[Congressional Record Volume 145, Number 90 (Wednesday, June 23, 1999)]
[Senate]
[Pages S7505-S7506]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        PATIENTS' BILL OF RIGHTS

  Mr. KENNEDY. Mr. President, I join with my friend from Illinois and 
others who have spoken before the Senate on the issue of the Patients' 
Bill of Rights, which, translated into layman's terms, means 
legislation that will give assurance to all Americans who are fortunate 
enough to have health insurance policies that medical decisions are 
being made by trained professional medical personnel and not by 
insurance company agents.
  That is the underlying concept of this legislation, as has been 
pointed out during the course of the morning with the examples that 
have been given, and there are scores more. If we get the chance during 
the debate on the provisions, hopefully later in the afternoon, we will 
be able to review the various protections that we are attempting to 
achieve and why they are important to the children and families of this 
country.
  Under the Republican program, there is a guarantee of getting direct 
access to a pediatrician for a child, but if that child has cancer, 
there is no guarantee the child will see a pediatric oncologist. Or if 
one has a disability, there is no guarantee that person will have 
access to the needed specialists. The guarantee they will have the best 
care available is important to patients, and there is no country which 
has better quality health care.
  We have a challenge nationwide regarding access to health care, and 
we have a challenge nationwide in terms of the cost of health care, 
particularly in a number of different areas. One that comes to mind now 
is the issue of prescription drugs. We are going to have an 
opportunity, hopefully in this Congress, to address that issue.
  On the issue of what we call quality, meaning that patients are going 
to get the best health coverage in terms of recommendations made by the 
professionals who have been trained and who have a wealth of experience 
in this area, we are trying to make sure that every medical decision 
will be based upon sound and meaningful medical teaching and 
experience.
  That is the heart of this legislation. It is very important we get 
this kind of protection. Otherwise, we will continue to have today, 
tomorrow, and the day after tomorrow the tragic circumstances we have 
experienced and are being experienced in communities and towns all over 
this country.
  Earlier in the day, we had some important statements and speeches by 
our colleagues. Senator Feinstein talked about a provision making sure 
every health insurance proposal has as its basis of treatment the best 
in terms of medical necessity. The best that is available will be the 
standard used in providing treatment for individuals.
  I took some time earlier today and illustrated how different health 
insurance programs have different definitions. Sometimes a definition 
works to the advantage of the HMO and works to the advantage of the 
insurance company but to the disadvantage of the individual. Such a 
definition can even threaten the life of that individual.
  It may be favorable to the HMO regarding its bottom line financially, 
but it certainly is not favorable to the patient. We ought to be about 
the business of doing what is important for the patient.
  Senator Feinstein has talked about this issue very eloquently and 
persuasively today. That certainly would be an area that we ought to be 
able to debate and discuss. I do not believe we have that kind of 
standard with the language which is included in the provision being 
advanced by our Republican friends.
  It is not only my opinion that this is important, but it is the 
opinion of the health practitioners in this country--the doctors, the 
American Medical Association, the nurses, the various specialists. They 
are concerned that the Republican proposal does not provide a good 
standard to protect the health and safety of children, of women, of 
patients in our country.
  We ought to be able to debate that issue. It is a very important 
issue. Senator Feinstein has spoken eloquently about that particular 
problem. But we cannot. We are virtually prohibited from being able to 
do so. We cannot even get this measure up. We were told yesterday to 
either take the whole package or we were not going to get anything at 
all. That has been repeated time in and time out. There appears to be 
the continuation of that policy now by the Republican leadership--delay 
and deny, delay and deny.
  Then later we had the excellent statement that was made by our 
colleague and friend, Senator Mikulski, who was talking about the 
importance of the kinds of protections that are guaranteed in our 
Patients' Bill of Rights, particularly with regard to women and 
children.
  She very eloquently pointed out how these gatekeepers who are part of 
these HMOs--the gatekeeper being the person who ultimately dictates to 
the doctor what they can effectively prescribe in terms of treatment 
and in terms of medicines--makes those medical judgments and decisions. 
That is what is happening out there; and that is startling.
  People can say, well, that really isn't happening in America. It is 
happening. We have given examples of the devastating results that occur 
as a result of that kind of interference. She illustrated the 
importance of having those kinds of specialists who are particularly 
trained and understand the particular needs of women and children.
  She talked from her own personal experience in a very significant and 
important way about how she had a gallbladder operation and was able to 
stay in the hospital in order to recover. But if a woman had a 
mastectomy--and she used the word ``amputation'' because she said that 
is what a mastectomy is --she would still be required to leave the 
hospital that same day. She reminded us about the unsuccessful efforts 
we made in the committee to try to alter and close that gap in the 
Republican bill. It makes no sense how those efforts were defeated.
  It seems to me we ought to be able to have some debate. I do not 
think that issue would take a long period of time. I thought that 
Senator Mikulski, in about an 8- or 10-minute presentation, made a 
presentation that was powerful and convincing and compelling.
  Maybe there is a good argument on the other side. We certainly have 
not

