[Congressional Record (Bound Edition), Volume 145 (1999), Part 10]
[Senate]
[Pages 14541-14544]
[From the U.S. Government Publishing Office, www.gpo.gov]



                       AGRICULTURE APPROPRIATIONS

  Mr. DORGAN. Mr. President, I understand yesterday there was a press 
conference on the Capitol lawn. They brought in some big, shiny farm 
tractors and a group of folks held a press conference, with the 
tractors as a background, wheezing and moaning about the agriculture 
appropriations bill, saying somehow that bill is getting held up and it 
will hurt family farmers.
  I advise my colleagues, if we had invoked cloture as the majority 
leader and others wanted with respect to that bill, we would have been 
prevented the opportunity to offer an amendment on the floor dealing 
with the farm crisis, an amendment that provides some basic income 
support to family farmers during this urgent farm crisis. We would not 
have been able to do that.
  Voting yes on cloture, on a bill that the majority leader pulled off 
the floor and then brought back on a cloture motion, would mean there 
is no opportunity to vote for some kind of income support package for 
family farms while there are collapsed prices. We have tried to get 
that before this Congress.
  I sat downstairs at midnight in the emergency conference on 
appropriations between the House and the Senate. Senator Harkin and I 
offered an amendment that would have provided about $5.5 billion in 
emergency help for family farmers during this collapse of farm prices. 
We lost on a 14-14 tie vote. Then we tried in the appropriations 
subcommittee and lost there on a partisan vote.
  We intend to offer the amendment on behalf of family farmers on the 
floor, saying when prices collapse, if this country cares about family 
farmers, if this Senate is indeed profamily and cares about family 
farmers and wants to have some family farmers in its future, then it 
will pass an emergency package to respond to family farmers' needs 
during this price collapse. We wouldn't have been able to do that if we 
voted to invoke cloture. We would not have been able to offer the 
amendment. Now we have people saying somehow those who voted against 
cloture have disserved the interests of farmers.
  The agricultural appropriations bill that came to the floor is a 
piece of legislation that funds USDA; it funds the research programs 
and the other programs at USDA. It takes effect October 1. It does not 
take effect for months.
  The delay of the bill is not going to injure, in any way, family 
farmers. The bill will get passed on time. It will be sent to the 
President and be signed. Contrary to those standing in front of a 
tractor yesterday, wheezing and blowing about farm issues--some of whom 
I bet wouldn't know a bale of hay from a bale of twine--I guarantee 
before that bill leaves the Senate, we intend to offer an emergency 
package to say to family farmers: You matter; we are going to help you; 
when prices collapse, we will help you over the price ``valley.''
  What happens to a company on Wall Street, Long-Term Capital 
Management, that threatens to lose billions of dollars? What happens is 
they get bailed out by the Federal Reserve Board.
  What would happen if we were talking about big corporations? They 
would get bailed out, but they are family farmers.
  Somehow in the minds of some, it does not matter what happens to 
family farmers. It matters to me. It does to many of my colleagues on 
this side of the aisle.
  I know why they held the press conference with tractors. It is 
because they are upset that folks on this side of the aisle offered a 
Patients' Bill of Rights. The reason the Patients' Bill of Rights was 
offered in the Senate on agriculture, and it would not have mattered on 
which bill it was offered, is we said it was going to be offered to the 
first bill that came up if we were not given the opportunity to have a 
Patients' Bill of Rights on the floor of the Senate.
  It was offered because we have pushed and pushed and pushed and we 
have been denied the opportunity to debate and offer amendments on a 
Patients' Bill of Rights. That is not the way the Senate is supposed to 
work. You are supposed to be able to offer legislation, offer 
amendments, have debates, and then have a vote. But some do not want 
the Senate to operate that way. They want to shut the place down, close 
the blinds, pull the windows shut, and then say: This is our agenda. 
Here is all we are going to allow you to do. You can offer these three 
amendments. They have to be worded this way. If we don't agree with 
them, we will not give you the privilege of speaking on the floor. That 
is not the way the Senate is supposed to operate and we will not let it 
operate that way. We have rights.
  The American people have rights. In my judgment, patients in this 
country have the right to know all of their medical options for their 
treatment, not just the cheapest. Patients have the right to get 
emergency room treatment when they have an emergency. Patients have a 
right to keep their own doctors during cancer treatment even if their 
employers change HMOs. All of those issues are issues we intend to 
fight for on behalf of patients in this country. But we are denied that 
right by a majority who says you can only talk about the things we want 
to talk about.
  Then when the agriculture appropriations bill or any other bill comes 
to the floor and we offer the Patients' Bill of Rights, we are told by 
the same folks who say they care about farmers that we have delayed the 
agriculture appropriations bill. This bill will not take effect until 
October 1 and is to fund the U.S. Department of Agriculture and had we 
voted for cloture, it would have prevented Senator Harkin and myself 
from offering the specific amendment

