[Congressional Record Volume 145, Number 91 (Thursday, June 24, 1999)]
[Senate]
[Pages S7560-S7561]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        PATIENTS' BILL OF RIGHTS

  Mr. WELLSTONE. Mr. President, my understanding is that we have not 
reached an agreement with my colleagues on the other side of the aisle 
about how we can have a serious, substantive, and important debate 
about health care, about patient protection in our country. The latest 
proposal as I understand it from the Republicans basically would amount 
to Democrats having an opportunity to maybe introduce four amendments. 
That would be it. Again, I challenge my colleagues on the other side of 
the aisle, as I said yesterday, to debate this.
  The evidence is irrefutable and irreducible: When it comes to who is 
covered, the Republican plan covers 48 million people, the Democratic 
plan covers 163 million people. That is a huge difference.
  Republicans argue that we rely on States for the coverage, once we 
deal with what is called the ERISA problem. Our argument is that a 
child, a family, regardless of where the child lives, where the family 
lives--be it Mississippi or Minnesota--ought to have some protection. 
People ought to have the right, or the assurance, that if their child 
has a serious illness, they will be able to have access to the best 
care. That assurance for a family should extend to all citizens in our 
country. It shouldn't be based upon what different States decide or 
where a family lives.
  I repeat, 163 million people with some protection versus 48 million 
people. It is no wonder my colleagues on the other side of the aisle 
don't want to debate patient protection.
  In the Health Committee, where we wrote this bill, I had an amendment 
that dealt with the Republican ``gag'' clause. This amendment would 
prohibit retaliation by a health plan when a doctor advocates for a 
patient. There were two parts: First, it said that plans can't penalize 
doctors who advocate for patients during an appeal process; and, 
second, it protected licensed and certified health care professionals 
from retaliation if they reported some problems with the actual quality 
of care being provided in a hospital or by a plan. Presenting this 
information to a regulatory authority or private accreditation 
organization is called whistleblower protection. This amendment was 
defeated, I think, on an 10-8 vote. It is no wonder the Republicans in 
the Senate don't want to debate patient protection.
  The front page story today says doctors are going to unionize. The 
American Medical Association announces doctors are going to unionize. 
No wonder, when doctors don't have protection if they advocate for a 
patient during an appeal process, when one of these managed care plans, 
owned by one these insurance companies practicing bottom-line medicine, 
and the bottom line is the only line, and the plan decides the patient 
is not going to be able to see a pediatrician who specializes in 
oncology.
  If a child is ill with cancer and that family makes an appeal, if the 
doctor is there for that family and says, yes, that child needs to see 
this expert, there is no protection in the Republican plan. There is no 
whistleblower protection for doctors who say, I have to speak out, I 
have to say this plan, or this hospital, is not providing the kind of 
care that people deserve. I don't blame my Republican colleagues for 
not wanting to debate patient protection.
  This chart shows whether or not you will have guaranteed access to 
specialists. The Republican plan has a little bit of access; the 
Democrats' plan makes it clear that people will have access.
  When it gets to the question of who is going to define medical 
necessity--that is a critical issue--we make it clear that the provider 
defines medical necessity, not a 1-800 number you call where you have 
utilization review by people not necessarily qualified, working for 
insurance companies that are just trying to keep costs down.
  When it comes to the issue of choice of doctor, points-of-service 
option, being able to find a doctor outside your plan, and making sure 
your child who needs to see that doctor can see that doctor, we are 
clear: Families should have that option. The Republican plan doesn't 
support that. No wonder they don't want to debate.

  When it comes to whistleblower protection for providers who advocate 
for their patients to make sure they don't lose their jobs, the 
Republican plan doesn't provide the protection. The Democrat plan does. 
No wonder my colleagues don't want to debate.
  When it comes to the concerns and circumstances of women's lives vis-
a-vis a health care system that has not been terribly sensitive and 
responsive to women, or with special emphasis on children and access to 
pediatric services, or making sure that people who struggle with mental 
health problems or substance abuse problems are not ``defined'' out and 
are not discriminated against, I don't see the protection in the 
Republican plan. We try to make sure there is that protection.
  These are two plans, two proposals, two pieces of legislation where 
the differences make a difference.
  I say one more time to my Republican colleagues, I have been trying 
to engage people in debate for 2 days. I will yield for any Senator who 
wants to debate, on my time, so I can ask questions. That is what we 
should be about. The Senate should be about deliberation and debate. It 
shouldn't be about delay and delay and delay and delay.
  It may be that we will not get the patient protection legislation on 
the floor today, Thursday, but we will get this legislation on the 
floor. We will continue to bring up these problems that the people we 
represent have with this health care system right now. We will continue 
as Senators to advocate for families, to advocate for consumers, to 
advocate for children, to advocate for women, to advocate for good 
health care for people.
  If I had my way, the Democratic Party would be out here on the floor 
also calling for universal health care coverage. We will get there. At 
the very minimum, let's make sure there is decent protection for 
consumers.
  I say to my colleagues, I have carefully examined your patient 
protection act. I think it is the insurance company protection act. We 
went through this in committee. We went through the debate in 
committee. I see a piece of legislation that pretends to provide 
protection for people, but once we have the debate and once we get into 
specifics, I think people in the country are going to be furious. They 
will say, don't present us with a piece of legislation with a great 
title and a great acronym that has no teeth in it, that has no 
enforcement in it, and that will not provide the protection we need.
  That is why the majority party, the Republican Party in the Senate, 
doesn't want to debate this. Republicans in the Senate right now--I 
hope this will change--do not want to have to come to the floor and 
debate amendments. They don't want to have to argue why they don't 
cover a third of the eligible people. They don't want to have to argue 
why they don't want to make sure families have access to specialized 
services. They don't want to argue why they don't want to provide 
doctors with whistleblower protection. They don't want to argue a whole 
lot of issues that deal with patient protection.
  When you want to debate is when you really believe you are right. 
When you want to debate is when you really think you have a piece of 
legislation that will lead to the improvement of lives of people. When 
you want to debate is when you have a piece of legislation that is 
consistent with the words you speak and you know you are not trying to 
fool anybody; you know it is authentic; you know it is real.
  When you don't want to debate, I say to my Republican colleagues, is 
when you have a whole set of propositions you cannot defend. When you 
don't want to debate is when you know in the light of day, with real 
debate, with people challenging you, you can't defend your proposal. 
When you don't want to debate is when you are worried

