[Congressional Record (Bound Edition), Volume 148 (2002), Part 11]
[Senate]
[Pages 15638-15642]
[From the U.S. Government Publishing Office, www.gpo.gov]




                        PATIENTS BILL OF RIGHTS

  Mr. KENNEDY. Mr. President, I regret that we continue to be unable to 
reach an agreement on the Patients' Bill of Rights that would protect 
the interests of patients instead of the profits of insurance 
companies. The sponsors of the Senate Patients' Bill of Rights, 
Senators McCain, Edwards and I, have spent many months talking with the 
White House. We have repeatedly tried to reach a fair compromise that 
would address many of the concerns voiced by the opponents of this bill 
without sacrificing the protection patients need. Unfortunately, we 
were not able to reach an agreement with them. The Bush administration 
has simply been unwilling to hold HMOs and insurance companies fully 
accountable when they make medical decisions. In the end, they were 
more committed to maintaining special preferences for HMOs and big 
insurance companies than passing legislation that would protect 
patients.
  This is, at heart, an issue of corporate accountability. HMOs and 
insurance companies have not been held accountable for their medical 
decisions; and, as a result patients are being injured every day. Just 
as Congress took the lead on corporate accountability in the Sarbanes 
legislation when the White House would not take strong action, I 
believe Congress will now take the lead and enact a strong Patients' 
Bill of Rights. The political climate is very different today than it 
was when the House acted last year. The public is focused. I do not 
believe the Republican leadership will be able to resist the tide of 
popular opinion.
  Throughout this process, we have been particularly concerned about 
those patients who sustain the most serious, life-altering injuries. If 
the law does not allow them to obtain full and fair compensation for 
their injuries, we will fail those who are most in need of our help. 
Yet, the administration has steadfastly refused to agree to liability 
provisions that would treat the most seriously injured patients justly.
  Holding HMOs and health insurers fully accountable for their 
misconduct is essential to improving the quality of health care that 
millions of Americans receive. Nothing will provide a greater incentive 
for an HMO to do the right thing than the knowledge that it will be 
held accountable in court if it does the wrong thing. Placing arbitrary 
limits on the financial responsibility which HMOs owe to those patients 
who have been badly harmed by their misconduct would seriously weaken 
the deterrent effect of the law. Yet, the administration has insisted 
on a series of provisions which were designed to limit the 
accountability of HMOs.
  The Bush administration wanted to weaken the authority of external 
review panels to help patients obtain the medical care they need. They 
demanded a rebuttable presumption against the patients in many cases 
that would effectively deny them a fair hearing in court. They demanded 
an arbitrary cap on the compensation which even the most seriously 
injured patients could receive. They wanted to allow HMOs and insurance 
companies to block injured patients from going to court at all, forcing 
them instead into a much more restrictive arbitration process. They 
insisted on preventing juries from awarding punitive damages even if 
there was clear and convincing evidence of a pattern of intentional 
wrongdoing by the HMO. At every stage of the accountability process, 
the administration was unwilling to treat patients fairly. A right 
without an effective remedy is no right at all, and the administration 
was unwilling to provide injured patients with any effective remedy.
  Every day, thousands of patients are victimized by HMO abuses. Too 
many patients with symptoms of a heart attack or stroke are put at risk 
because they cannot go to the nearest emergency room. Too many women 
with breast cancer or cervical cancer suffer and even die because their 
HMO will not authorize needed care by a specialist. Too many children 
with life-threatening illnesses are told that they must see the 
unqualified physician in their plan's network because the HMO won't pay 
for them to see the specialist just down the road. Too many patients 
with incurable cancer or heart disease or other fatal conditions are 
denied the opportunity to participate in the clinical trials that could 
save their lives. Too many patients with arthritis, or cancer, or 
mental illnesses are denied the drugs that their doctor prescribes, 
because the medicine they need is not as cheap as the medicine on the 
HMO's list.
  The legislation passed by the Senate would end those abuses, and it 
would assure that HMOs could be held responsible in court if they 
failed to provide the care their patients deserved. The Senate bill 
said that if an HMO crippled or terribly injured a patient, it had a 
responsibility to provide financial compensation for the victim and the 
victim's family. It said that if an HMO killed a family breadwinner, it 
was liable for the support of that patient's family.
