at the appropriate time, and that I so 
hope this body will agree to, will ensure that medically appropriate 
and necessary treatment is prescribed by the physician and not 
contradicted by a green eyeshade.
  I very much hope this body will accept it. I have introduced this 
kind of amendment now with Senator D'Amato as a cosponsor and with 
Senator Olympia Snowe as a cosponsor. Perhaps the time has come to have 
the opportunity to pass this amendment and to get it done once and for 
all.
  I thank the Chair, I thank the Senator from Nevada, and I thank the 
Senator from Massachusetts as well.
  I yield the floor.
  Mr. COCHRAN addressed the Chair.
  The PRESIDING OFFICER. The distinguished Senator from Mississippi is 
recognized.
  Mr. COCHRAN. Mr. President, is there an order for the conduct of 
business at this point?

  The PRESIDING OFFICER. The Senate is now in morning business, with

[[Page S7490]]

the majority having 25 minutes remaining and the minority having 
approximately 15 minutes remaining.
  Mr. COCHRAN. I thank the Chair.
  Mr. REID. Mr. President, I say to the Presiding Officer, we were 
given 20 minutes and we have approximately how much time remaining?
  The PRESIDING OFFICER. The Senator has 14 minutes 59 seconds.
  Mr. REID. Has the Senator from California completed her statement?
  Mrs. FEINSTEIN. I have completed it. I could go on.
  The PRESIDING OFFICER. The Senator from Nevada.
  Mr. REID. The question is: Are we going to be able to go forward with 
a debate on the Patients' Bill of Rights?
  It seems to me that would be the right thing to do. I am a member of 
the Appropriations Committee. I recognize that we are working under 
very difficult budget constraints because of the budget we have now in 
this body. I think it is important we move forward on the appropriation 
bills. We have done fairly well thus far.
  We have already passed four appropriation bills. The agriculture 
appropriations bill is currently pending. Yesterday, we reported the 
interior appropriations bill out of the subcommittee. Tomorrow, we will 
take up three appropriation bills in full committee. I agree that we 
need to continue to move these bills forward.
  I think we could complete all debate on the Patients' Bill of Rights 
in 3 legislative days. If we had 3 long, hard days, we could do that. 
If we use the majority's bill as a working model, they should not 
require any amendments, because it is their bill.
  We have acknowledged that we need 20 amendments. As we have stated on 
a number of occasions, we have had other bills that have been brought 
before this body, in this Congress, that have had a lot more than 20 
amendments. The military bill of rights had 26 amendments; the 
supplemental appropriations bill had 66 amendments; and the first 
budget resolution had 104 amendments. Twenty amendments is a reasonable 
request.
  We could agree, as far as this Senator is concerned, on having time 
limits on these amendments. We could do that. We could have good 
debates on what should be done on the Patients' Bill of Rights. We 
should do that.
  We are not going to allow this legislation to move forward until we 
have the opportunity to debate our amendments. As I indicated, in this 
Congress, the Y2K bill had 51 amendments; DOD authorization, 159; 
defense appropriations, 67; juvenile justice, 52; the first budget 
resolution, 104; Education Flexibility Act, 38; supplemental 
appropriations, 66. Relative to these bills, 20 amendments is nothing.
  We should proceed to the Patients' Bill of Rights as quickly as 
possible. We are, in effect, wasting time by having to come here and 
talk about why we need the opportunity to consider this legislation. It 
is not a question of whether we are going to debate the Patients' Bill 
of Rights, but when we are going to do it. We are going to offer our 
Patients' Bill of Rights as an amendment to every vehicle moving 
through this body. Under Senate rules, we can't be stopped from doing 
that.
  We believe it is important that Americans have access to specialty 
care. We are talking about the real life stories of real people who 
have been and will continue to be denied access to specialty care until 
we pass a meaningful Patients' Bill of Rights.
  As I mentioned earlier, Karrie Craig from Minden, NV, wrote me a 
letter. In her letter, she explained to me that her mother is dead 
because she was not able to see a specialist, even when her primary 
care physician recommended that she see one. She was denied specialty 
care because her managed care organization, not her physician, did not 
think it was necessary.
  We believe that patients should not be subjected to a one-size-fits-
all brand of health care. We believe there are situations where the 
doctor and the patient--not some bureaucrat--should decide what care is 
necessary. The American people also believe that. We think there are 
some real problems with the majority's so-called ``Patients' Bill of 
Rights''. We are willing to debate this issue and to determine whether 
or not our legislation is better than that of the majority. Clearly, we 
are willing to set time limits on our debate.
  We are allowing a limit on the number of amendments we offer, but the 
majority should allow this bill to go forward. The most striking 
loophole in the majority's plan--and it is hard to say what this is 
because there are so many of them--is that it doesn't cover most 
Americans. In fact, the Republican bill leaves out almost 120 million 
Americans. Their bill would only cover a small number of people. Only 
one-third of the 161 million people protected by our bill would be 
covered by the Republican proposal.
  All Americans who have insurance should be protected. That is what 
our legislation is all about. The Republican bill uses our title, 
``Patients' Bill of Rights,'' but that is all it uses. It does not 
extend coverage to the people who deserve to be covered.
  All Americans deserve guaranteed access to specialty care, and we 
believe that we should at least be able to debate this issue. There are 
many different areas we need to talk about regarding the Patients' Bill 
of Rights.


