[Congressional Record Volume 146, Number 101 (Tuesday, September 5, 2000)]
[Senate]
[Pages S7980-S7981]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




      PROTECTING AGAINST HMO ABUSES AND PRESCRIPTION DRUGS BENEFIT

  Mr. KENNEDY. Mr. President, as we enter the final weeks of the 106th 
Congress and the home stretch of the Presidential campaign, two health 
issues demand immediate action--protecting patients against the abuses 
of HMOs and other health insurance plans and providing coverage of 
prescription drugs under Medicare for senior citizens. The American 
people deserve action on each of these issues from this Congress. The 
position of the two Presidential candidates on these issues has become 
a key factor in determining whether they are truly committed to serving 
the needs of the American people, and the position of every member of 
Congress on these issues is important for the same reason.
  With regard to the Patients' Bill of Rights, last week, ABC began to 
air a documentary series--``Hopkins 24/7''--that vividly illustrates 
once again the need for prompt action to end HMO abuses. Hopkins 24/7 
is a documentary on life at one of the nation's finest hospitals--Johns 
Hopkins. The documentary is the result of three months of intensive 
filming. The first segment, shown on August 30, showed American 
medicine at its best, and the abuses by managed care at their worst.
  A 14-year-old girl, Tiffanie Salvadia, sought care from Johns Hopkins 
for her cancer of the uterus. The diagnosis had been delayed for six 
critical weeks because crucial tests were not ordered by her HMO 
physicians. When Tiffanie finally reached Johns Hopkins, the cancer had 
spread from her uterus, raising the risk of this serious illness even 
further. When Tiffany finally reached an institution capable of giving 
her the quality care she needed, the problems with her HMO were not 
over: Authorization for a vital test was needed, but the hospital was 
unable to contact the HMO for the authorization. Fortunately, Hopkins 
simply went ahead and performed the test, and hoped that the hospital 
might be able to obtain payment later.
  Tiffanie ultimately received fine care from Hopkins, and her chances 
of recovery from the cancer now seem good. But her favorable prognosis 
is no thanks to her HMO. Here is what Dr. Paul Colombani, the 
oncologist at Hopkins, had to say about Tiffanie's case and about his 
experience with managed care generally.
  On the difficulty in getting the test authorized, he said, ``I have 
to do the diagnosis codes and the procedure codes. And we have to 
submit them to the insurance company ahead of time. And they have to 
say yea or nay. We're not going to do this. You have to do that. I 
think it is ridiculous that a high school clerk should be telling me 
that I can or cannot do an operation on a patient.''
  On the delay in getting Tiffanie an accurate diagnosis and treatment, 
the doctor said, ``We see delays in diagnosis because of the 
inadequacies of the managed care system all the time. And for . . . the 
.1 percent of patients where it turns out to be a life and death 
situation, they just look at that as the price of doing business. It's 
pathetic. In October or September, or whatever, that was the time to do 
that surgery. Now we're playing catch up.''
  Perhaps the most heart-rending comment came from Tiffanie's mother. 
It is a comment that any parent who has ever had a child with a serious 
illness can understand. She said, ``My daughter has cancer. I want to 
concentrate on her, and getting her better and not have to worry about 
if I have a referral for this or a referral for that.''
  ``I want to concentrate on her.'' That should be the right of any 
parent whose child is seriously ill. But today, because of the abuses 