  The Senate passed a strong, effective patients' bill of rights by an 
overwhelming bipartisan vote. It was not a Democratic victory or a 
Republican victory. It was a victory for patients. It was a victory for 
every family that wants medical decisions made by doctors and nurses, 
not insurance company bureaucrats. It said that treatment should be 
determined by a patients' vital signs, not an HMO's bottom line.
  Under our legislation, all the abuses that have marked managed care 
for so long were prohibited. Patients were guaranteed access to a 
speedy, impartial, independent appeal when HMOs denied care. And the 
rights the legislation granted were enforceable. When HMO decisions 
seriously injured patients, HMOs could be held accountable in court, 
under state law, under the same standards that apply to doctors and 
hospitals.
  The story was different in the House. There, a narrow, partisan 
majority insisted on retaining special treatment and special privileges 
for HMOs. That legislation granted HMOs protection available to no 
other industry in America. Under the guise of granting new rights, it 
denied effective remedies. It tilted the playing field in favor of HMOs 
and against patients. The Republican majority in the House said yes to 
big business and no to American families. Their bill represents the 
triumph of privilege and power over fairness.
  Under the House Republican bill, a family trying to hold an HMO 
accountable when a patient was killed or injured would find the legal 
process stacked against them at every turn. The standard in their bill 
for determining whether the HMO was negligent would allow HMOs to 
overturn the decision of a patients' family doctor without being held 
to the same standard of good medical practice that applies to the 
doctor. Think about that. One standard for a doctor trying to provide 
good care for patients. Another, lower standard for the HMO which 
arbitrarily overturns that doctor's decision because it wants to 
protect its bottom line.
  The House Republican bill puts artificial limits on the liability of 
HMOs when a patient is killed or injured. The Republicans often 
complain about one-size-fits all legislation, but their bill is an 
extreme example of it. No matter how seriously a patient is injured, no 
matter what remedies are available under state law, no matter how 
negligent or outrageous the actions of that HMO, no matter what a judge 
and jury decides is an appropriate remedy, there is the same flat 
dollar limit on the HMOs' liability. And the limit in the Republican 
bill is far below what the most seriously injured patients receive when 
they are badly hurt by a doctor's negligence or by the negligence of 
any other industry. For a child paralyzed for life by an HMO's penny-
pinching--an arbitrary limit on compensation. For a child who loses 
both hands and feet--an arbitrary limit on compensation. For the 
families of women needlessly killed by improper treatment for breast 
cancer an arbitrary limit on compensation. For a father or mother

[[Page 15639]]

hopelessly brain-damaged--an arbitrary limit on compensation.
  In addition, the bill essentially provides no punitive damages to 
deter the most egregious denials of care. Even if the HMO denies 
medically necessary care over and over and over again, no punitive 
damages. Even if the HMO engages in fraud or willful misconduct, no 
punitive damages. Even if the HMO routinely turns down every request 
for expensive treatment, no punitive damages.
  If a patient ever gets to court under the Republican plan, they face 
a form of double jeopardy--the so-called ``rebuttable presumption.'' If 
a patient loses an appeal to an external review agency, that patient 
faces an almost impossible legal hurdle in court. But if an HMO loses 
an external appeal, the patient does not gain a comparable advantage. 
In effect, the patient has to win twice. The HMO only has to win only 
once. This one-way presumption is grossly unfair.
  In area after area of Federal legislation, Congress has set minimum 
standards guaranteeing basic fairness but allowed states to go farther 
in protecting their citizens. But the House Republican bill sets a 
ceiling instead of a floor. States are not permitted to have stronger 
patients' rights laws. The bill would preempt the external review 
process in more than 40 states, abolishing state laws that provide 
greater protection for patients.
  In a bill that purports to expand patient protections, it is 
remarkable that the Republican bill actually takes rights away. The 
Federal RICO antiracketeering statute is a powerful weapon against 
fraud. Under current law, patients and businesses buying health 
insurance policies have the right to bring a RICO class action suit 
against a health insurance company which has engaged in systematic 
fraud. The House Republican bill would in essence repeal that right, 
erecting new barriers to class actions against health insurance 
companies.
