Tom Daschle

Mr. DASCHLE

Mr. DASCHLE. Madam President, we yield back the remainder of the time on the substitute, and I send an amendment to the desk on behalf of the distinguished Senator from Massachusetts, Mr. Kennedy.

Mr. DASCHLE. Madam President, I commend the distinguished Senator from New Mexico for his excellent statement and for his leadership on this issue. He has been very much a part of the effort from the very beginning and has lent the caucus and the Senate an extraordinary amount of his expertise on this issue, and we are deeply grateful to him. Amendment No. 1233 To Amendment No. 1232 (Purpose: To ensure that the protections provided for in the Patient's Bill of Rights apply to all patients with private health insurance)

Mr. DASCHLE. Mr. President, let me explain the amendment I have just offered. This amendment is the Republican HMO reform bill. We are offering it as a substitute to the Democratic bill for one reason. Senator Lott has been very candid and open about his intentions. His intention, of course, is to offer at the end of this debate a Republican bill that has not been debated or amended or scrutinized in any way. By offering as our first amendment the Republican substitute, we now lay down a dual track for the week--their bill and our bill. Both bills are subject to amendments. Both are subject to consideration. Both are subject to the debate that we had anticipated when we reached this agreement. We will be offering amendments to the Republican bill. We would love nothing more than for our bill to pass without amendment. But certainly, if that is not to be, we will at least do what we can to make sure the Senate deals honestly with this issue. By offering the Republican bill, we hope to make sure the Senate at least has an honest debate, and we have the opportunity to try to make the Republican bill what it should have been in the first place--a good bill that deals with each of the issues and offers real protections. I retain the remainder of our time both under the amendment as well as the general debate.

Mr. DASCHLE. Mr. President, I ask unanimous consent that reading of the amendment be dispensed with.

Mr. DASCHLE. Mr. President, I send an amendment to the desk.