of the insurance industry, it is not a right--it is a privilege of the 
fortunate few.
  Whether the issue is diagnostic tests, specialty care, emergency room 
care, access to clinical trials, availability of needed drugs, 
protection of doctors who give patients their best possible advice, or 
women's ability to obtain gynecological services--too often, in all 
these cases, HMOs and managed care plans make the company's bottom line 
more important than the patient's vital signs. These abuses should have 
no place in American medicine. Every doctor knows it. Every patient 
knows it. And in their hearts, every Member of Congress knows it.
  Almost 11 months ago, the House of Representatives passed the 
bipartisan Norwood-Dingell bill to end these abuses. It is endorsed by 
300 groups of doctors, nurses, patients, and advocates for women, 
children, and families. It is supported by virtually every medical 
group in this country. It passed by an overwhelming bipartisan 
majority. It should have sailed through the Senate of the United 
States. But it continues to languish because the Republican leadership 
continues to put a higher priority on protecting industry profits than 
on protecting patients.
  We have come close to successful passage. On June 8th, the Norwood-
Dingell bill fell just one vote short of passage in the full Senate. It 
was supported by every Democratic Senator--and only four Republican 
Senators.
  The American people deserve action before this Congress ends. Every 
day we delay, more patients suffer. The Patients' Bill of Rights is one 
of the most important issues facing this Congress--facing every family, 
too. There is no question where Vice-President Al Gore stands. If 
Governor Bush supported patients' rights and were willing to show the 
leadership that the American people have the right to expect in a 
Presidential candidate, this legislation would clearly pass the Senate. 
But on this issue, Governor Bush has failed to show the leadership we 
need.
  I still believe that enactment of strong, effective legislation is 
possible this year. I am here to serve notice to the Senate today, that 
there will be new votes on this issue before we adjourn. I am hopeful 
that we will be successful. The American people are waiting for 
relief--and we owe it to them to act.
  On Medicare prescription drugs, the second major issue of health 
reform facing us is insurance coverage of prescription drugs under 
Medicare.
  After a year of full-time campaigning, Governor Bush today has 
finally offered a specific prescription drug plan for the consideration 
of the American people. Unfortunately, that plan is an empty promise 
for senior citizens. It is not Medicare--and it is not adequate. It is 
part of a broad plan to make regressive changes in Medicare that will 
raise premiums, force senior citizens to join HMOs, and further a 
radical right-wing program of privatization. And drug benefits would 
not even be available to most senior citizens for four years.
  Senior citizens need a drug benefit under Medicare. They earned it by 
a lifetime of hard work. They deserve it, and it is time for Congress 
to enact it. The clock is running out on this Congress, but it is not 
too late for the House and Senate to act. The Administration and Vice 
President Gore have proposed one. So have Democrats in Congress. And we 
intend to assure that the Congress will vote on a real prescription 
drug program this month. The American people deserve action, and we 
intend to see that they get it.
  Too many elderly Americans today must choose between food on the 
table and the medicine they need to stay healthy or to treat their 
illnesses. Too many senior citizens take half the pills their doctor 
prescribes, or don't even fill needed prescriptions--because they can't 
afford the high cost of prescription drugs.

