[Congressional Record Volume 146, Number 125 (Tuesday, October 10, 2000)]
[Senate]
[Pages S10127-S10129]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
UNFINISHED BUSINESS IN HEALTH CARE
Mr. DORGAN. Mr. President, we are nearing the end of the 106th
Congress. No one is quite sure where the finish line is. My expectation
is that within a week or two this Congress will be history.
Many will ask what this Congress did and what it did not do. There
will be some people who will be joyous about its accomplishments and
some who will be sorely disappointed over its failures. I think its
accomplishments, however, will be a rather short list, and the areas
where we could have and should have done better will represent a very
long list. I rise to briefly discuss two of those areas before we near
the end of the session.
I have spoken many times in the Senate about health care, and
especially the two issues this Congress has a responsibility to
address. One issue is providing a prescription drug benefit to the
Medicare program. We have talked about providing a prescription drug
benefit to the Medicare program for some long while. We are near the
end of this session, and it looks as though it will not get done. Why?
Because some people don't want to do it well. Everybody here talks
about wanting to do this, but somehow they are not willing to support a
plan that really accomplishes it.
On the second issue, we are nearing the end of the legislative
session and we are apparently not going to pass a Patients' Bill of
Rights. The Patients' Bill of Rights has been an issue over which we
have battled for 2 to 3 years, and it has been a tough battle. I don't
think there ought to be room left for those who believe there is not a
need for a Patients' Bill of Rights. All we have to do is look at the
evidence. The evidence is overwhelming that we need to pass a real
Patients' Bill of Rights. The House did it; we have not. This Senate
has dug in its heels and has not moved on either of these issues.
I will talk first about the issue of a prescription drug benefit in
the Medicare program. When the Medicare program was developed, many of
the miracle drugs that now exist weren't available. People got old.
They did what they were expected to when they got old. They retired and
led a more sedentary life. Then something might happen to them. They
would be hospitalized. They would stay for long periods in acute care
beds in the hospital. It was very expensive. The kinds of prescription
drugs that are available now were not available then.
So when Medicare was created, a prescription drug benefit was not
made a part of the Medicare program. When Medicare was developed, that
too was fairly controversial. In the early 1960s, a fair number of
Members of this Senate said: No, we can't do that. We can't provide
health insurance for older Americans. We oppose that. That is some sort
of encroachment of government into our lives.
I wasn't here at the time of that debate. But when they had that
debate, fully one-half of all senior citizens in this country had no
health insurance coverage at all. Why? Because it was too expensive.
Insurance companies aren't running around this country trying to find
old people to sell health insurance to. That is just a fact of life.
They want to find somebody who is 22 years old and healthy as a horse
and isn't going to need any health care treatment for a long while.
There are not people running around trying to figure out how they can
attract a 70-year-old or a 75-year-old to buy their health insurance
policy. They are not doing that because it is much more expensive to
insure people who are 70 and 80 years of age. The result was, nearly 40
years ago half of the senior citizens in this country had no health
insurance coverage at all.
So this Congress had a big debate. As is typical, those progressive
voices who said this is something we should do were met by those voices
of negativity who oppose everything for the first time. There are
always people who just dig in their heels at any suggestion and say,
no, this can't be done; no, it won't work.
Well, enough votes prevailed in the Congress over time that it passed
a Medicare proposal. Now 99 percent of America's senior citizens are
covered with health insurance under the Medicare program. What a
remarkable success. People are living longer, better, healthier lives.
Now we know, however, that there is a deficiency in the Medicare
program. The deficiency is that it does not cover prescription drugs.
Let us me read some letters from North Dakotans. We could name a
different State, and we would get exactly the same letters. My
colleague from Florida just spoke. His constituents, I am sure, are
writing exactly the same letters.
This is from a woman who lives in Bismarck, ND. She writes:
Dear Senator Dorgan: I am writing in regard to the
medication I take. I think something has to be done about the
prices they charge. I get $303 each month in Social Security.
