[Congressional Record (Bound Edition), Volume 145 (1999), Part 10]
[Senate]
[Pages 13942-13943]
[From the U.S. Government Publishing Office, www.gpo.gov]


[[Page 13942]]

                        PATIENTS' BILL OF RIGHTS

  Mr. ROCKEFELLER. Mr. President, I join what I suspect are one or two


Democratic colleagues of mine who have come out to the floor to speak 
about the Patients' Bill of Rights and the need to move forth with 
that. I think I am correct, but in listening to National Public Radio 
this morning, I heard that the American Medical Association was meeting 
and that one of the matters under discussion was the right of 
physicians to unionize. Since you cannot replay NPR, or ask for a 
repeat, I had to just hear what I heard; I think I heard it correctly. 
That is an amazing thing. I know physicians have been unionizing in 
Arizona and places where one would expect it. But to have the American 
Medical Association actually considering that, and the President, Dr. 
Dickie, a woman, discussing the frustration of physicians with their 
ability to give health care to their patients in a way that they 
believe and, in fact, were trained to do is extraordinary.
  I could name any group in the world that would be looking for a place 
to find a union and I would put physicians among the very last. But, 
evidently, it is not that way. That in itself is an extraordinary call 
for this Congress to move forward with health care. The call comes from 
the American people also. They are calling for action on our part 
because of their sense of deep dissatisfaction.
  Last year, we were told there wasn't enough time to take up a 
Patients' Bill of Rights. I don't think that could be the case this 
year, since time seems to be mostly what we have, and therefore one 
might conclude there might be a lack of willingness to take up a 
Patients' Bill of Rights this year. So we have to keep our priorities 
straight. I intend to, and I think a lot of my colleagues on both sides 
of the aisle feel that way.
  Every single day that passes without enactment of patient protections 
is another day that millions of Americans, and thousands of the people 
I represent from West Virginia, are subject to the denial of needed 
treatments because of the instinct of insurance companies to go to 
their bottom line and stay there. Every single day that we, as a 
Congress, fail to act on the Patients' Bill of Rights is another day 
that Americans are left vulnerable to health care decisions that are 
made perhaps not by their doctors, as they wish, but by business 
executives, or by boards, or people at the end of 1-800 numbers. We 
used to talk about this years ago, and we agreed it was a terrible 
thing and it had to stop. We were all going to do that, except that we 
have not. We just haven't.
  Every day we don't act, Americans are refused, No. 1, the specialty 
treatments they need and deserve; No. 2, the ability to use any 
emergency room.
  Imagine that. The Senator from Illinois is here. This Senator 
remembers being in Chicago a number of years ago, for whatever purpose, 
and I was told that six emergency rooms in the city of Chicago were 
closed, and there were relatively few left. That is one of the largest 
cities in all of America. Emergency rooms are the most expensive form 
of health care, and they are always the things closed down when 
business decisions are dominating hospitals.
  On the other hand, the only way, having 43 million, 44 million, 45 
million uninsured Americans, they can get health insurance is by going 
to emergency rooms. They have to have that right. It has to be 
accessible to them, not just somewhere out in the next State, or on the 
other side of the Mississippi River but accessible so they can get to 
it.
  Third, they have to have the right to appeal the decision of their 
health care plans. It is a basic right. I will talk more about it.
  Fourth, they should have the ability to ensure that medical decisions 
are made by their doctors, not by a board of executives.
  We all know that managed care has changed the way health care is done 
in this country. We started saying that in the Finance Committee 10 or 
12 years ago. The question was, Does managed care save money for 1 year 
or 2 years? The general consensus was that managed care would save 
money for about 2 years, then it would come up against a hard wall and 
people would have to start cutting. That was the general consensus 
then. It is clearly showing itself to be even more the case now. That 
is for both delivery and the payment of health care in our country.
  Obviously, a lot of problems have been created along the way. 
Americans are very dissatisfied with the quality of their health care. 
They make their feelings about that very clear. They don't like their 
lack of choice. They don't like the indiscriminate nature of insurance 
company decisionmaking.
  Meanwhile, physicians often have, from their point of view --and from 
my point of view--much too little input into health care decisions, and 
hence the NPR story this morning. They believe so strongly that they 
are doing something, which is an anathema, it would seem to me, to any 
physician. But they are evidently doing this, or they are voting on 
that as a matter of ``doctor rights,'' or whatever, at the American 
Medical Association meeting.
  I think doctors think they face too much interference from the 
insurance companies. Patients and doctors alike see health care 
decisions driven by the financial concerns of something called health 
plans. What do we have to do? We have to guarantee access to specialty 
care. I hear it all the time. We all hear it all the time in our homes 
and wherever we go.
  Under managed care plans--most of them, not all of them--the 
patient's primary care physician may refer a patient to a specialist if 
they determine that specialty care is necessary. However, things may 
change, if the specialist is not on the list of the plan.
  Then you come to this amazing situation of trying to ask a consumer 
of health care to understand that they are allowed to go to a 
specialist, but they cannot because that specialist is not on their 
plan. Even the much criticized Clinton health care plan allowed that. 
You could always go outside your HIPAA. You could always go to your 
specialist, no matter where your specialist was. You could always go to 
your specialist. Under the present system of health care, you can't do 
that.
  Then somebody from the ``administrative office,'' or some other 
division, takes over this whole question of whether you can or whether 
you can't. Suddenly, the patient asks to see a specialist and finds out 
that the executives in charge are not doctors. They are not medical 
people. They refuse the right to go see a specialist. They refuse 
payment for the specialist who in fact was recommended by the patient's 
original primary care physician. That is wrong.
  We must put an end to insurance company ``gag rules.'' That is 
another point.
  Patients need to trust the providers--that they are acting in the 
best interests of the patients. There cannot be a situation where HMOs 
preclude doctors from prescribing necessary treatments or making 
referrals to a specialist in the name of preserving the company's 
bottom line.
  There is a sacred trust between a patient and a doctor. I don't have 
to elaborate on that. It is Norman Rockwell stuff. In fact, there are 
many, many. He did many pictures of it. It is the classic American 
situation--the trust between, the bond between, the patient and the 
doctor.
  For the doctor to be second-guessed by an insurance company 
bureaucrat just doesn't make sense.
  I have listened to literally hundreds of patients and doctors 
complain that managed care plans are making decisions about care, about 
what types of procedures are allowed and are not allowed, and this 
decision just creates a division between the patient and the doctor. 
The patient is confused. The doctor is angry. It is not right.
  Another point: Real access to emergency room care 24 hours a day has 
to be. It has to be 7 days a week. Wherever they are, it has to be. 
They cannot be concerned about their insurance company second-guessing 
their health concerns.
  Americans must be able to go to the nearest emergency room without 
the fear that they will not be able to afford it, and they must be able 
to receive all necessary care in that facility to take care of their 
situation.