  Not only does the Republican plan fail to protect patients against 
HMO abuse, it includes unrelated provisions that could actually harm 
patients. The bill provides new tax breaks for the healthy and wealthy 
by expanding and extending so-called ``Medical Savings Accounts.'' 
These accounts are the pet project of certain insurance companies that 
have made large donations to the Republican party. They not only 
benefit the healthy and wealthy purchasing high deductible insurance 
policies, but a number of independent analyses have concluded that they 
could result in dramatic premium increases for everyone else. Every 
day, we seem to find new evidence that the Republicans have never found 
a tax break for the wealthy that they didn't eagerly embrace.
  And finally, the Republican bill eliminates state regulation of so-
called ``association health plans,'' a new name for multiemployer 
welfare arrangements. While well-run plans of this kind can benefit 
consumers, too often they have failed financially and left patients 
holding the bag. Fraud has been their frequent companion. Most 
authorities believe that they need more regulation, not less. And not 
only does the Republican plan expose millions of families to financial 
disaster, it would deny more millions important benefits required by 
state insurance laws--benefits that help women at risk of cervical 
cancer, children with birth defects, and the disabled. According to 
estimates by the Congressional Budget Office, hundreds of thousands of 
people, predominantly those in poorer health, could lose their coverage 
as a result of this proposal.
  I am disappointed that we were unable to reach an agreement with the 
Administration that would have made it possible to pass a strong, 
effective patients' bill of rights--one that would have protected 
patients without providing sweetheart deals for HMOs.
  It is unfortunate that this Administration so consistently sides with 
the wealthy and powerful and against the interests of ordinary people. 
The positions taken by the White House on these critical health issues 
do not represent the views of the American people. Just a few days 
after the President called for severe limitations on a patient's right 
to seek compensation when he or she is seriously injured by medical 
malpractice, a strong bi-partisan 57-42 majority of the Senate rejected 
the President's position and sided with patients.
  The Senate version of the patients' bill of rights--supported by 
virtually every group of patients, doctors, nurses, and advocates for 
workers and families--passed the Senate with a strong, bipartisan 
majority of 59-36 . In contrast, the key vote in the House of 
Representatives gutting the provisions of the bill which would hold 
HMOs accountable for injuring patients passed by a narrow partisan 
majority of only six votes--and then only after the Administration used 
every weapon of arm-twisting and patronage in the book to hold their 
votes in line.
  In the last two weeks, the Senate debated the critical issues of 
reducing the high cost of prescription drugs and providing a long-
overdue prescription drug benefit under Medicare. Over the strenuous 
objections of the Republican leadership and the Administration, the 
Senate voted by an overwhelming bipartisan majority of 78-21 to end 
abuses by wealthy and powerful drug companies that stifled competition 
and raised prices to patients.
  A majority of the Senate also voted to provide comprehensive 
prescription drug coverage under Medicare--but the objections of the 
Administration and the Republican leadership proved too strong to reach 
the 60 votes necessary for passage. The misplaced priorities behind the 
Republican position were made clear by separate comments of the 
President and the Republican leader. Senator Trent Lott stated that 
both the comprehensive plan a majority of the Senate supported and even 
the scaled-back downpayment plan were too expensive for the Republican 
leadership. But while Republicans rejected prescription drug coverage 
for the elderly as just too expensive, the President reiterated 
yesterday his support for extending the trillion dollar plus tax cuts 
that primarily benefitted the wealthy.
  While I am disappointed by the failure to reach agreement on the 
patients' bill of rights and to achieve 60 votes for Medicare 
prescription drug coverage, I am not discouraged. The American people 
want action, and in the end, I believe the Congress will listen to 
their voice.
  We will never give up the struggle for prescription drug coverage 
under Medicare until we mend the broken promise of Medicare and 
guarantee senior citizens the prescription drug coverage they deserve. 
And we will never give up the fight for a strong, effective patients' 
bill of rights.
  Now we will move to a patients' bill of rights conference with the 
House of Representatives and try once again. We commit today that we 
will do everything we can to make the conference a success. We will 
never give up this fight until all patients receive the protection they 
deserve. We will not rest until medical decisions are made by doctors, 
nurses, and patients, instead of insurance company bureaucrats.
