[Congressional Record Volume 145, Number 99 (Wednesday, July 14, 1999)]
[Senate]
[Pages S8428-S8429]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                 THE IMPORTANCE OF PATIENT PROTECTIONS

  Mr. FEINGOLD. Mr. President, I rise today to speak about the 
importance of passing a meaningful Patients' Bill of Rights package 
that will ensure that managed care companies cannot put their cost-
control measures ahead of the well-being of their patients. This 
legislation is absolutely vital to protecting the quality of health 
care for all Americans.
  Many of my colleagues have spoken on various aspects of this issue 
over the past few weeks. But I would like to bring my colleagues' 
statements ``home'' by speaking a bit about what we mean when we talk 
about ``Protecting Patients' Rights.'' We are talking about the grim 
reality that the American health care system is no longer controlled by 
those who best understand how to treat patients--our physicians.
  Instead, managed care companies, primarily HMOs but also other health 
insurance providers, have become so involved in the business of health 
care that they control nearly every aspect of health care including 
where the health care is provided, and by whom. Of greatest concerns to 
me the most is that these managed care organizations can decide whether 
that health care can be provided at all--they make the key medical 
decisions. In other words,, regardless of whether that care is 
determined to be medically necessary by the physician who is treating 
you, managed care administrators can override your doctor's medical 
decisions and refuse to cover the care that you need.
  How does this happen? Well, managed care companies control costs by 
limiting supply--screening which health care providers its enrollees 
are permitted to see, requiring patients to go through insurance 
company gatekeepers prior to seeing a specialist, tracking physician 
practice patterns to ensure that doctors are complying with HMOs' cost-
control efforts. Some HMOs go so far as to impose a gag-rule on 
doctors, prohibiting physicians in their system from discussing 
treatment options that the HMO administrators deem too expensive.
  Managed care companies control how--or even whether--we receive 
health care. Their control over what goes on in the examination room 
can be matched only by their significant political clout in Washington, 
which they've gained in part through generous political donations. Mr. 
President, during earlier remarks I gave on the Patients' Bill of 
Rights, I talked about the power special interests wield in the health 
care debate, but I want to remind my colleagues and the public of those 
remarks, because I think it's vital that we keep the power of these 
wealthy interests in mind throughout this discussion.
  During the last election cycle, managed care companies and their 
affiliated groups spent more than $3.4 million on soft money 
contributions, PAC, and individual contributions--roughly double what 
they spent during the last mid-term elections.
  Managed care giant United HealthCare Corporation gave $305,000 in 
soft money to the parties, and $65,500 in PAC money to candidates;

  Blue Cross/Blue Shield's national association gave more than $200,000 
in soft money and nearly $350,000 in PAC money;
  And the managed care industry's chief lobby, the American Association 
of Health Plans, has given nearly $60,000 in soft money in the last two 
years.
  Mr. President, these numbers are just the tip of the iceberg, but I 
mention them today to present a clearer picture of the power the 
managed care industry wields in Washington as we debate managed care 
reform. As we talk here on the floor about why Americans have such an 
important stake in this body passing the Patients' Bill of Rights, we 
should also be aware of what a huge stake the industry has in stopping 
this legislation, and how they have used the campaign finance system to 
protect their interests.
  Regardless of how you feel about any particular Patients' Bill of 
Rights proposal, I think any reasonable person would agree that an 
arrangement where someone has financial incentives to deny health care 
to my family and me--that the very existence of such incentives has to 
raise flags. As a parent, and as a consumer, I want to be sure that 
managed care cost-control systems don't compromise the quality of 
health care for my family and me.
  So I want to make it clear that the central goal of protecting 
patients' rights is to ensure that medical necessity is what drives our 
health care. That's what we're talking about. We need to be sure that 
the people making health care decisions are licensed health care 
professionals, not administrative personnel whose primary mission is to 
protect their bottom line. I do not think that is an outrageous, pie-
in-the-sky goal. I think it's a common sense expectation when I buy 
health insurance for my family, and I don't think any of my colleagues 
would demand any less from their own health insurance.
  During the year or so since Senators Daschle and Kennedy first 
introduced the Patients' Bill of Rights, I have had the opportunity to 
visit every county in my state to speak with my constituents and to 
find out what issues they care about. I can tell you that health care--
the quality of health care, the availability of health care--is 
consistently one of the top issues that my constituents raise with me. 
In general, the quality of health care in Wisconsin is quite good. 
Wisconsin was one of the first states to regulate HMOs as insurance 
providers, and the state has developed a set of basic, common sense 
patient protections--many of which are included in S. 6, the Democratic 
Patients' Bill of Rights.
  Mr. President, I would like to share a story that was told to me by a 
pediatrician who practices in Madison, Wisconsin. This pediatrician 
told me about a newborn infant she saw who looked fine upon first 
examination, but on the second day, the pediatrician detected a heart 
murmur. Knowing that this newborn urgently needed to see a specialist, 
the pediatrician immediately called for a referral to a pediatric 
cardiologist, which in this particular HMO requires first going through 
an adult cardiologist for the referral to a pediatric specialist. By 
sheer luck, a pediatric cardiologist happened to be in the hospital on 
a separate matter and was able to examine the baby.

  The pediatric cardiologist ordered an echocardiogram and diagnosed 
coarctation, a tightening or narrowing of the aorta that is specific to 
newborns. That pediatric cardiologist happened to be in the right place 
at the right time--but under usual circumstances, time would have been 
lost while a referral was sought from an adult cardiologist. As a 
result, that baby immediately began receiving medication--
prostaglandin--intravenously until she could be transported to 
Children's Hospital in Milwaukee to receive emergency heart surgery. 
The baby survived and is doing well.
  When I heard this story, apart from relief that the baby survived, my 
first question was, ``What would have happened if you and the baby's 
parents had to go through the normal processes of the HMO's rules?'' 
The pediatrician told me that that process, even if expedited, would 
have taken at least 24 hours, which didn't sound very long until the 
pediatrician informed me that the untreated coarctation would have 
resulted in the baby's death within a few hours.
  I am greatly relieved and happy that this particular baby was cared 
for and survived. But what I find frightening, though, is that this 
baby survived almost as a fluke, in spite of the system. The Patients' 
Bill of Rights includes a guarantee of access to pediatric specialists. 
Fortunately for the family of

[[Page S8429]]

the baby with the heart murmur, many pieces fell into place to save the 
baby, including a dedicated and vigilant pediatrician willing to be an 
advocate for her patient and a pediatric specialist in the right place 
at the right time. This situation didn't turn into a horror story. But 
we simply cannot let these sorts of happy endings happen only by 
chance. We must enact meaningful patient protections, such as 
guaranteed access to pediatric specialists as contained in the 
Democratic Patients' Bill of Rights but lacking in the Republican bill, 
to ensure that people get the care that they need.
  The patient protections we are talking about ought to be part of the 
deal when you enroll in health insurance. These are pretty basic 
concerns, Mr. President, concerns that I think may get obscured 
sometimes when we get into jargon like ``prudent layperson,'' ``point 
of service,'' and so on. So when we speak about protecting patients' 
rights, I want to be clear that we are talking about how to make sure 
that corporate cost-control concerns don't result in people being 
denied the care that they need.
  I thank the Chair.

                          ____________________