[Congressional Record Volume 145, Number 91 (Thursday, June 24, 1999)]
[Senate]
[Pages S7563-S7565]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    PATIENTS' BILL OF RIGHTS AND THE AGRICULTURE APPROPRIATIONS BILL

  Mr. DORGAN. Mr. President, I take this opportunity to respond just a 
bit to some of the discussion that has occurred with respect to both 
the Patients' Bill of Rights and also the agriculture appropriations 
bill.
  I just heard the discussion about the Kennedy position in the House 
and the Kennedy bill this and the Kennedy bill that. It is not what 
this issue is about. This is about a Patients' Bill of Rights. It is 
about the kind of health care the American people get when they show up 
with a disease or with an injury and need health care treatment, what 
kind of treatment do they get under current circumstances, and what 
kinds of protections are reasonable protections for them to expect in 
this system.
  We have been pushing, for a long while, to try to get a Patients' 
Bill of Rights enacted by this Congress and by the previous Congress, 
but our efforts have not met with great success. I will tell you why. 
Because as health care has reorganized, and the largest insurance 
companies have herded people into HMOs, they have decided they do not 
want Congress to pass a Patients' Bill of Rights. They want to be 
making health care decisions in their insurance offices, often 1,000 
miles away from a hospital room or a doctor's office. They do not want 
Congress, in any way, to pass a Patients' Bill of Rights. They have 
gotten enough folks here in this Congress, and here in this Senate, to 
decide that they would block it. And it has been blocked forever.
  So it does not matter that it was the agriculture appropriations 
bill. It would have been any bill. The Democratic leader last week said 
to the majority leader: We intend to offer it. If you don't give us an 
agreement and an opportunity to decide that we're going to have a fair 
and free and open debate on the Patients' Bill of Rights, we're going 
to offer it.
  We are going to pass the agriculture appropriations bill. Before we 
pass the agriculture appropriations bill, we are going to have a debate 
on responding to the emergency of the farm crisis. That is not in this 
bill at the present time. We tried to put it in the bill in the 
subcommittee and were defeated in our attempts to do so.
  But we are going to have a debate that is much larger than just this 
bill. This bill deals with the funding of USDA programs, research, food 
stamps--a range of things--but it does not address the farm crisis that 
exists out there today that deals with income: The fact that farmers go 
to a grain elevator someplace and the grain trade decides that their 
food is not worth much, they do not get a fair price for it. Family 
farmers are in desperate trouble. We are going to debate that bill, but 
we are also going to debate a bill to try to respond to the farm 
crisis.
  Mr. CRAIG. Will the Senator yield?
  Mr. DORGAN. I will in a moment.
  But let me point out, we are also going to debate the Patients' Bill 
of Rights. It is not going to be some gatekeeper who is going to tell 
us what our rights are on the floor of the Senate. Someone will stand 
over there and say: Well, we have reviewed this amendment. We think 
we'll allow you to offer that. We are not going to do that. That is not 
the way the Senate rules exist. The Senate rules exist in a way that 
says to every Senator: You have a right to offer amendments.
  I understand that we are not in the majority and we do not set the 
agenda. The other side sets the agenda. But when they decide that the 
agenda will be to enhance all of their interests and shut off any 
debate of interests on the other side, they miss, in my judgment, the 
history of the Senate. That is not what this body is about.
  We have rights. We intend to exercise those rights. We are going to 
talk about education. We are going to talk about health care. Yes, we 
are going to talk about the farm crisis. And we are going to insist on 
it. The debate at the moment is our insistence that we be able to have 
a fair opportunity to offer amendments with respect to our Patients' 
Bill of Rights, that we have a full debate on them, and to have them 
voted on. We insist on that.

  I am happy to yield for a question.
  Mr. CRAIG. Very briefly, I was a bit surprised last week when the 
Senator came to the floor and offered the Patients' Bill of Rights to 
the ag bill, because I know of his commitment to agriculture. I know of 
our joint belief about the farm crisis and the reality of it.
  What this Senate has not done yet with the Department of Agriculture 
is shape the size and the scope of the farm crisis. We agree that 
crisis exists. You and I agree that it exists. The Presiding Officer 
comes from a farm State. We agree it exists. But we don't know the 
magnitude of it yet.
  We have asked the President and the Secretary of Agriculture to 
engage with us. That is why it is not attached to this appropriations 
bill. We are not going to start legislating into a vacuum. We have to 
legislate because we are dealing with billions of dollars. And the 
Senator is right about farmers' and ranchers' incomes. That has to be 
done accurately.
  But I am a bit confused. Being the farm State Senator that he is, he 
seems to be offering the Patients' Bill of Rights to this ag approps 
bill.
  Mr. DORGAN. Reclaiming my time, I offered the amendment the other day 
on behalf of the Senate Democratic leader. It was an amendment that we 
said last week we would offer to any bill on the floor of the Senate. 
This is not going to delay the agriculture appropriations bill. The 
Senator from Idaho well knows that.
  The PRESIDING OFFICER. The time of the distinguished Senator has 
expired.
  Mr. DORGAN. Mr. President, I ask unanimous consent for 10 additional 
minutes.
  The PRESIDING OFFICER. Is there objection?
  Mr. CRAIG. I will not object, if there is an additional 10 minutes 
for our side.

