[Congressional Record (Bound Edition), Volume 145 (1999), Part 10]
[Senate]
[Pages 14555-14559]
[From the U.S. Government Publishing Office, www.gpo.gov]



                        PATIENTS' BILL OF RIGHTS

  Mr. REED. Mr. President, I will speak for a few moments about a topic 
that has consumed many of us for many days this week and preceding 
weeks, and that is the Patients' Bill of Rights.
  A particular concern to me has been the status of children in the 
various versions of the Patients' Bill of Rights. I argue very 
strenuously and very emphatically that the Democratic proposal 
recognizes the key differences between children and adults when it 
comes to health care, and there is a significant difference. For a few 
moments, I will try to sketch out some of these differences.
  First of all, if one looks at the adult population in terms of types 
of illnesses, they are characterized as chronic diseases with 
relatively simple symptoms, simple manifestations with known 
consequences. They are quantifiable over a short period of time. 
Prostate cancer, breast cancer, heart attack are familiar diseases to 
all of us.
  The other aspect of adults is that there is a large volume of adults 
who have these types of diseases. As a result, there is more than a 
sufficient supply not only of physicians but of specialists, those who 
are particularly skilled and particularly knowledgeable about the most 
efficacious treatments one can use for these types of conditions.
  In contrast, children present another type of population to the 
health professionals. The good news is that most children are healthy. 
But if a child is sick, that child usually does not have one of these 
chronic diseases that is well-researched and well-treated and staffed 
by numerous specialists, but something more complicated. In fact, as 
the professionals say, these diseases are usually complex and with 
multiple co-morbidities. For the layperson, that means different 
problems interrelated causing a much more complicated case for the 
physician.
  There is another aspect of this dichotomy between adult health and 
children's health. There are so many healthy children --the good news. 
The bad news is in terms of managing this population, there is a very 
small volume of very sick children. This makes it very difficult for 
physicians to maintain their clinical competency, particularly for 
general practitioners. They will see many adults who have similar 
symptoms and they know very well how to treat them. By contrast, they 
very rarely see chronically ill children, so treating them effectively 
becomes especially difficult for a general practitioner.
  Another difficulty is the sense these general practitioners or even 
adult specialists can treat this population of patients. There is a 
further complicating factor, that is, to manage cases you need volume, 
you need data, you need to understand what the best treatments are, and 
you can only do that in a rational way by studying lots and lots of 
cases and, frankly, because of the nature of children's health, they do 
not have the same type of volume in children's diseases as they do in 
adult illnesses.
  One other complicating factor is that many times children's true 
health conditions manifest themselves long after they have actually 
contracted the condition. It is not the short duration, it is not the 
heart attack that one can rush the person into the emergency room, do 
the surgery, apply the drugs, and get that adult on the road to 
recovery. It is much different when it comes to a child.
  Managed care organizations and the way they deliver care can compound 
these inherent differences between the adult population and the 
children's population.
  First, let me give credit where credit is due. When a managed care 
plan does it right, they do preventive care very well. They can 
anticipate, through the management of the child's case, immunizations 
and well-baby visits, et cetera. But there are certain inherent 
characteristics of the managed care system of health care delivery that 
makes it--appropriate for adults but less appropriate for children. 
That is why we have to focus a part of our efforts on making sure that 
children are truly recognized in the legislation we are discussing.
  First of all, because there are a relatively small number of very 
sick children, there is not the adequate number of patients for the HMO 
to maintain a number of pediatric specialists in their provider 
network. The other fact is that HMOs tend to fragment the market. They 
go after parts of the market

[[Page 14556]]

and leave other parts out, but they do not tend to accumulate large 
groups of children so that a pediatric specialist in a particular area 
can be fully employed.