  Finally, I want to once again commend my two friends and colleagues 
who provided such important leadership here on the floor of the Senate. 
They were valued advisers, counselors, and helpers in trying to work 
through, in a constructive and positive way, the differences that 
existed. They took an enormous amount of time, including great 
diligence, expertise, and understanding of the issues at stake; They 
were enormously constructive and helpful in trying to move this in a 
positive way. We were unsuccessful in that phase of this path towards 
completing our mission of achieving an effective Patients' Bill of 
Rights, but we are all committed to achieving it ultimately. I thank 
them for all the good work they have achieved.
  The PRESIDING OFFICER. The Senator from Arizona.
  Mr. McCAIN. Mr. President, I thank Senator Kennedy and Senator 
Edwards for the over-a-year-long effort we have been involved in 
attempting to reach agreement on S. 1052, the bipartisan Patient 
Protection Act. It has been over a year since the Senate passed it. It 
has been just under a year since another version was passed by

[[Page 15640]]

the House of Representatives. The White House was instrumental in 
crafting the House-passed version.
  So since last year Senator Kennedy, Senator Edwards, and I have 
worked with the White House in the hopes of reconciling the Senate and 
the House bills. Much progress has been made as a result of these 
negotiations. But, regrettably, a resolution eludes us, and I think it 
is time to appoint conferees.
  America has been patiently waiting for Congress to pass a Patients' 
Bill of Rights. It will grant American families enrolled in health 
maintenance organizations the protections they deserve. For too long 
this vital reform has been frustrated by political gridlock, 
principally by trial lawyers who insist on the ability to sue everyone 
for everything and by the insurance companies that want to protect 
their bottom line at the expense of fairness. Caught in the middle are 
average citizens who are members of HMOs. Americans want and deserve 
quick enactment of this legislation.
  Several years ago I began working with my colleagues on both sides of 
the aisle to address the problems in HMO's provisions in health care 
and to craft a bipartisan bill that truly protects the rights of 
patients in our Nation's health care system.
  The Senate passage of the bipartisan Patient Protection Act furthered 
the effort to restore critical rights to HMO patients and doctors.
  I, again, express my appreciation to the Senator from North Carolina, 
Mr. Edwards, for his incredibly fine work. Both the Senate- and the 
House-passed versions contain important patient protections for the 
American people. I am confident that with perseverance we can resolve 
the few differences that remain. If we do not continue to work toward a 
resolution on this issue, we will be turning our backs on strong 
patient protections included in both bills.
  This is really the shame of our failure so far because included in 
both bills are external and internal review, direct access to an OB-GYN 
for women, direct access to pediatricians for children, access to 
clinical trials for cancer patients, access to emergency room care, 
access to specialty care, and access to nonformulary prescription 
drugs. If we do not negotiate, and if we do not reach a successful 
conclusion, these important commonalities and progress will be lost.
  I believe a conference report represents one final opportunity to 
work out the differences between the House and Senate efforts to enact 
meaningful HMO reform. I remain committed to working with Members of 
both bodies, and with the President, to make sure we will enact into 
law these important protections for which too many Americans have 
waited far too long.
  I look forward to working with my colleagues in conference to bridge 
the differences between the House and the Senate bills and provide 
patients with the protection they deserve.
  The problem, as I see it, is that we have very small differences, and 
during the course of our negotiations there will be different versions 
about how close we came and what our differences were. But I believe 
they were very narrow differences, and I am very disappointed that they 
were unable to work out. And I got to spend a lot more time than my 
colleagues wanted--Senator Kennedy and Senator Edwards and I together--
but I believe there was a good-faith effort made.
  I believe we are going to lose so many important advances on behalf 
of patients because of a small difference that really has to do with 
cases that will be adjudicated in court. And that is a very small 
number of these cases because with internal and external review, and 
other safeguards in the bill, there would be a minuscule number of 
cases that actually would end up in court. And that is the aspect of 
this agreement on which we were unable to reach agreement with the 
White House. And I regret it very much.
  So as Senator Kennedy just stated, I believe we will prevail over 
time, just as we have prevailed on other issues over time, because this 
is something the American people need and deserve.