[[Page 14542]]

to deal with income support for family farmers during this farm crisis.
  I just have to say it takes some imagination to hold a conference and 
suggest we are the problem.
  Mr. DURBIN. Will the Senator yield for a question?
  Mr. DORGAN. I am happy to yield.
  Mr. DURBIN. Is it not true the course of the debate we have literally 
taken is to debate measures such as the Y2K liability bill with dozens 
of amendments, and there was not a complaint made that we were slowing 
down the process on appropriations?
  Mr. DORGAN. That is exactly the case. It is the case that we are in 
the circumstance which now exists because there are some here in the 
Senate who simply do not want to have to vote on the issues we are 
talking about with respect to the Patients' Bill of Rights. They want 
to have a slogan so they can vote for something titled the Patients' 
Bill of Rights but one that will not have any strength; one that will 
really not have any provisions to provide people with the basic rights 
they ought to be provided with respect to this health care issue.
  We have talked at great length about the too many instances in this 
country where health care decisions are not made by a doctor in a 
patient's room in the hospital or by a doctor in a doctor's office at a 
clinic, but where the answer to what kind of patient care will be 
allowed is to often, in too many circumstances, made by an accountant 
making medical judgments somewhere in an insurance company office 1,000 
miles away. That is what is wrong with the system.
  Mr. DURBIN. Will the Senator yield?
  Mr. DORGAN. I am happy to yield.
  Mr. DURBIN. Is my understanding correct that some 200 groups that 
represent consumers and doctors and hospitals and business and labor 
have endorsed the Democratic Patients' Bill of Rights and, to my 
knowledge, the only group endorsing the Republican approach to this is 
the insurance industry?
  Mr. DORGAN. The Senator describes it exactly. It is the difference 
between one approach that is toothless and an approach that has some 
teeth to it that says we are going to make this work; we are going to 
offer some basic protections to patients.
  I have a poster I was going to show today. I will show it later in 
the day. It is a poster of a young boy in a wheelchair named Ethan who 
was denied treatment by the HMO. He was born with very difficult 
problems that impaired the use of his limbs. He was denied treatment 
because a doctor who had never seen this young patient decided that the 
patient had a 50-percent chance of being able to walk by age 5, and a 
50-percent chance of being able to walk if he gets the appropriate 
therapy is ``not significant.'' This is from a doctor who did not see 
the patient. It is not significant that this person might have a 50-
percent chance of being able to walk, therefore we deny coverage.
  That is the kind of thing that is happening time and time again. I 
say to the Senator from Illinois, I have talked about this woman who 
falls off a cliff, drops 40 feet, fractures her bones in three places, 
is knocked unconscious, taken by medevac helicopter out to a hospital, 
is brought into the emergency room unconscious, survives, and later is 
told: We will not pay the emergency room bill because you didn't have 
prior approval for emergency room treatment. This is a woman 
unconscious, brought into the emergency room for help. That is the kind 
of thing that ought to stop. Does she have a right through her health 
care coverage to emergency room treatment when she is knocked 
unconscious from a fall in the mountains? The answer is yes, of course. 
We demand that right be given that patient in this Patients' Bill of 
Rights.
  Mr. DURBIN. If the Senator will yield for one other question, it is 
my understanding the Republican bill, supported by the insurance 
industry, provides no protection to 115 million Americans who have no 
health insurance, whereas the Democratic bill provides protection to 
all of those in this country who have health insurance. That is a 
pretty dramatic difference; is it not?
  Mr. DORGAN. The Senator is absolutely correct. Again, it is the 
difference between an approach that is toothless and an approach that 
has teeth; one that works, makes a difference, one that matters.
  So we have a couple of bills ricocheting around here for which the 
other side has adopted the same title--which is a nice thing to do, I 
guess: The Patients' Bill of Rights. The question is scope. How many 
Americans will it cover and what kind of coverage will it offer? Will 
it, in fact, help people like that young boy who was told a 50-percent 
chance to be able to walk by age 5 really doesn't cut it with us; we 
will not provide the therapy you need? Or will it, in fact, provide 
assurance to someone who is knocked unconscious in an accident, that if 
he or she goes into an emergency room unconscious nobody is going to 
say later: You should have gotten prior approval from the emergency 
room?
  Mr. REID. Will the Senator yield?
  Mr. DORGAN. I will be happy to yield.
  Mr. REID. I will ask this in the form of a question. Not only are we 
concerned now about the terrible care that is being given or not given 
to patients, but would the Senator care to comment on what we are 
seeing as a result of how doctors are being treated? Could you have 
imagined 5 or 10 years ago that the doctors would join together to form 
unions to protect their interests, as they are doing now?
  Mr. DORGAN. I say to the Senator, I was as surprised as anyone to 
read the news these days about doctors wanting to join a union. But the 
reason is pretty obvious. They are tired of not being able to practice 
health care on their own. They are tired of someone making decisions 
about their patients who they have seen. They are the ones who have 
been in the examining rooms. They are the ones who have visited the 
hospital beds. Yet an accountant 500 miles away or 1,000 miles away in 
some insurance office, is telling them how to practice medicine. They 
are flat sick of it.
  Mr. REID. So I say to my friend, it is not only the patients who are 
rising up, but now we have the doctors rising up because of this 
managed care program. I think that is the reason the American people 
have latched onto this issue and are saying please, Washington, do 
something. Does the Senator think that is a fair statement?
  Mr. DORGAN. I think that is exactly the case, the reason over 200 
medical, consumer, and labor groups support this legislation. I have a 
picture loaned to me by Dr. Ganske, who is a Member of Congress from 
the House, a Republican, a very thoughtful Congressman. He is a doctor 
who does reconstructive surgery. He held up the picture of this young 
boy. Let me hold up that picture, if I might, just so everyone 
understands what we are talking about. This is a terrible deformity. 
Dr. Ganske held this picture up to use it as an illustration.
  Obviously, you look at this young boy and you say what an awful 
deformity to have to live with. But there are ways, of course, to 
correct this. A young boy doesn't have to live with that deformity. Dr. 
Ganske pointed out he did a survey of his fellow doctors and discovered 
that half of his fellow doctors had experienced the circumstance of 
having an HMO say: No, this is not medically necessary. You don't need 
to correct this. It is not medically necessary.
  Can this young person live with this? Yes, I suppose so. Would any 
prudent American say it is medically necessary to help fix this 
problem, to give this young child the opportunity to get reconstructive 
surgery? The answer is clearly yes. That is what is at the root of this 
issue.
  Mr. REID. Will the Senator yield for a question?
  Mr. DORGAN. I am happy to yield.
  Mr. REID. Dr. Ganske, who is a conservative Republican from the State 
of Iowa, voted on this issue and joined the Democrats' Patients' Bill 
of Rights because of this and other instances. Here is a man who also 
brought in a picture later showing what could happen to a child who has 
surgery that has been perfected over the decades. This is a child who 
has a cleft palate; is that not true?