  Another aspect of the managed care delivery system is that they 
typically look for an affiliation with what they call centers of 
excellence, hospitals that are well-known for their practice in a 
certain field of medicine. In most cases, what they consider to be the 
center of excellence is a center that provides the best adult medicine 
because after all, they are marketing their products to adults, not to 
children. They are marketing their products to human resource managers 
who have to buy for a company, or they are marketing directly to people 
who make decisions about health care who are by definition adults. When 
they are out looking for centers of excellence, they are looking for 
those hospitals that have the best urology departments, have the best 
records with prostate cancer and breast cancer and heart attack. That 
is another built-in aspect of the HMO dilemma which complicates the 
care to children.
  There is something else. There is an economic incentive for these 
HMOs to refer children to adult specialists and not to pediatric 
specialists. There is a great difference between a cardiologist and a 
pediatric cardiologist because of the differences in caring for a child 
versus caring for an adult. The incentives are sometimes very 
compelling.
  For example, if you have a staff model HMO--that is where the doctor 
actually works for the HMO--you have a cardiologist simply because that 
is expected, and if you look at the numbers, you are likely to have a 
lot of adult cardiology patients and very few children. To add a 
pediatric cardiologist increases the fixed costs. Why do that when you 
can simply make a referral to the adult cardiologist that is already in 
the plan's network?
  When you look at the nonstaff model, one where they will contract 
with individual physicians, typically what they will do is look at 
volume discounts. A physician will say: Sure, I will sign up for so 
much per visit, but you have to assure me that I will get a lot of 
visits. That is another incentive to drive children not to pediatric 
specialists but to adult specialists.
  As a result, these incentives tend to diminish the quality of health 
care that HMOs give to children, particularly very sick children. It is 
not because they have some type of grudge against kids. It is simply, 
if you look at the market dynamics, if you look at the volume they are 
trying to manage, it all argues against the type of care that sick 
children must be assured. In other words, there is a failure in the 
market to recognize the needs of children.
  That is why we have to step in. That is why we have to require HMOs 
to make sure that there is access to pediatric specialists, to make 
sure HMOs are tracking the health progress of children, to make sure 
they are measuring their outcomes in terms of children and not just 
adults. If we do not, the system will always be driven to the needs of 
the adults who managed care plans are trying to recruit as patients. 
Another way to say this very simply is that HMOs operate on economies 
of scale. That is how they make the money. And children with 
particularly complicated pediatric health care cases do not conform to 
those types of economies of scale.
  I mentioned before there are other particular issues about the health 
status of children that make them distinct from adults, and one of them 
is the fact that children are still developing. They are constantly 
changing their functional levels --mobility, toddlers start walking, 
and then they start running, speech, puberty--all issues which are 
seldom associated with adult health.
  As a result, unless you consider development as a first order of 
priority, you are going to overlook a lot of the emphasis that should 
be placed on children's health care. I suggest that most HMOs do not 
factor in the sensitivities to development that are so necessary.
  Also, when you get into a situation like this, when the development 
of a child is at stake, the challenge is early intervention. It is not 
simply catching the disease someplace along its course and providing 
some type of treatment. It is early intervention.
  There are numerous examples. One that I recently read about is a 
condition in infants called strabismus, which is muscle weakness of the 
eye. If it is not corrected soon after birth when the neurological 
connections between the eye and the cortex of the brain are being 
formed--again, this is not a situation that an adult would ever 
encounter--if you do not catch it early, you are going to have 
significant and irreversible loss of sight.
  That is a special concern for kids, a very serious developmental 
concern for children diagnosed with the disease. That is why we need to 
make sure that development is built into HMOs consideration of the type 
of treatment and services they provide children. The economics of HMOs 
means they will not do it themselves. Therefore, we must make it our 
job. I think that is what is part and parcel of a good part of the 
Democratic initiative.
  Let me suggest something else on the issue of development. My 
colleague from California, Senator Feinstein, and so many others, have 
talked about medical necessity. This whole definition of medical 
necessity tends really to prejudice kids from getting a fair shake in 
HMOs, for many reasons.
  First of all, most medical necessity determinations are documented by 
data. How efficacious is the treatment? How often do we use it? And it 
goes right back to one of the inherent issues: The very lack of the 
volume of seriously ill children to generate the kind of data, 
treatments and outcomes.