[[Page 13943]]

  In the United States of America we have been through this before. We 
are the only country in the world that doesn't have universal health 
insurance. If we don't have that, at least let's allow a Patients' Bill 
of Rights so that people can have--including those who are not 
insured--certain rights.
  Another point: We must let people challenge the decisions made by 
HMOs and seek retribution when HMO decisions lead to harm.
  Is that radical? No. That is a standard part of American life, except 
it is more important in a lot of American life because of the actual 
health and physical safety of a patient. When Americans go to a doctor, 
they should get the care they need. If they don't get it, they should 
have the means and the right to address disputes. They should not have 
to worry about insurance companies cutting that off.
  A central element of the Democratic Patients' Bill of Rights is that 
point--the ability to hold health care plans accountable for the 
medical decisions that lead to harm.
  The Republican plan fails to hold HMOs accountable. Under the 
Republican plan, the only remedy available when a patient is harmed by 
an HMO decision is recovery of the actual cost of a denied procedure, 
even if the patient is already dead or disabled for life.
  Make no mistake. If we don't respond quickly and forcefully enough, 
more and more Americans are going to lose confidence in our system and 
in us. Already 90 percent of Americans are unhappy with their plan. 
Shocking, shocking. We can do something about it. I think we have a 
moral obligation to take up the Patients' Bill of Rights. We certainly 
have the time because we are not doing a whole lot of other things 
around here that I can put my hands on. I think it is time that 
Congress take up and pass these patient protections this year.
  I yield the floor.

                          ____________________