  There are too many compelling cases out there of people who have been 
deprived of fundamental care which has inflicted incredible damage, 
hardship, and sorrow on so many Americans because they have been 
deprived of simple rights, such as a woman to see an OB-GYN, such as 
the right of a child to see a pediatrician, such as a doctor making a 
decision rather than a bureaucrat.
  This is what it is all about: Who makes the decisions on patients' 
care? Should it be someone who is wearing a green eyeshade who can 
count up how much the costs are or should it be a doctor, a qualified 
physician, who makes the decision? That is really what this reform is 
all about.
  Unfortunately, it has gotten hung up over court proceedings and who 
should go to court and whether there should be caps on economic and 
punitive damages, and other aspects of the minuscule number that would 
ever be required to do so.
  So I hope we can all step back and look at this situation. In the 
context of how far we have gone, we have gone 99 percent of the way in 
doing what my colleagues and I set out to do a long time ago; and that 
was to provide members of health maintenance organizations with 
fundamental protections which they need and deserve.
  So, again, I conclude by thanking Senator Kennedy and Senator Edwards 
for their hard work and for their dedication to the resolution of this 
issue. I thank the White House for their efforts as well. In the little 
interest of straight talk, I think from time to time they were 
constrained by the other body in the latitude as to the agreements they 
could make, but I also understand that is how the system works.
  But I believe that while we are gone in August, back with our friends 
and neighbors and fellow citizens, our friends and neighbors are going 
to come to us and say: Look, we deserve this legislation--the millions 
and millions of Americans who are members of HMOs--we deserve that we 
get certain basic protections.
  I hope that will reinvigorate us, upon our return, to enact final 
legislation and resolve the few remaining differences in this bill.
  I yield the floor.
  The PRESIDING OFFICER (Mrs. CLINTON). The Senator from North 
Carolina.
  Mr. EDWARDS. Madam President, first, I say thank you to my colleagues 
and my friends, Senator McCain and Senator Kennedy, who have worked so 
hard on this legislation. Senator Kennedy worked long and hard on this 
before a number of us, including Senator McCain and myself, became 
actively involved. He has been rowing the boat for a long time. And his 
work has been critical to the progress that has been made on behalf of 
patients. And Senator McCain has had such an enormous influence on the 
work that has been done and the progress that has been made.
  Today conferees will be appointed, which is unfortunate. I want to 
say a word about why this matters and why it matters for people, for 
patients, and why most of the people in this country don't care at all 
about the process or the procedures inside the Senate or a conference 
between the House and the Senate. All they care about, and all they 
know, is they write those checks every month to the insurance company 
for their insurance premiums, and they want to get what they are paying 
for.
  They expect, if they are going to pay the insurance company for 
health care coverage, they ought to get it. If their child needs to see 
a specialist, that child ought to be able to see that specialist. When 
they are going to the emergency room, they should not have to call a 1-
800 number to get permission to go.
  If a woman wants to participate in a clinical trial, she ought to be 
able to participate in a clinical trial. If the insurance company and 
the HMO say, we are not paying for this, we will not give you the care 
toward which you have been writing those checks for every month, they 
ought to have a simple, inexpensive, fast way of getting that decision 
overturned. That is what the Patients' Bill of Rights is about. It 
affects real people's lives.
  There is a fellow from North Carolina named Steve Grissom whom I got 
to

[[Page 15641]]

know over time. Steve developed all kinds of health problems as a 
result of a blood transfusion. It got to the place where he needed 
oxygen basically 24 hours a day in order to continue to function. All 
of his doctors, including a specialist at Duke University, said he 
needed it--everybody except an HMO bureaucrat who came along after the 
fact and said: You don't need this. We are not going to pay for it.
  Steve, because of what happened to him, became an enormous advocate 
for doing something about patients' rights and the Patients' Bill of 
Rights. He became a powerful, passionate voice for regular people 
against the HMOs in order to do what needs to be done for families to 
be able to make their own health care decisions.
  Steve lost his life this week, not as a result of what the HMO did, 
but he is the personification of the problem that exists all over 
America and what HMOs are doing to patients all over America. Millions 
and millions of people, children, and families can't make their own 
health care decisions. Health care decisions are being made by 
bureaucrats sitting behind a desk somewhere who have no training, no 
business making those kinds of decisions, and the patients and the 
families can do nothing about it. They are totally powerless.