  There is nothing in the law that I can see today at the Federal level 
that even requires HMOs to start thinking about outcomes, to start 
thinking about effectiveness in terms of kids.
  The other thing that we should be concerned about is that a lot of 
medical necessity is cost based--using the cheapest option. Once again, 
when you have a very small volume of very sick kids, the appropriate 
form of treatment may be extremely costly.
  Another factor concerning medical necessity is that usually it is 
tied to the notion that a health plan will not pay for innovative 
treatment. It will not pay for experimental treatment.
  Once again, many of the treatment modalities used for children, 
simply because they are not routine, can be called innovative or 
experimental. That is another example of how children are prejudiced by 
the system. It is something that we have to correct.
  Finally, very seldom will you find in the definition of medical 
necessity this concept of developmental impacts, beyond simply 
returning to normal function. As a result, it is easy for HMOs to say a 
treatment or procedure is not medically necessary when children present 
themselves or their parents present them for care. It is not 
threatening their lives today, or even their ability to function today. 
However, they probably know that months from now, a year from now, 2 
years from now, their development will be severely impaired. But that 
is not part of medical necessity. So that is another example of why we 
have to step up to the plate, particularly when it comes to children.
  We have learned so much about the development of young children, 
particularly from ages 0 to 3, including the way the brain develops.
  Once again, this is an issue that has very little correlation with 
adult experience. Children are developing.
  Just a few examples.
  At the Baylor College of Medicine there was a survey of abused and 
neglected children. They focused on 20 children who they described, in 
technical jargon, as living in ``globally understimulating 
environments.'' In other words, these children were rarely touched; 
they had no real opportunity to play; they had no opportunity to 
explore and experiment. They found that the brains of these young 
children were 20 to 30 percent smaller than those of children who had 
the opportunity to be stimulated. Indeed, literally parts of their 
brains had wasted away. Again, this is an issue that would never 
confront a practitioner looking at an adult.

[[Page 14557]]

  Another example relating to development is in the area of childhood 
trauma. We have been able to show, through scientific examination, that 
children who have witnessed violence have physically continued to 
register that violence, they remain in a high-alert state, and this 
leads to emotional, behavioral and learning problems.
  Again, these are conditions that you would never find in an adult, 
with some exceptions of course. But they are part and parcel of the 
developmental process of children. If we do not understand that, we do 
not recognize it. If we do not provide particular protections for 
children, it will not be done by the HMOs. It costs too much. They do 
not have the data. It is just something that they do not think about a 
lot.
  I see my colleague from Oregon is here. Let me make one other point, 
if I could.
  Mr. WYDEN. I just want to, at a convenient time, ask my good friend 
from Rhode Island to yield for a question or two because I think the 
Senator has made an excellent presentation on the need to advocate for 
kids. All the latest research with respect to these children is really 
dropped-dead material. Unless you get there early, as the Senator from 
Rhode Island is suggesting, you end up, with a lot of these poor kids, 
playing catchup ball for the next 10 years.
  So when it is convenient, I would like to engage the distinguished 
Senator from Rhode Island in a few questions about some of the other 
areas where he has contributed on this bill that, frankly, I think 
ought to help bring the parties together and help us fashion a 
bipartisan proposal.
  I just want the Senator from Rhode Island to know how much I 
appreciate him standing up for those kids who do not have political 
action committees and do not have clout and cannot speak for 
themselves. At an opportune time in the Senator's address, I would like 
to be able to ask the Senator to yield just to address a few other 
questions about some of the areas on which he has focused.
  Mr. REED. I thank the Senator from Oregon.
  I want to make one final point about children, and then I would very 
much like to yield to the Senator. And I compliment him, too, on his 
efforts because we are working together on many of these issues, 
including children's health.
  One final point: Children's health is, I would argue, more dependent 
on environmental conditions than adults. Of course, there are certain 
situations in the workplace where adults are exposed to chemicals, and 
we try to deal with that in terms of regulations and standards. 