[[Page 14543]]


  Mr. DORGAN. That is correct.
  Mr. REID. I would ask one further question to the Senator.
  Isn't it true there are over 200 organizations that support our 
Patients' Bill of Rights and that the only organization that opposes 
our Patients' Bill of Rights is the insurance industry basically?
  Mr. DORGAN. As I understand it, the Senator describes the case 
exactly. Virtually every organization in health care supports what we 
are trying to do. The doctors in this country, the patients all support 
what we are trying to do because they know we are trying to solve 
problems.
  Let me go back to this notion there are two different approaches. The 
approach they offer is toothless. It has a title and does not mean 
anything very much. The approach we offer has teeth, is real, and makes 
a difference in people's lives.
  I want to make one additional point and then conclude because I know 
there are others who wish to speak. I came to the floor today because 
the majority leader and others held a press conference yesterday with 
tractors as a backdrop saying what we have been doing here is 
shortchanging American farmers. Nothing is further from the truth. 
American farmers are going to be well served by a Senate that does not 
push this agriculture appropriations bill through without emergency 
help which farmers desperately need. That is exactly what would have 
happened if we had voted for cloture as the majority leader was 
insisting.
  Had we voted for cloture on the agriculture appropriations bill, the 
amendment that Senator Harkin and I were going to offer for $6 billion 
to $7 billion in emergency help for farmers would have been ruled 
nongermane. It would have been over. We cannot pass an agriculture 
appropriations bill in the Senate without addressing this farm crisis, 
and those who stood in front of tractors and talked about farmers know 
that. They know better than that. We cannot pass an agriculture 
appropriations bill and say we have done our job if we ignore the 
crisis which now exists and if we do not pass some basic income support 
package.
  Senator Harkin, Senator Durbin, and I tried in the midnight hours of 
the emergency appropriations bill. We lost on a 14-14 tie vote. We 
tried to get it in this year's appropriations bill but lost on a 
partisan vote. We must try again on the floor of the Senate, and we 
will in the coming weeks.
  We had a farmer and author testify before the Democratic Policy 
Committee named Wendell Berry. He has written a book called ``Another 
Turn of the Crank.'' I was thinking about that today because 
yesterday's show in front of these polished tractors was just another 
turn of the crank.
  As I said, some of these folks would not know a bale of hay from a 
bale of twine and they are telling us about the long-term interests of 
farmers. Many of us who fight for farmers every day in every way are 
insistent that before this Senate moves any appropriations bill dealing 
with agriculture out of this Senate, it does not just deal with the 
programs and research over in USDA, that it deals with the income needs 
of family farmers. That is what has been at stake in the last couple of 
days.
  Frankly, I am not a happy person to see the criticism that has been 
leveled by those who do not know anything about family farmers and 
those actions which will undercut our attempt to help family farmers.
  Mr. EDWARDS. Will the Senator yield for a question?
  Mr. DORGAN. Yes.
  Mr. EDWARDS. I wonder if the Senator has the same perception I do, 
being from the State of North Carolina. The Senator and I both know 
that agriculture and our family farmers are in desperate crisis, and 
they need help in the worst kind of way. He and I are committed to help 
them. I know that. I have heard him talk about that subject in this 
Chamber. I feel very strongly about that.
  My question is about this Patients' Bill of Rights issue. It seems to 
me what we have--there has been a lot of discussion about the 
Democratic version and the Republican version--is an insurance company 
bill, on the one hand, and a patients' and doctors' bill on the other 
hand. Will the Senator agree with that?
  Mr. DORGAN. I think that is correct.
  Mr. EDWARDS. Also, we have such extraordinary medical technology in 
