[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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