I pay $400 a month for my medication. I have had heart
surgery and I have osteoporosis and this medicine is very
high-priced. We are using our savings now and I am 86 years
old so I can't work. Can you help?
This is a letter from a fellow in Rolla, ND. He writes:
Between me and my wife, we pay $350 to $400 a month on
prescription drugs. We receive less than $900 a month in
combined Social Security benefits. We have trouble paying for
our prescription drugs.
A person from Rocklake, ND, writes:
One-fourth of my Social Security check goes for my
prescription drugs, so that doesn't leave a lot for household
and personal expenses. It would sure help if Medicare covered
these.
A man from Cavalier, ND, writes:
Our drugs for the two of us--he is referring to his wife
and himself--just about tripled last year from the year
before. The total for last year was near $2300, and it only
gets worse. We need a little help.
A woman from Williston, ND, who titled her letter ``Message In A
Bottle,'' writes:
I have asthma and my medications and inhalers cost me over
$100 each month, and my health insurance does not cover
prescriptions. I am 84 years old, and it would be a great
help to me to get Medicare coverage on my medications.
A woman from Bismarck, ND, writes:
Dear Senator Dorgan: Enclosed please find my prescription
bottles. I just had these medicines filled today. I am having
a hard time financially with a Social Security check of $400
a month. My medicines cost $175 per month. That doesn't leave
much to pay for food, rent, utilities and gas. Something has
to be done with the high cost of prescription medicines. I am
thinking of stopping some of my medicines. Please help!!!
These letters could have come from any State, from senior citizens
everywhere struggling mightily to pay for their prescription drugs.
Senior citizens make up 12 percent of America's population, but they
consume one-third of all the prescription drugs in our country because
they have reached that age where they have various ailments and
problems and they need prescription drugs.
We need to add a prescription drug benefit to the Medicare Program.
We have been trying very hard to do that. Some have said, well, let's
not put it in the Medicare program, let's pay the insurance industry so
they will sell an insurance policy providing for prescription drug
benefits. The problem with
[[Page S10128]]
that is, the Health Insurance Association of America says insurance
companies will not be able to put together a policy like that which is
affordable. In fact, I had CEOs from two insurance companies come to my
office, and one said: In order to provide $1,000 worth of benefits to a
senior citizen for prescription drugs, I would have to charge $1,100
for the premium. Do you know anybody that will pay $1,100 for an
insurance policy that provides $1,000 worth of benefits? Not where I
live.
I say to those who say we can have the private insurance industry
deal with this: it won't work. Even if they could offer the policy, it
would not be affordable. We must, it seems to me, put a prescription
drug benefit in the Medicare program, and we ought to do it now.
We are nearing the end of this session and this ought to have been
one of the top priorities for the Congress. It just should have been
one of our top priorities. We live in good economic times, we have
unprecedented economic growth, and we are going to have some surpluses
this year and, we hope, in the years ahead. But do you know what the
priority was for the surpluses? The priority was to run out here on a
big trolley a huge batch of tax proposals that would give big tax cuts
really fast. Let's provide very large tax cuts, most of which will go
to the upper-income folks in this country, and let's do it even before
we experience these surpluses.
My feeling is that we ought to have a more balanced approach. First,
if we have surpluses, let's use some of those funds to pay down the
Federal debt. Yes, we can use some, perhaps, for middle-income tax
cuts, and we could use some of it to make the other investments we need
to make. We should put a prescription drug benefit in the Medicare
Program that is optional, has a copayment, and provides Medicare
recipients protection against these high drug prices.
The proposal I support also has the ability, through purchasing
power, to drive down prescription drug prices. So I say to those who
schedule the Senate: Time is wasting here. Let's see if between now and
the end of this week or next week we can perhaps get a prescription
drug benefit bill to the floor of the Senate and get it passed. Those
who want to give tax cuts to the top 1 percent of the income earners
were certainly quick to get that to the floor of the Senate. Let's see
if we can't do something similar in terms of legislative speed to try
to add a prescription drug benefit to the Medicare program. We have
time to do that. The question is, Do we have the will to do it?