  Too many seniors are paying twice as much as they should for the 
drugs they need, because they are forced to pay full price, while 
almost everyone with a private insurance policy benefits from 
negotiated discounts.

[[Page S7981]]

  In the face of declining coverage and soaring costs, more and more 
senior citizens are being left out and left behind. The vast majority 
of the elderly are of moderate means. They cannot possibly afford to 
purchase the prescription drugs they need if serious illness strikes.
  The older they are, the more likely they are to be in poor health, 
and the more likely they are to have very limited income to meet their 
health needs.
  Few if any issues facing this Congress are more important than giving 
the nation's senior citizens the health security they have been 
promised. The promise of Medicare will not be fulfilled until Medicare 
protects senior citizens against the high cost of prescription drugs, 
in the same way that it protects them against the high cost of hospital 
care and doctor care.
  Vice President Gore has been fighting for prescription drug coverage 
under Medicare since 1993. President Bill Clinton has called for 
immediate action in his last two State of the Union Addresses.
  The Administration has put a solid program on the table for the 
consideration of Congress--and their program is affordable for senior 
citizens and also for the federal budget--because they do not use the 
surplus for hundreds of billions of dollars in tax breaks for the 
wealthy.
  The Bush plan is not adequate and it is not Medicare. In fact, he has 
also endorsed a regressive plan to change Medicare in a way that will 
raise premiums and force senior citizens to join HMOs.
  That is not the kind of Medicare the American people want, and it's 
not the kind of prescription drug benefit they want either.
  Under Bush's version of Medicare reform, the premiums paid by senior 
citizens for conventional Medicare could increase by as much as 47% in 
the first year and continue to grow over time, according to the 
nonpartisan Medicare actuaries. The elderly would face an unacceptable 
choice between premiums they can afford and giving up their family 
doctor by joining an HMO.
  Senior citizens already have the right to choose between conventional 
Medicare and private insurance options that may offer additional 
benefits. The difference between what senior citizens have today and 
what George Bush is proposing is not the difference between choice and 
bureaucracy--it's the difference between choice and coercion--driven by 
a right-wing agenda of privatization. On this ground alone, it deserves 
rejection, regardless of its provisions for covering prescription 
drugs.
  But the program to cover prescription drugs is equally flawed--so 
flawed that it is an empty promise for millions of senior citizens. To 
begin with, the value of the Bush program to senior citizens is only 
one-half of what Vice President Gore has proposed. The reason is 
obvious--after massive tax breaks for the wealthy, there is not room in 
the Bush budget for adequate prescription drug coverage for senior 
citizens.
  The Bush plan provides little help to the vast majority of senior 
citizens who are not poor, but are of modest means and cannot afford 
large drug expenses or large increases in Medicare premiums. Under the 
Bush plan, these seniors have to pay three-quarters of the cost of 
their prescription drug coverage--and the coverage is not even 
adequate.
  In the entire history of Medicare, senior citizens have never been 
asked to pay such a high share of the cost of the premiums for any 
benefit.
  The defects in the Bush plan go far beyond the inadequacy of the 
benefits. It is a program that only a drug company executive could 
love. For the first four years, there is no Medicare benefit at all, 
just a program of block grants to the states for providing coverage for 
low income senior citizens. Senior citizens want Medicare, not welfare, 
and they deserve Medicare, not welfare.
  When the Bush plan finally becomes available to all seniors, it does 
not provide a real Medicare benefit--or any other adequate 
benefit. Instead, it gives senior citizens what is, in effect, a 
voucher--and it tells them to go out and buy their own coverage from a 
private insurance company. If the price is too high in the area in 
which they live, they are out of luck. If the drug company's list of 
approved drugs does not include the medicine they need, their only 
recourse is a time-consuming appeal. There is no defined benefit--
senior citizens are not even guaranteed the same coverage in Missouri 
that they would get in Mississippi. It is all up to the insurance 
company.

  The nonpartisan Congressional Budget Office has estimated that under 
the similar Republican plan passed by the House of Representatives, 
benefits would be so inadequate and costs so high that less than half 
of the senior citizens who need help the most--those who have no 
prescription drug coverage today--will even participate.
  A prescription drug benefit that leaves out half of the senior 
citizens who need protection the most is not a serious plan to help 
senior citizens.
  It is ironic that in offering this inadequate plan, Mr. Bush has 
criticized Vice President Gore for a ``big-government, one-size-fits-
all'' solution. The Gore plan covers prescription drugs under Medicare 
in exactly the same way that Medicare covers doctor and hospital costs. 
Mr. Bush obviously feels this is a one-size-fits all solution. That is 
why he has endorsed an extreme restructuring of the Medicare program. 
He may favor forcing the elderly into HMOs, but that is not what 
Democrats in Congress support. That's not what Vice President Gore 
supports. Most important, that's not what the American people support.
  There is still time for Congress to enact a genuine prescription drug 
benefit under Medicare. The Administration has presented a strong 
proposal. Let's work together to enact it this year. It is not too 
late. The American people are waiting for an answer.
  I am hopeful we will pass that legislation. Again, I am strongly 
committed, as I believe my colleagues, Senator Daschle and others are, 
to ensure we will have an opportunity to vote on that measure before we 
adjourn.
  I thank the Chair, and I yield the floor.

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