this country. We have the most advanced medical treatment available in 
the world today. Can the Senator explain to us how that treatment and 
the fact we are the most advanced medical country in the world today 
does anybody any good if folks cannot get access to it? Does the 
Senator have any explanation for that?
  Mr. DORGAN. The Senator asks a question that relates to the key 
components of our piece of legislation. I again refer to this picture 
used by Dr. Ganske, a Congressman in the House of Representatives, a 
Republican who supports our basic legislation.
  Does current medical technology and all the advances in 
reconstructive surgery do this young child any good, if the child does 
not have access to it, if the child's parents belong to an HMO that 
says, no, it is not medically necessary we correct that deformity, it 
is not medically necessary at all? Does that kind of medicine help this 
child? The answer is no. What helps this child is a determination by 
this Senate that health care plans ought to judge on a uniform basis 
that this type of deformity is medically necessary and this child would 
get reconstructive treatment to solve that problem.
  Mr. EDWARDS. Will the Senator yield for one last question?
  Mr. DORGAN. I will be happy to yield.
  Mr. EDWARDS. We discussed it briefly a moment ago, and that is the 
fact that doctors are finding it necessary to unionize or to make an 
effort to unionize because they are no longer able to prescribe the 
treatments and tests for their patients they know their patients need, 
in fact because they are not able to make determinations about what is 
medically necessary, whether a child--if the Senator would hold this 
photograph up one more time--whether such a child medically needs the 
surgical procedure the Senator talked about in the last few minutes, 
the fact that doctors find it necessary to unionize in order to do what 
they have spent their entire lives being trained to do, which is to 
provide the best possible medical care to their patients. Can the 
Senator imagine a more powerful indication and symptom of the medical 
crisis confronting this country today?
  Mr. DORGAN. I cannot. The Senator makes a point with his question. 
This is real trouble for a lot of patients, and what we are trying to 
do and say is health care is changing and patients ought to have 
rights. That is what our Patients' Bill of Rights does. It empowers 
patients and allows them to believe that if they are covered with 
health care through their HMO, there will be some basic guarantees that 
just, prudent people expect would be there anyway but which we have now 
seen in recent years by some HMOs have systematically been denied 
patients.
  Let me make one final point. Not always, but too often health care 
treatment has become a function of profit and loss for some 
corporations. Look at their executives. Find how much money they are 
making in this industry. Then they say: But we can't afford to provide 
emergency room care for someone who is unconscious and presents himself 
on a gurney to emergency room workers, or we can't help this young 
child with a facial deformity which clearly needs attention. We can't 
help a child in a wheelchair who has a 50-percent chance of walking and 
told you don't get the therapy because a 50-percent chance of walking 
by age 5 is insignificant.
  We are saying those are not medical judgments made by a doctor. Those 
are insurance judgments made by HMO accountants 1,000 miles away, and 
they undercut the very premise of this health care system in which we 
ought to expect prudent treatment that a doctor believes is necessary 
for a patient. Yet in too many instances, they are not getting it. This 
is not just a consumer bill or a patients' bill, it is a bill that 
really gets at the root of health care in this country. I yield the 
floor.

[[Page 14544]]

  The PRESIDING OFFICER. The Senator from Minnesota.
  Mr. WELLSTONE. Mr. President, my colleague from North Carolina has 3 
minutes. I wonder if he can speak, and I ask unanimous consent I follow 
him and Senator Boxer follow me.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. WELLSTONE. I thank the Chair.
  The PRESIDING OFFICER. The Senator from North Carolina.
  Mr. EDWARDS. I thank the Senator.

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