However, it is also important to recognize that children are 
particularly prone to environmental and sociological conditions.
  For instance, lead poisoning--it is an epidemic in so many cities. In 
my city of Providence it is an epidemic. But it is not just Rhode 
Island, it is across the country.
  For too long, we used lead paint in houses, and now we do not have 
enough HUD money to clean up homes that have lead-based paints. That is 
why so many children have lead paint poisoning.
  We have to recognize, for kids, is they these are important health 
problems. We have to be developing mechanisms so managed care 
organizations recognize these issues as health problems and that the 
Government recognizes them as health problems, and that they work 
together with linkages.
  My final point is, unless we pass the kind of language that we have 
in the Democratic alternative, we are not going to give the special 
needs of children the attention it needs and deserves. When we start 
collecting the data, when we start having the HMOs publish what they do 
for kids--what is their success rate with kids? How many kids with 
complicated conditions do they have enrolled in their program? When we 
start doing that, they are going to have an incentive to start talking 
to the schools and the local authorities about their patients because 
now they have a real visible, accountable incentive to do it.
  Just one final point: Again, Bruce Clarke, Gen. Bruce Clarke, one of 
the great combat leaders of World War II, said--and I remember this 
from my days at West Point--``A unit does well what its commander 
checks. If the commander doesn't check, you are not going to find that 
unit paying attention.''
  We have not been checking on kids in HMOs in this country. I do not 
think they are doing particularly well as a result. When we start 
checking on kids specifically, as the Democratic alternative does, then 
we will start doing much better, I think we will start doing well.
  I yield to the Senator from Oregon.
  Mr. WYDEN. I thank my colleague for yielding. He has made an 
excellent presentation with respect to the need for strong advocates 
for these kids.
  I will turn briefly to another area where the Senator from Rhode 
Island has, in my view, done yeoman work, and an area, frankly, that I 
think has sort of gotten lost a little bit in this discussion. That is 
the proposal the Senator from Rhode Island has made with respect to 
having ombudsmen or advocates for consumers around the country. It 
ought to be one of the areas that both political parties could 
gravitate to, because I believe that what the Senator from Rhode Island 
has done--of course, we have gotten great input from Families USA and 
Ron Pollack and some of the folks who have done so much for consumers 
over the years--is essentially talk about a true revolution in the area 
of consumer protection.
  What happened--I have seen this so often since my days as director of 
the Gray Panthers; I was head of the Gray Panthers at home for about 7 
years before I was elected to the House--what we saw was that the 
consumer would have a problem and, without any advocates or the ability 
to get it handled early on, a problem that started off relatively 
modest and minor would just fester and get worse and eventually blossom 
into a huge controversy which ended up in litigation.
  As the distinguished Senator from Rhode Island knows, one of the most 
controversial aspects of this whole debate about managed care is 
litigation. It seems to me that if the Senate were to adopt the 
proposal of the Senator from Rhode Island or some version of it, this 
would shift the focus of consumer protection away from litigation, away 
from problems after they have unnecessarily developed into something 
serious. Instead, we would resolve a lot of the problems early on and 
we wouldn't need this focus on litigation.
  Certainly, we ought to have legal remedies for the really outrageous 
examples of consumer rip-offs and the like. But I think what the 
Senator from Rhode Island has done, and it is such a valuable service 
in this debate and a real revolution in consumer protection, is said: 
Let's get at it early on when the consumer and the families can find 
somewhere to turn. We will prevent problems then. It can be done 
relatively inexpensively.
  I would like the Senator from Rhode Island to elaborate a little bit 
on this and make sure that over the next few minutes the Senator from 
Rhode Island can lay out his proposal, on which I am honored to join 
with him. I think this has the potential of, frankly, being one of the 
areas where the parties, once they focus on it, can say: This is good 
public policy that will reduce the need for litigation and, as Ron 
Pollack and Families USA have said so eloquently, help a lot of 
consumers when they need it most. Perhaps the distinguished Senator 
from Rhode Island could take us through it.