Just one other point. I want to talk for a moment about the issue of
a Patients' Bill of Rights. A Patients' Bill of Rights is not some
theory that represents our interests or a wish. It is an absolute
necessity to provide protection for patients in this country. Some
managed care plans--although not all of them--have decided that health
care is a function of their profit and loss. They administer their
health care plans that way. The result has been devastating to some
patients in our health care system. In fact, in some cases an HMO will
not tell you all of your options for medical treatment, only the
cheapest options. That is not fair.
Every patient in this country ought to have a right to understand all
of his or her options for medical treatment, not just the cheapest one.
There are some HMOs that don't give you the opportunity to have
emergency room treatment when you have an emergency. That ought to be a
patient's right. There have been instances of people hauled into an
emergency room unconscious who are denied coverage because the HMO said
they didn't get prior approval for the emergency room. It ought to be a
patient's right, if you have insurance through an HMO, to have
emergency room treatment when you have an emergency.
How about oncology care? In the case of a woman who has breast cancer
and whose spouse's employer switches to a different health care plan,
should that woman not be able to continue with her same oncologist and
with the same cancer treatment under the new plan? Of course she ought
to be able to. That ought to be a right.
I had a hearing recently with some of my colleagues on this subject,
and a woman named Mary Lewandowski came. It was the third time Mary has
come to Washington, DC, at her own expense. I want, for Mary's benefit,
to put in the Record her complete testimony from this hearing. I ask
unanimous consent that her entire testimony be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
Testimony of Mary Munnings Lewandowski Before the Democratic Policy
Committee, September 21, 2000
My name is Mary Munnings Lewandowski. I reside in
Scottsville, NY. The picture that I have brought with me, is
my youngest daughter Donna Marie at age 18.
This is my third trip to Washington to plead for passage of
a bill that will protect patients rights. I've pounded on
doors, handed out pictures of Donna and a picture of her
headstone. I've done most anything I can to make people here
aware that the Patients Bill of Rights is a Life and Death
issue.
The week of February 3rd, 1997 Donna went to our PCP 4
times in 5 days. With each visit her symptoms were worsening.
She was told that she had an upper respiratory infection and
panic attacks. On Saturday Feb 8th, she could barely get off
the couch. I assisted her up the stairs to get cleaned up at
8 PM. At 8:30 she started crying that she was very ill. I
tried repeatedly to reach our PCP but only reached the
answering service, as this was a Saturday evening.
I called the hospital at 9 and was told I couldn't bring
her in unless her doctor authorized it or if I thought it was
a life and death situation.
I am a school bus driver and a mom not a doctor or a nurse.
At 9:10 I called 911, at 9:12 she screamed that her back hurt
and that she thought she was going to die. She lapsed into a
coma. My husband tried in vain to do CPR on her. She was
pronounced dead at 10:45 PM at the young age of 22.
I went to our PCP on Monday and the very first thing that
was told to me, was ``they couldn't justify to her HMO to
send her for the diagnostic tests that would have shown what
was wrong with her''.
22 year old kids, don't die. There were no tests done,
none. In my subsequent research I found that HMO's can and do
penalize and sanction doctors for ordering tests which HMO's
feel are unnecessary.
I found out on Tuesday, February 11th, that she died from a
bloodclot on her lung, literally the size of a football. A
$750 lung scan would have shown this. But all for the sake of
money, we lost a vital beautiful young lady that had only
begun her life.
We were at the cemetery in August and my 6 year old
granddaughter was with me. She went to Donna's grave and
started crying. ``Grandma, I shouldn't have to come here to
see my Aunt Donna'' Why did God take her.
Please, it is up to you, the Senators, our elected
officials to change things. Health insurers should not be
able to put profits before a person's life.
There is evidence that lives have been lost because of HMO
decisions. Isn't that enough reason to pass legislation that
would provide direct protection to patients?