[[Page S7561]]

you will get into trouble with the people in the country because you 
haven't done the job.
  That is what is going on.
  One final time, I come to the floor of the Senate to urge my 
Republican colleagues to be willing to debate this question.
  Let me make a connection to what Senator Kerrey said earlier, because 
it is so important to me. If there is anything we should be about as 
Senators, it should be about focusing on good education, opportunities 
for children, good health care for people, making sure families don't 
fall between the cracks. These are the issues that people talk about 
all the time in our States. That is what we ought to be focusing on 
right now.

  I yield the floor.
  The PRESIDING OFFICER (Mr. Roberts). The Senator from Georgia is 
recognized.
  Mr. CLELAND. Mr. President, I thank my distinguished colleague from 
Minnesota for his remarks today on the subject of health care and HMO 
reform, and particularly his strong advocacy for what has become known 
as the Patients' Bill of Rights.
  I would like to report to my colleagues in the Senate the most recent 
Kaiser Family Foundation/Harvard University survey reports that 
problems with managed care are, indeed, growing and that Americans are 
increasingly worried about how their health care plan will treat them. 
The survey found that in 1998 as many as 115 million Americans either 
had a problem or knew someone who had a problem with a managed care 
plan.
  A number of provisions have been included in the Patients' Bill of 
Rights to maintain the sanctity of the provider-patient relationship, 
basically known as the doctor-patient relationship. We used to think 
that was sacrosanct. Unfortunately, it is not today under many HMO 
plans. Health plans frequently impose restrictions on that relationship 
by taking it upon themselves to determine the most appropriate 
treatment. These determinations are often made on the basis of costs 
rather than what is in the patient's best interest. The fact that 
health plans are now making medical decisions that were traditionally 
made by the treating physician really causes me great concern. I think 
it concerns a number of Members of this body.
  If health plans continue to arbitrarily define medical necessity, 
patients will be ultimately denied the health care they were promised. 
In this HMO debate, this debate on reforming health maintenance 
organizations, I do not think there is any more pressing issue than 
ensuring that patients are protected against the practice of some 
health plans of having insurance bureaucrats determining medical 
necessity rather than trained physicians. I think that is an incredible 
abuse of the system. I think it is terrible when we treat people based 
on financial necessity rather than medical considerations.
  Health plans, I don't think, should interfere with decisions of 
treating physicians when those decisions concern a covered benefit that 
is medically necessary, according to that physician, and appropriate 
based on generally accepted practices and standards of professional 
medical practice. It seems to me that is common sense.
  The Patients' Bill of Rights protects the sanctity of the doctor-
patient relationship by allowing physicians, not accountants, to make 
medical necessity determinations. I think that is critical. In 
addition, some managed care organizations use improper financial 
incentives to pressure doctors to actually deny care to their 
patients--incredible. The Patients' Bill of Rights, I think, will go a 
long way to stopping this practice.
  I would like to share one personal experience. I am glad that when I 
was wounded in Vietnam I was not covered by a HMO. I am glad I was 
covered by the full faith and credit of the U.S. Government. I could 
see myself laying there after the grenade went off, trying to call an 
insurance bureaucrat, being told my conditions were not covered by what 
was in the plan and, second, I was not cost effective.
  I am afraid more and more Americans are experiencing that, which is 
why I personally support the Patients' Bill of Rights. Many of my 
colleagues do as well.
  I appreciate the opportunity to discuss this important issue in the 
Senate. Mr. President, I yield the floor and suggest the absence of a 
quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative assistant proceeded to call the roll.
  Mr. THOMAS. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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