  Mr. REED. I thank the Senator from Oregon for his very kind words. 
Let me also thank him for his help and support in working so closely 
with me and Families USA and others to ensure that this proposal will 
work for all consumers and for the insurance industry as well.
  Part of our attempt is to find answers before, as the Senator from 
Oregon has said, they wind up in court. My experience--I think your 
experience, too--is that people want their health care to be addressed. 
They don't want a lawsuit. They want to get their children cared for. 
They want their

[[Page 14558]]

own health care. This is not an attempt to figure out some way to get 
involved in a messy multiyear litigation process. Yet if there are no 
mechanisms, such as an ombudsman and an internal/external review 
process, if we don't have these mechanisms, that is where we inevitably 
will find ourselves.
  Let me quickly accept the Senator's invitation to lay out some of the 
details.
  First, it would be a State-based program, not a national program in 
the sense of some collective wisdom here in Washington, but each State 
could design their own ombudsman program. We would provide financial 
support. There would be some general guidelines for the states to 
follow. Basically, this ombudsman operation or consumer assistance 
operation would inform people about their plan options that are 
available and to answer other questions about a person's health plan.
  Frankly, one of the great dilemmas most of our constituents have is, 
they don't know whom to ask about health plans, what health plans are 
available. This would be a source, a clearinghouse, if you will, for 
that type of information.
  Then the ombudsman or the consumer assistance center would operate a 
1-800 telephone hotline to respond to consumer questions and requests 
for information--again, such a necessary ingredient, for several 
reasons: First, the general befuddlement one experiences when you try 
to read a health plan contract. Two, I sense there is deep skepticism 
about the kind of response you expect to receive from your own 
insurance company about your rights and your benefits, if you get a 
response at all. Too many times I have heard constituents say they have 
just found themselves entangled in a voice mail hell, if you will. As 
you push one number and find one recording, you push another number and 
find another recording. The ombudsman program with the 1-800 number 
would serve as a place where you could get information and get it 
quickly.
  Then this objective ombudsman, or woman, as the case may be, would 
provide assistance to people who think they have a grievance. They 
would have an opportunity for a patient to go in and say: My plan said 
I could not have this procedure for my child. My doctor says my child 
needs it. Can you help me? Frankly, not only will the ombudsman help 
the individual consumer, but they will look at the plan, and they will 
conclude that under the terms and conditions of the contract, that is 
or is not covered.
  It won't be the insurance company protecting their own interest, it 
will be an objective agency that will be able to step in and advocate 
for consumer rights when they need to vindicate their rights and 
explain to them the limitations of the policy, when that is the case.
  That is the general outline.
  I yield the floor.
  Mr. WYDEN. I appreciate the distinguished Senator yielding. I have 
felt that he has really gone to great lengths to try to ensure that 
this could be supported by every Member of the Senate.
  Frankly, I feel about his proposal much like I do about the gag 
clause discussion. I think he and I have talked about this. I am 
probably a lot of things, but one of the last things I guess I would 
qualify as is an HMO basher. We have a lot of good managed care in my 
part of the United States. My hometown of Portland has the highest 
concentration of folks in HMOs in the United States. About 60 percent 
of the older people are part of a managed care program.
  The distinguished Presiding Officer, Senator Smith, and I have worked 
together on a lot of these issues. Frankly, one of our big concerns is, 
we do offer a lot of good managed care. We end up getting the short end 
of the stick in terms of reimbursement. I think what the Senator is 
talking about with an ombudsman, much like gag clauses where people, of 
course, ought to be entitled to all of the information about their 
options, the ombudsman concept is much the same kind of approach to 
good government.
  The Senator from Rhode Island has written this now so as to ensure it 
cannot result in litigation, that this specifically is designed to help 
consumers at the front end and bars litigation. I don't think the 
majority of the Senate is aware of that. The Senator from Rhode Island 
has indicated to this Senator and the Senator from Maine, Ms. Collins, 
who has been very interested in this issue over the years, who has done 
good work, that he wants to make sure we don't duplicate existing 
services.