Please, pass legislation that ensures that patients like my
daughter get the test they need and access to emergency care
before it is too late.
It could be your loved one.
Thank you for your time.
Mr. DORGAN. Mary lost her youngest daughter, Donna, at age 22.
She said:
The week of February 3, 1997, Donna went to our PCP--that
is her primary care provider--4 times in 5 days.
With each visit her symptoms were worsening. She was told
she had an upper respiratory infection and panic attacks. On
Saturday, February 8th, she could barely get off the couch. I
assisted her up the stairs to get cleaned up at 8 p.m. At
8:30 she started crying that she was very ill. I tried
repeatedly to reach our PCP, but only reached the answering
service, as this was a Saturday evening.
I called the hospital at 9 and was told I couldn't bring
her in unless her doctor authorized it or if I thought it was
a life and death situation.
Mary continued:
I am a school bus driver and a mom, not a doctor or a
nurse. At 9:10 I called 911, at 9:12 she screamed that her
back hurt and that she thought she was going to die. She
lapsed into a coma. She was pronounced dead at 10:45 p.m. at
the young age of 22.
I went to our PCP on Monday and the very first thing that
was told to me was they couldn't justify to her HMO to send
her for the diagnostic tests that would have shown what was
wrong with her. Twenty-two-year-old kids don't die, so there
were no tests done. None. In my subsequent research, I found
that HMOs can and do penalize and sanction doctors for
ordering tests which HMOs feel are unnecessary. I found out
on Tuesday, February 11, she died from a blood clot on her
lung literally the size of a football. A $750 lung scan would
have shown this. But all for the sake of money, we lost a
vital beautiful young lady that had only begun her life.
I have about 50 stories just like this which have been compiled from
all around the country--people dealing with HMOs and discovering they
have
[[Page S10129]]
to fight their cancer and their health plans at the same time. That is
not a fair fight.
We should pass a Patients' Bill of Rights. Now, the House of
Representatives passed a bipartisan Patients' Bill of Rights and this
Senate passed what I call a ``patients' bill of goods.'' It is a hollow
vessel, one of those charade-like things that doesn't do anything. In
fact, the Republican Congressmen from the House have said the Senate
passed proposal is a step backward, even worse than nothing. It is a
charade. We still have an opportunity to enact a real Patients' Bill of
Rights. This legislation is still in conference. This Congress can, in
its final days, pass the Patients' Bill of Rights. When Mary
Lewandowski comes to Washington, DC, three times because her daughter
died--and this young woman should not have died--and says, ``Do
something, please,'' we have a responsibility to respond. We ought to
do it now.
If the past is prologue, of course, we will end this session and we
will not do the kinds of things we should--putting a prescription drug
benefit in the Medicare program or enacting a real Patients' Bill of
Rights. The American people will have lost. We will be back in January
organizing as a new Congress and many of us will reintroduce exactly
the same legislation. We will, once again, engage in this battle. The
battle will not be over until we get done what needs to be done. Go
back 40 years and the same people who stood on the floor of the Senate
and opposed Medicare, oppose doing these important tasks. They do not
think the Federal Government should do it. This same mentality is what
is now providing the roadblock for doing what we should and adding a
prescription drug benefit to Medicare and passing a real Patients' Bill
of Rights.
We can alter that result. We can do it this week, if there is the
will. There is a way. The question for the Members of this body is,
Does the will exist in the Senate to do the right thing in these final
days? I hope so.
I yield the floor.
The PRESIDING OFFICER. The Senator from Arizona.
Mr. KYL. Mr. President, I say to my colleague from North Dakota that
I very much agree with him that we should be taking up the Patients'
Bill of Rights legislation. I hope he will join those of us on this
side of the aisle when we bring a conference report to this body which
will report a very important Patients' Bill of Rights piece of
legislation. We would then hope to pass it in the Senate, send it over
to the House of Representatives, and have the President sign it.
I am very much hopeful that we can get such a conference report to
the Senate and that my colleagues on the other side of the aisle will
help us to pass it.
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