                       National Rifle Association

  Mr. President, while my friend from the State of Illinois is present, 
I would like to shift and talk about something else that is certainly 
important. As I have indicated, we are going to spend whatever time is 
necessary making sure that we have the right--I should not say the 
right, but that we have a debate on our Patients' Bill of Rights. We 
have the right, and that is why we are here today talking about this. 
So we are going forward until we have the debate on it.
  I would like to discuss with my friend from Illinois another issue 
that seems to have been lost in the shuffle, which is the debate 
related to guns. I say to my friend from Illinois that I have here a 
letter from a man from Reno, NV, by the name of David Brody. I would 
like my friend to comment on this.
  He writes:

       I am writing in regards to the enclosed National Rifle 
     Association membership that was mailed to my 13-year-old 
     daughter. I am not a gun advocate and have never voiced an 
     opinion and I certainly believe in our Constitution and the 
     right to bear arms, but I am rather astonished that the 
     membership application is addressed to my 13-year-old 
     daughter.

  I say to my friend from Illinois, do you think the NRA should be 
sending applications to 13-year-old children to join the NRA? This 
isn't something that is made up. I have here the National Rifle 
Association 1999 membership identification. It gives her a number, and 
the letter is addressed to Brittany Brody. The NRA also sent this 13-
year-old girl a survey wanting to know how she feels about opposing 
President Clinton on his gun issues. Does the Senator think this is 
appropriate to send to a 13-year-old girl?
  Mr. DURBIN. I thank my colleague for raising this issue. This really 
gets to the heart of the debate we had a few weeks ago on the floor of 
the Senate. Remember how America reacted to Littleton, CO, and the 
Columbine High School shooting? I think it fixed the attention of this 
Nation unlike any other event I can remember. We felt we needed to come 
to the floor of the Senate to try to find a way to reduce the 
likelihood that guns would get into the hands of children and 
criminals. The debate went on for a full week, and it ended finally 
when we had six Republican Senators join the overwhelming majority of 
Democrats for a tie vote, 50-50, at which point Vice President Gore 
came to the floor and cast the tie-breaking vote and sent a good, 
sensible gun control bill over to the U.S. House of Representatives 
where, unfortunately, the same organization, the National Rifle 
Association, tore it to pieces, leaving nothing.
  So we have our Senate bill, but the National Rifle Association 
prevailed over in the House. I say to the Senator from Nevada, I wish 
that I could tell you that I was shocked that the National Rifle 
Association would be so careless as to send a membership application to 
a 13-year-old. But when I look at what they did in the U.S. House of 
Representatives to a good bill, a bill that would have said we are 
going to have background checks at gun shows so we know that we are not 
selling to criminals and kids, and Senator Feinstein's amendment that 
would have prohibited importing these big magazine clips that are just 
used by gangbangers--they have no value in sport or hunting--and to 
make sure we

[[Page S7491]]

have trigger locks so when kids find a gun in the house, they won't 
pull the trigger and kill themselves, the NRA opposed that.

  Mr. REID. I say to my friend from Illinois, that kind of reminds me 
of our debate on the Patients' Bill of Rights. They call their bill a 
``Patients' Bill of Rights'', but it does not give patients any rights. 
On the gun issue, they say they had in the House bill protection 
against gun shows because they had a 24-hour time limit, but they know 
that most gun shows are on weekends and they can't research on the 
weekends, so basically nothing would happen; is that right?
  Mr. DURBIN. They are very similar, and the Senator is correct. The 
National Rifle Association is trying to put up some figleaf and say 
they are really for gun control. America knows better. We have been 
listening to these folks for a long time. They were opposed to the 
prohibition against cop-killer bullets--special bullets that would 
penetrate the bulletproof vests worn by policemen--because it infringed 
on people's constitutional rights. Give me a break. There isn't a right 
in the Bill of Rights that isn't limited for the common good.
  Mr. REID. I would like the Senator from Illinois to comment on the 
second and third paragraphs of this letter from Mr. Brody:

       As we strive in our community to ensure that our schools 
     are safe for our children, one of the biggest fears that 
     parents have is a gun at school. We have been able to turn 
     her particular school around from a very violent and non-
     academic oriented institution to one that we are all very 
     proud of and where the students are doing extremely well.
       I am absolutely amazed that the National Rifle Association 
     would have the audacity to mail membership applications to 
     children. At some point, I believe this must be part of our 
     government regulations. Will my youngest 11-year-old daughter 
     be contacted next with another outrageous suggestion that is 
     only supporting violence?