  I am happy to yield to the Senator.
  Mr. REED. Reclaiming my time, it is quite specific in the 
legislation. Again, the Senator is one of the contributors to this 
legislation, along with Senator Wellstone, and I thank him.
  The ombudsman, or the consumer assistance center, could not 
participate in litigation. Their scope of participation is informal and 
could include contacting the insurance company, explaining rights, 
advocating for the patient as an ombudsman, not as a lawyer, not as a 
litigator.
  Let me add one other point and then, again, yield to my colleague 
from Oregon. Interestingly enough, again I think he has identified an 
issue that we all can rally around. One of the great talents the 
Senator from Oregon brings to the Senate is an ability to be a bridge 
in so many different ways, i.e., the Education Flexibility Act--to find 
a mechanism that we all can agree upon.
  This is another one of these areas. Interestingly enough, a few weeks 
ago we passed with little controversy and with much enthusiasm the 
defense authorization bill that included an authorization for an 
ombudsman program to address the problems and complaints associated 
with military HMOs--the TRACER system--looking at the same problem that 
all of the Senator's constituents from Oregon face, and all of my 
constituents face, but in the context of military families and 
complaints, and legitimate complaints of military families. They cannot 
get the care they need. They cannot get the answers. They get the 
runaround. They do not get the support.
  In response to that, this body voted enthusiastically to authorize an 
ombudsman for the TRACER system. Frankly, both the Senator from Oregon 
and I are saying if it works well, or we think it is going to work well 
for our military families who are enrolled in an HMO that has a great 
deal of responsibility for them, why not give it a chance in the 
context of the private insurance HMO industry in the United States?
  I think that underscores what the Senator from Oregon has said. This 
is not controversial. This is helpful. This is practical. This is not 
about litigation, it is about making sure that people get answers, that 
people get results, and that people get the care. That is what I think 
we are all here to do.
  Again, I will yield.
  Mr. WYDEN. I appreciate the chance to continue this for a moment 
because the Senator from Rhode Island is essentially being logical. 
Heaven forbid that actually takes over some of the debate we have. 
There is nothing partisan about making sure that consumers have all the 
facts about their health care. That is the effort with respect to 
barring gag clauses. And there is nothing partisan about this ombudsman 
approach.
  I am very hopeful, frankly, that as the Senate learns more about this 
kind of concept pioneered by the Senator from Rhode Island, Families 
USA, and others, that we will see some of the good health care plans in 
this country saying we are going to support this because it makes sense 
to solve problems early on.
  Frankly, if we can win support for the Reed proposal early on--I am 
honored to join in on it--I think this will go a long way to eventually 
resolving the controversy about litigation because I think we will see 
good advocacy programs early on, and we can confine then the need for 
litigation to really only the outrageous, outlandish cases where I 
think every Member of the Senate would say, goodness, this is an area 
where you really ought to have a legal remedy. But we would have skewed 
the whole system toward prevention and early intervention, or answering 
the questions that the Senator

[[Page 14559]]

from Rhode Island has properly identified.
  I will tell you that in my hometown, where we do have a lot of good 
managed care, folks want to see this kind of proposal. They want to see 
what is laid out in the legislation that our colleagues on this side of 
the aisle are offering, and they want to see us reach a bipartisan 
agreement.
  The Presiding Officer of the Senate and I have had the most 
competitive elections in the history of the West. We have teamed up 
together on a whole host of issues in the Senate.
  It would seem to me that around the ombudsman program and around 
barring gag clauses, this is another area where essentially partisan 
politics ought to stop outside the Chamber. We ought to work together 
to enact a good ombudsman program to say that this is the best anecdote 
to frivolous litigation, frankly, that we could possibly find.
  I thank the Senator from Rhode Island, with whom I have enjoyed 
working for well over a decade on senior and consumer issues, and for 
the chance to work with him on it.