[[Page S7564]]

  The PRESIDING OFFICER. Is that the Senator's request?
  Mr. DORGAN. That is my request.
  Mrs. BOXER. When the Senator finishes his thought, will he yield for 
a question?
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DORGAN. Let me just make this point: We are going to pass an 
agriculture appropriations bill. The Senator from Idaho says: Well, we 
all agree there is a problem. We need to understand the scope and the 
depth.
  I understand the scope and the depth of this problem. I sat in the 
Appropriations Committee conference in the basement of this building at 
midnight one night, when nobody said we needed to understand the scope 
and depth of the Defense Department issues. The Pentagon asked for $6 
billion to prosecute the airstrikes needed to replenish their funds, 
and the Congress said: Well, you don't know what you are doing. We want 
to add another $6 billion. You didn't ask for enough money for the 
Pentagon. We demand that we give you $6 billion more.
  Nobody was sitting around saying we need to understand the scope and 
the depth of that. They said: We demand you take $6 billion more money. 
That night, about 1 in the morning, Senator Harkin and I said, if there 
is an extra $5 or $6 billion around, we demand a debate on the priority 
of its use. We have people going broke in farm country. We demand that 
some of it be used for that.
  So we offered an amendment. By 14 to 14, we lost on a tie vote; I 
suppose, because some didn't know the scope and the depth. The Senator 
from Idaho cares a lot about family farming, as do I. It is mixing, in 
my judgment, a concoction of bad meals here to suggest that by adding a 
Patients' Bill of Rights to this particular bill it does something to 
agriculture or somebody isn't committed to agriculture. That is all 
fog.
  We wouldn't be here talking about this had someone, some long while 
ago, said, yes, we will give you your rights on the floor of the Senate 
to bring a bill to the floor and to offer amendments. Yet we have been 
systematically denied that opportunity. That is why, whether it is this 
bill or any other bill, you are going to find these kinds of 
amendments.