  Would the Senator say that Mr. Brody is out of line in writing this 
letter and crying out for help that his 11-year-old daughter and 13-
year-old daughter aren't given a membership--I mean, they got it; she 
has a card here that looks like a credit card. It says 13-year-old 
Brittany Brody is a member of the NRA.
  Mr. DURBIN. I say to my colleague, I know he is a father and he is 
proud of his family, and I am, too. Think about this. This father saw 
this come through the mail. Think of the world we live in, with the 
Internet and the webs. How many others are trying to lure kids into the 
purchase of weapons or a membership in a National Rifle Association and 
the like? I really think when we talk about responsibility and 
accountability, it applies to parents and it applies to organizations 
such as the NRA as well.
  I say to my friend from Nevada that he raises an excellent point. If 
we are going to make sure our kids have a fighting chance, we have to 
keep guns out of their hands. When the Senator from Nevada and I were 
both growing up a few years ago, there were always troubled kids in the 
schools. We called them bullies in those days. You feared getting 
punched in the nose on the playground. I wish that is all our kids had 
to fear today. Now they have to fear that the bully will get a gun and 
show up in school, as it happened in Conyers, GA; at Columbine High 
School; Jonesboro; West Paducah; Springfield, Oregon; Pearl, 
Mississippi. Those unfortunate incidents are the reality of the dangers 
our kids can face.
  Mr. REID. My time is about to expire, but I am here today to alert 
this body that we are going to make sure that when there is a call for 
conferees to be appointed on the juvenile justice bill, that we act 
appropriately, that we send a message to the conferees that we don't 
want business as usual, that we want the National Rifle Association to 
understand that the vast majority of Americans do not agree with them.
  The Senator from Illinois would agree that when the conferees are 
called, we are going to ask for a resolution to send to the conferees 
that they should follow what is already taking place in the Senate 
that, in effect, says a majority of the people of this country are in 
agreement with the Senate; is that true?
  Mr. DURBIN. I say to the Senator from Nevada that the Democrats may 
be in the minority in the Senate. I believe our position for sensible 
gun control to keep guns out of the hands of criminals and kids is a 
majority opinion in America. I think our position for the Patients' 
Bill of Rights, so doctors make decisions and not insurance companies, 
is a majority opinion in America. We are going to fight for that.
  I thank the Senator for his leadership.
  Mr. REID. Mr. President, how much time does the Senator have?
  The PRESIDING OFFICER. The Senator from Nevada has 12 seconds.
  Mr. REID. I yield that time.
  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. REID. 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. REID. Mr. President, the Senator from Maryland just arrived. I 
ask unanimous consent that she be allowed to speak as if in morning 
business for 15 minutes.
  The PRESIDING OFFICER. Acting as an independent Senator from Kansas, 
I object.
  Mr. REID. I ask unanimous consent that the Senator from Maryland be 
allowed to speak in morning business for 10 minutes.
  The PRESIDING OFFICER. The acting Presiding Officer informs the 
Senator from Nevada that the majority has 25 minutes and that there is 
a Senator expected on the floor at any moment. Would the Senator like 
to repeat his request?
  Mr. REID. I ask unanimous consent the Senator from Maryland be 
allowed to speak 10 minutes and that the morning hour be extended for 
35 minutes.
  The PRESIDING OFFICER. Acting as an independent Senator from Kansas, 
I object.
  Ms. MIKULSKI. Mr. President, I ask unanimous consent that I be 
allowed to speak in morning business for no more than 5 minutes.
  Mr. NICKLES. Will the Senator repeat the request?
  Ms. MIKULSKI. I ask unanimous consent that I be allowed to speak as 
if in morning business for no more than 5 minutes.
  The PRESIDING OFFICER. The Senator from Oklahoma.
  Mr. NICKLES. If I might engage my colleague from Nevada, are there 
additional Senators requesting time on his side?
  Mr. REID. No.
  Mr. NICKLES. This Senator has no objection to the request. I was 
going to suggest that we give an additional 15 minutes on both sides.

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