  HMOs live in a privileged, rarified world that no other business in 
America lives in. In this era of corporate responsibility, we are 
trying to say on the floor of the Senate that corporations ought to be 
held accountable for what they do, for their decisions, they ought to 
be responsible for what they do; not HMOs, HMOs can do anything they 
want, and we are powerless to do anything about it.
  What the Senate did in the Patients' Bill of Rights, which received 
strong bipartisan support, was create real rights for patients: 
Allowing people to make their own health care decisions, to go to the 
emergency room, to participate in clinical trials, to get bad decisions 
by HMOs overturned. That is what we did in the Senate. All we said was 
this: We want HMOs to be treated like everybody else. Why in the world 
should every person in America be responsible for what they do, every 
other business in America be responsible for what they do, but we are 
going to put HMOs up on a pedestal and treat them better and 
differently than everybody else? They can't be held responsible. They 
can't be held accountable. They are different. They are better than all 
the rest of us.
  Well, they are not. They are just like everybody else. What could be 
a better example of the abuses that occur than what we have seen happen 
over the course of the last several months with the corporate 
irresponsibility that has had an enormous effect on all American 
people--investors, Wall Street, the economy?
  In this era of trying to do something about corporate responsibility, 
are we going to maintain this special, privileged, protected status for 
a group of businesses that have proven--there is no question about it--
that they are willing to engage in abuses, all in the name of profit 
and all at the expense of patients? That is what this is all about.
  That is the reason virtually every group in America that cares about 
this issue supported the Patients' Bill of Rights that passed the 
Senate. Unfortunately, when the bill went to the House, a much weaker 
bill passed, a bill that in many cases would have actually taken away 
rights that States had put into place on behalf of patients. Many would 
argue it was an insurers' bill of rights, not a Patients' Bill of 
Rights.
  If you put the bills side by side, on every single difference between 
the Senate bill and the House bill, the Senate bill favored the 
patients, the House bill favored the HMOs. It is no more complicated 
than that. As a result of having two bills passed--a strong bill in the 
Senate and a weak bill in the House--it was necessary for Senator 
McCain, Senator Kennedy, and me to begin negotiating with the White 
House because, as I said earlier, the people of this country couldn't 
care less about the process of what goes on inside Washington. They 
want to be able to make their own health care decisions. They depend on 
us to do something about that.
  So over the course of many months, Senator McCain, Senator Kennedy, 
and I had a whole series of meetings, many meetings over long hours, to 
talk about trying to bridge the differences. I do have to say, on every 
single one of the discussions, the differences between us and the White 
House in the negotiations were the same as the differences between the 
Senate bill and the House bill. Our position favored the patients; 
their position favored the HMOs.
  They did make a good faith effort to talk to us. Senator Kennedy, 
Senator McCain, and I made a very good faith effort to try to bridge 
the gap. The differences could not be bridged.
  At the end of the day, decisions have to be made. To the extent there 
is a conflict, you have to decide which side you are on. You can 
compromise. You can compromise. You can compromise. We made so many 
proposals in these discussions, new, creative proposals to try to 
bridge the gap, to try to find a way to bring the differences together. 
Over the course of time, we did make progress. Senator McCain said 
that. He is right. We did make some progress.
  But at the end of the day, a judgment has to be made about whether 
you are going to decide with patients and families or whether you will 
decide with the HMOs. It gets to be a fairly simple judgment.
  At the end of the day, the White House stood with the HMOs, and we 
were with the patients, as we have always been. We were willing to 
compromise. We were willing to make changes. We were willing to do 
things to get something done. Throughout the whole discussion, we were 
willing to do that. But our focus was always on the interests of the 
patients, not on the interests of the HMOs. We knew the HMOs were being 
very well represented, both in terms of their voice here in Washington 
and on Capitol Hill, and their influence with the administration.
  Unfortunately, this is a pattern. This is not one isolated example. 
The White House stands with the HMOs, and has throughout this process, 
and against patients. They have done exactly the same thing in standing 
with pharmaceutical companies. When we try to do something about the 
cost of prescription drugs, about bringing a real and meaningful 
prescription drug benefit to senior citizens, we know where they are; 
they are with the pharmaceutical companies. They always have been.