  As soon as those who are in charge allow the Senate to operate the 
way it ought to operate and function, you will not see these 
amendments.
  In my judgment, we are here on the Patients' Bill of Rights because 
we have been told: We don't want you to be able to offer your 
amendments on the Patients' Bill of Rights dealing with scope, dealing 
with emergency room treatment, and so on. That is why we are here.
  Mrs. BOXER. Will the Senator yield?
  Mr. DORGAN. I am happy to.
  Mrs. BOXER. I find it quite interesting. I ask my friend, do the 
people who live in farm country need health insurance? Do the people 
who live in farm country have problems if they need to go to emergency 
rooms? Do the people in farm country have problems when their child 
needs a specialist?
  I wonder whether or not we segment things too much. I think people 
who live in farm country also need health care. If we could reach 
agreement so we could offer our amendments and give the people in farm 
country and in suburbia and in urban America the right to decent health 
care--my friend from Idaho said: Oh, my God, what you are doing will 
cost so much. We have a letter from GAO. It is $2 a person a month to 
get decent health care in this country.
  I ask my friend, because he is such a stalwart supporter of family 
farmers, do they not have a problem as well as all the rest of us?
  Mr. DORGAN. The answer to that is, of course, they do. This issue is 
not an issue of urban versus rural. The issue of health care and 
medical treatment exists all around this country. We have talked on the 
floor at great length about the specifics of it.
  Yesterday I told the story--I will tell it again, because it 
describes something more than a Patients' Bill of Rights--does someone 
who was taken a 40-foot fall and has been helicoptered to a hospital 
and thrown into an emergency room unconscious with fractured bones in 
three parts of her body, does that person have a right to emergency 
room treatment? Or does the HMO have a right to say: We won't cover 
your emergency room cost because you didn't get prior approval to get 
to an emergency room?
  How do you get prior approval when you are unconscious on a gurney 
being wheeled in from a helicopter, medivac'ed from the mountains where 
you were hiking? Does a patient in this country who has health care 
coverage have a right to expect emergency room treatment in those 
circumstances? Of course.
  That is what the Patients' Bill of Rights is about. Not just that, 
but the right to keep the same doctor, and cancer treatment, a whole 
series of issues like that. Does that affect rural America? Of course, 
it does.
  But I want to go back to the point made by my colleague. The 
agriculture appropriations bill does not come to the floor of the 
Senate with an ag crisis response because it was not deemed appropriate 
by those who decided they didn't want to put it there. We are going to 
try to put it there at some point. I hope perhaps we can do that on a 
bipartisan basis.
  I know the scope and the depth of the problem in rural America. The 
problem is that it costs about $4.50 to produce a bushel of wheat. They 
drive to the country elevator and the grain trade says wheat is only 
worth $2.70 a bushel. That is a quick way to go broke. We have a lot of 
families who are experiencing broken dreams of being able to continue 
in family farming because the hungry world and the grain trade of the 
hungry world have said: Your food doesn't have value.
  It is not in the bill now, so don't be in such a hurry about the 
underlying bill. We need to add to the underlying bill the farm crisis 
package that Senator Harkin and others are going to push. In the 
meantime, we will insist on our rights to try to offer a Patients' Bill 
of Rights on the floor of the Senate.
  Mrs. BOXER. One final question. The Senator from Idaho chastised my 
friend and said: You are from farm country, yet you are supporting a 
Patients' Bill of Rights and want that debate now, when the underlying 
ag bill is so important. What my friend is saying is that this bill, 
the underlying bill, comes up short for America's farmers.
  Mr. DORGAN. Absolutely.
  Mrs. BOXER. I watched at 1 in the morning. I saw the Senator, with 
Senator Harkin, offer a package that addresses the emergency needs of 
America's family farmers. It was turned down pretty much on a partisan 
vote. Is that correct?
  Mr. DORGAN. It was a partisan vote except for one.
  Mrs. BOXER. So pretty much a partisan vote.
  We basically had the Republicans--who are out here saying, oh, bring 
on this bill, our poor family farmers--voting down an emergency package 
for those very same farmers and fighting us so those farmers and 
everyone else in America can't get decent health care.
  Lastly, I wonder if my friend sees a connection, because I am 
thinking about it. I saw my friend from Idaho come out and, instead of 
debating us on the bill, scare America by saying: Oh, my God, with this 
Patients' Bill of Rights, 1 million, 2 million people are going to lose 
their insurance. It sounds like scare tactics.
  It reminded me a little bit of the debate we had on the juvenile 
justice bill, when all we were saying on our side of the aisle was that 
we wanted to do background checks on criminals and mentally disturbed 
people before they get a weapon. They said: Oh, my God, they are trying 
to take everyone's guns away.
  America knows that is not the case. When you fight for sensible 
things, you hear scare tactics from the other side.
  I wonder if my friend notices this kind of desperation deal going on, 
every time we try to do something, of trying to scare the people of 
this country.
  Mr. DORGAN. The only reason I stood up to respond is because there is 
information from the GAO and elsewhere that suggests that the Patients' 
Bill of Rights may actually encourage more health care coverage. You 
may have more people buying health insurance understanding that in 
their HMO they have rights. They have the right to demand information 
on all the potential treatments available to them,

[[Page S7565]]

not just the cheapest, for example. They might well believe that is a 
pretty good thing.
  The GAO and others say this may well increase the coverage. The 
assumption that a couple million people will opt out, I do not believe 
that.
  The second thing is, we are going to need to solve the farm problem 
with folks around here from both sides of the political aisle. The 
Presiding Officer is from Kansas, a big State in dealing with the farm 
issue. I would never suggest that somehow he doesn't care about 
farmers. I have served with him in the House and the Senate and know 
too well how much he cares about family farmers. We need, at some 
point, to get together on a solution to deal with the farm crisis. I 
understand that. I have not said--and I could, I suppose--all right, 
you took $6 billion that you created someplace and gave it to defense.

  So my contention is this: You gave the Defense Department money they 
didn't ask for that should have gone to farmers. I could come out here 
and make that case, I suppose. But I am not doing that. I have said I 
thought if there was $6 billion, we should have a debate about the 
priorities. We didn't. The Defense Department got it, and I am sure 
they will use it for security needs, readiness, and other things.
  My point is, on the underlying bill, I don't think we should be too 
quick to pass it, because it doesn't have the fundamental resources to 
deal with the farm crisis.
  In any event, last week the Democratic leader informed the majority 
leader: If you don't give us the opportunity that we insist upon as 
Senators, to bring these issues to the floor, such as the Patients' 
Bill of Rights, then we intend to offer it as an amendment to whatever 
vehicle is on the floor. Anybody who is surprised by that simply wasn't 
awake last week.
  So we will get through this. I think the way we will do it is to have 
a full debate on the Patients' Bill of Rights at some point, with the 
ability to offer amendments, as we should, and I hope we will also have 
a robust debate on the issue of the farm crisis response.
  The PRESIDING OFFICER. The time requested by the Senator has expired.
  Mr. DORGAN. 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. GREGG. 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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