  Perhaps by way of wrapping up my question to the Senator from Rhode 
Island, could he fill us in on progress with other colleagues? I know 
that Senator Collins has been very interested in this issue. She has 
done good work in her home State of Maine. Perhaps the Senator from 
Rhode Island could just wrap up by telling us where his proposal 
stands. I want to assure him and Senator Kennedy, who has been leading 
this fight--and I am anxious to work with him. In fact, when I first 
came to the Senate, just a few weeks after arriving I had a chance to 
work with the distinguished Senator from Massachusetts on the effort to 
bar gag clauses. I only wish we had gotten that in place back then 
several years ago. It is long overdue that we get that protection for 
consumers as well as the Reed proposal.
  Perhaps the Senator from Rhode Island could tell us where the 
ombudsman proposal stands at this time.
  Mr. REED. Very quickly, we have been working, as the Senator knows, 
closely on the Reed-Wyden-Wellstone proposal, which was formally 
introduced as separate legislation. It is incorporated in the Democrat 
Patients' Bill of Rights. I know Senator Collins of Maine is very 
interested in this issue. I think she is also convinced that this is 
important and significant.
  Let me also say that the Senator from Oregon made reference to his 
experience as a senior advocate. There are, in fact, senior ombudsman 
programs throughout the United States which we support with the Older 
Americans Act. These programs have been very effective and are doing 
precisely what we want to do in the context of managed care.
  Again, we just adopted an ombudsman program for military personnel in 
the TRICARE system. It was noncontroversial. In fact, we have a great 
deal of expectation and hope that this will be helpful to our military 
families. We are working together across the aisle. I hope that we can 
also incorporate this provision in whatever Patients' Bill of Rights 
legislation that emerges. It is not designed to be a tool of 
litigation; it is designed to be a tool of conciliation.
  On those grounds, I am optimistic and hopeful.
  But, once again, let me finally conclude by thanking the Senator from 
Oregon not only for our colloquy this afternoon but also for his 
support, not only on this issue but so many others.
  Mr. WYDEN. I will be very brief as well.
  I think the distinguished Senator from Rhode Island, particularly 
with Families USA, is on to something that really constitutes a 
revolution in consumer protection. What we have seen on one issue after 
another--just a few minutes ago the distinguished Senator from Arizona, 
Mr. McCain, and Senator Dodd of Connecticut, and I were able to get an 
agreement on the Y2K issue with respect to trying to hold down 
frivolous lawsuits surrounding Y2K. What the Senator from Rhode Island 
and Families USA have been able to do is essentially say in the health 
care system: We are going to do everything we possibly can to limit 
frivolous lawsuits; we are going to help people when they need it most, 
when the problem first develops.
  I want to assure the Senator from Rhode Island and the distinguished 
Senator from Massachusetts that I am anxious to work with them on this 
proposal, because I think this is one of the areas where the parties 
ought to be able to come together. It may sound quaint, but the 
ombudsman notion is simply good government. It is preventive kind of 
medicine.
  I thank the Senator for the chance to work with him on it. I will not 
ask him to yield further. But I am very hopeful that in the days ahead 
both political parties can see the merit in this idea and have it 
included.
  Mr. REED. Before yielding the floor, let me just say that I, along 
with my colleague from Oregon, must recognize Families USA and Ron 
Pollack for the inspiration and thoughtful analysis that helped propel 
this proposal. It is a good one.
  Frankly, we could do very well in this Senate this year if we could 
protect children through better managed care legislation and give all 
of our citizens a real voice in our health care decisions through an 
ombudsman program. This will be a very satisfactory and very successful 
endeavor for all of us in the Senate.
  With that, I yield the floor.
  The PRESIDING OFFICER (Mr. Smith of Oregon). The Senator from New 
Hampshire.
  Mr. GREGG. Mr. President, are we in morning business?
  The PRESIDING OFFICER. The time for morning business was concluded at 
5 p.m.
  Mr. GREGG. Mr. President, I ask unanimous consent that I be allowed 
to speak for 10 minutes as if in morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                          ____________________