  The same thing is true when we try to protect our air. Right now they 
are changing the law, the regulations under the Clean Air Act, to give 
polluters, energy companies, the ability to pollute our air at the 
expense of children with asthma and senior citizens who have heart 
problems. We know where they stand. They don't stand with the people 
who are going to be hurt. They stand with the energy companies that are 
doing the polluting.
  Over and over and over, they were dragged kicking and screaming into 
doing something about corporate responsibility, and they finally 
embraced the Sarbanes bill that passed in the Senate. This is not an 
isolated incident. This has happened over and over and over. And at the 
end of the day, it is about corporate responsibility. There is 
absolutely no question about that.
  We will, though, get a bill. We will get a bill for exactly the 
reason Senator McCain said: Because ultimately we will do what the 
American people are demanding that we do. They have been saying to us 
for years now: We are not going to continue to stand by and have HMOs 
run over us. We will not let insurance companies make health care 
decisions. We want you, our elected leaders, to make decisions that are 
in our interest, not in the interest of the HMOs.
  We all know we can't move out here without bumping into some lobbyist 
for an HMO. They are everywhere. Who is going to look out for the 
interests of regular people in this country, for kids and families who 
need to be able to make their own health care decisions? We are going 
to; that is who is going to.
  That is why, when this process is over, we will have a real Patients' 
Bill

[[Page 15642]]

of Rights. We will put decisionmaking authority back in the hands of 
kids, back in the hands of families. And if HMOs are going to make 
health care decisions, they ought to be treated just like the people 
who make health care decisions every day--doctors and hospitals.
  We never said we wanted them to be treated any worse. What we did in 
the Senate was pass a bill that said exactly that. If you make a health 
care decision--if some HMO bureaucrat makes a health care decision and 
overrides the decision of a doctor or of a hospital, they are going to 
be treated exactly as the hospital and the HMOs are treated. They will 
stand in the shoes of the people who make the decisions. We are going 
to treat them as everybody else.
  Madam President, we are still optimistic. We believe we can do what 
needs to be done for the American people. This is a critical piece of 
legislation to families all over America. We will not stop. We will not 
stop until this legislation and this law that is so desperately needed 
is signed by the President of the United States.
  The PRESIDING OFFICER. The Senator from Pennsylvania is recognized.
  Mr. SANTORUM. Madam President, they said they are standing with the 
American public on what they are demanding. The American public is 
demanding health care insurance. The Patients' Bill of Rights 
dramatically increased the cost of health insurance. If we are 
interested in what the American public is demanding, it is lower health 
insurance bills. What they would have gotten if this bill had passed 
and become law in the Senate is higher health care bills, because under 
this bill we would allow employers to be sued--yes, not HMOs. You 
always hear HMOs, HMOs. Look, I am happy to have HMOs, but what this 
bill allows, what they have been arguing for from day one is to allow 
people who have employer-provided insurance is to let the employer be 
sued.
  To be clear, I haven't talked to one employer in Pennsylvania who, if 
the Senate bill were passed, which allows employers to be sued simply 
by providing insurance to their employees--I haven't talked to one who 
said: I am out of the insurance business; that is not my job; that is 
not why I provide insurance to employees. I do it as a benefit and to 
be competitive in the marketplace. But do you know what. I am not going 
to open up the books and the entire revenues of my company to trial 
lawyers suing on behalf of my employees because they got a bad health 
care outfit.
  This bill will not only drive up costs, but it will drive employers 
out of providing health insurance. That is not what the American public 
is demanding. They are not demanding higher costs and to be uninsured 
by their employers. That is what this bill would do.
  I respect greatly the President for standing firm and saying we are 
not going to cause massive uninsurance, we are not going to cause 
massive increases in health insurance, all to the benefit of the trial 
lawyers of America. That is not what we are about, and it is not what 
the American public wants, and that is not what we are going to do. I 
thank the President for not going along with this scheme to end up 
driving the private markets into the ground and then having those who 
drove the market into the ground come back to the Senate floor and say: 
See, look, private employers are not doing their job anymore, so we 
need a Government-run health care system; let's pass that.
  Madam President, that is not why I got up to talk. That is what 
happens when you listen to other people's speeches.

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