[[Page S7506]]

heard it yet. We never heard it in the committee when we were marking 
this bill up. We did not hear one. So maybe there is an argument on the 
other side that we haven't heard yet. A woman who is going to have a 
mastectomy ought to be under the care of the doctor, and the doctor and 
the patient ought to decide whether that person can leave the hospital 
that day or ought to be there 1 or 2 or 3 more days. Leave it up to the 
doctors and their recommendations. That is not permitted under the 
majority's bill.
  We heard a great deal of talk about that. That is not in the bill 
that is the Republican proposal. The specific amendment that the 
Senator talked about on the Senate floor would be an amendment that we 
ought to be able to debate. We ought to be able to debate why it is not 
in the Republican bill that will eventually, hopefully, be laid down 
before the Senate.

  There is not that protection for women in this country. There is not 
that protection that will permit the doctor to make a judgment about 
how long it will be medically necessary to keep that woman in the 
hospital if she has a mastectomy. That protection is not there. It was 
defeated when it was offered.
  Let's have a brief debate on that issue, and let's have the call of 
the roll. Why is it we are being denied that today? Why is it we are 
being foreclosed from that kind of an opportunity? Why is it we cannot 
have the kind of debate in relation to the excellent presentation that 
the Senator from California, Senator Feinstein, made, the excellent 
presentation that the Senator from Maryland, Senator Mikulski, made on 
two different kinds of phases?
  Yesterday we talked with our Democratic leader, Senator Daschle, 
about the importance of clinical trials and the necessary aspects of 
increasing the clinical trials. Historically, the insurance companies 
of this country have basically supported clinical trials. There is a 
very good reason why they should, because--besides the medical reason 
that it is important for the patient--if the person gets better they 
will not need as many services, and that means the insurance company 
will pay out less in the long run. That is something that should be a 
financial incentive for the insurance companies; and it is.
  Let me repeat that. While clinical trials make sense in terms of the 
treatment for the patient, they make sense for the insurance companies, 
too. But what we are seeing, under the health maintenance 
organizations, is the gradual squeeze and decline in terms of the 
insurance companies' payments for routine health needs of the 
particular patients.
  Under our proposal, they would only pay for routine costs, as they 
have historically. The research regime pays for the special kinds of 
attention, treatment, and tests that are necessary in order to review 
whether that particular pharmaceutical drug or other therapy is useful 
or not. That is not paid for by the insurance companies. So they only 
have to pay for the routine health needs--the costs that they would pay 
for even in the absence of a clinical trial. The regime, the testing 
group or organization or pharmaceutical company that is having that 
clinical trial, pays for the rest.
  But what we are seeing is virtually the beginning of the collapse of 
clinical research taking place. I will just make a final point on this 
issue. The group that has had the greatest amount of clinical research 
done on them in this country has been children. The greatest progress 
that has been made in the battle for cancer has been--where?--with 
children.
  Most of the clinical researchers who have reviewed this whole 
question of our efforts on cancer would make the case that one of the 
principal reasons that we have made the greatest progress in the war on 
cancer in children, in extending their lives and improving their human 
condition, is because of these clinical trials.
  We want to continue to encourage participation in clinical trials. 
They offer hope for the future. If the doctor says this is what is 
necessary for the life and the health of a woman who has cancer, that 
this is the one way she may be able to save her life, and there is a 
clinical trial available, we want to be able to say she ought to be 
able to go there. The opposition says: Let's study it. I say: Let's 
vote on it.
  I yield the floor.
  Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. NICKLES. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Gregg). Without objection, it is so 
ordered.

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