Mr. DASCHLE. Mr. President, this is truly a historic day. My Democratic colleagues and I have been trying for nearly 2 years to bring this debate to the floor of the Senate. For the past 2 years, I have listened to people and their complaints about the health care system. I have come to the conclusion that the reason the insurance companies call them HMOs is that H-M-O sums up their patient philosophy: Having Minimal Options. I thank the majority leader. It is no secret that Senator Lott faced considerable pressure to prevent this debate. On behalf of the 161 million Americans who need the protections in our bill, we thank him for agreeing, finally, to bring this debate to the floor. Most of all, I want to acknowledge my Democratic colleagues. We would not be having this debate were it not for their steadfast determination and hard work. That is particularly true of the senior Senator from Massachusetts, Mr. Kennedy. They have each taken considerable risks to demand that this Senate listen to and deal with the real problems America's families are having with their HMOs. Every one of them deserves recognition. The general debate on this bill is supposed to last 3 hours--which, according to an HMO, is enough time for a woman to check into a hospital, deliver a baby, and be sent home. Senator Kennedy and I and others intend to use these 3 hours to talk about the extraordinary difference in approach between the Democratic and the Republican plans. There are no bills pending in this Congress that will have a greater impact on the lives and health of America's families than this bill. There are no decisions we will make that will have a more profound effect than the decisions we make this week. The issues we will debate these next 4 days are literally life-and- death issues. The insurance industry has spent tens of millions of dollars to try to prevent us from ever having this debate. Many of our Republican colleagues responded and worked with them. The Republicans seem to protect insurance companies the way Briana Scurry protects a soccer goal. The insurance industry has spent millions of dollars on ads designed to confuse and frighten the American people, and intimidate us. They hope that by repeating untruths often enough they will be able to kill this bill and keep their license to practice bad medicine. The truth is, this whole debate comes down to one critically important question: Who should make medical decisions, doctors or insurance company accountants? We have all heard the horror stories. In Georgia, a 6-month-old boy was burning up with a 105-degree fever. His mother called her HMO twice and begged to be allowed to take her son to the emergency room. Both times the HMO refused. She finally decided to take him to the hospital anyway. By the time they arrived, the infection that was causing the fever had destroyed the circulation in the baby's extremities. Both his hands and feet had to be amputated. In Washington, DC, a 12-year-old boy was diagnosed with a cancerous tumor in his leg. His oncologist recommended a treatment that could save the leg. But when the doctor's office called the boy's HMO, they were told the only treatment the HMO would pay for was amputation. Four months and several appeals later, the HMO finally agreed to pay for the treatment the doctor ordered. But by then, the cancer had spread; the leg had to be amputated. In Kentucky, a man with prostate cancer needed one chemotherapy injection a month. The injections cost $500 each. His insurance company policy said they were fully covered. But when the HMO changed administrators, the man was told he would have to pay $180 a month out of his own pocket. He didn't have $180 a month, so he had to go with the only other treatment his doctor said could control his cancer. He was castrated. The day he returned from the hospital, he got a letter from his HMO saying they had made a mistake; the HMO would now pay the $500 after all. Three different people, three different parts of the country, but they all have one thing in common: They were all powerless against their insurance companies. Unfortunately, I could go on and on. Two years ago, 130 million Americans said they or someone they knew had a problem with a health insurance company. Last year, that number had grown to 154 million Americans. When we first introduced our bill, nearly 2 years ago, a lot of our Republican friends said we didn't need a Patients' Bill of Rights. Today, they have a bill of their own. We consider that progress. But we still have big differences of opinion about what a Patients' Bill of Rights should do. Our bill covers 161 million Americans. Their bill covers 48 million people; it leaves out more than 100 million Americans. Our bill lets health care professionals make medical decisions about your health. Their bill lets insurance company accountants make those decisions. Our bill guarantees you the right to see a qualified medical specialist, including pediatric specialists for your children. The Republican bill doesn't guarantee that either you or your children will be able to see qualified medical specialists. If your HMO refuses to pay for care your doctor says you need, our bill allows you to appeal that decision to an independent review board. Their bill contains an appeal process, too--except they let the HMO decide what decisions can be appealed. They also let HMOs handpick and pay the people who hear the cases. Finally, our Patients' Bill of Rights is enforceable. Theirs isn't. CBO estimates that the most our Patients' Bill of Rights would increase premiums is 4.8 percent over 5 years--less than 1 percent a year. That comes out to less than $2 per beneficiary --less than $2 a month to guarantee that your health insurance will be there when you need it. Last month, when we offered our Patients' Bill of Rights, a Republican colleagues voted to kill it, without discussing its specific pieces. Yet, they claim they support nearly all the protections in our plan. So this week, we intend to offer our plan again, piece by piece. Let's debate each of the protections in our plan. Maybe when our colleagues really look at our proposals, they will decide they can support some of the protections in our bill. The American people deserve to know exactly where each of us stands on each of these protections. Let me just say a word at this point about the kind of debate we expect this week. By agreeing to this debate, we are assuming our Republican colleagues intend to allow a real, honest debate. That means debating and voting on each of the major protections in our Patients' Bill of Rights. If we have that sort of debate, then, whether we win or lose, we will certainly agree not to bring the Patients' Bill of Rights up again this year. Up or down, win or lose, if the debate this week is fair and honest, we will not offer our Patients' Bill of Rights again this year. But, if we are not able to do that, if we don't have a real debate, if we are not permitted to offer our protections as amendments so that the Senate can discuss and vote on each of them, if there are those who try to prevent an honest debate by using parliamentary tricks, we are putting them on notice now: This debate will certainly not end on Thursday. We will continue to offer the protections in our plan as amendments for as long as we have to until we finally have that honest debate. We know from experience that we can pass bills that protect the health of American families when we want. Together, Republicans and Democrats passed a bill allowing people to take their health care with them when they change jobs. Together, we passed a bill to help working parents purchase private, affordable health insurance for their kids. Together we can pass a real, meaningful Patients' Bill of Rights this week. Amendment No. 1232 (Purpose: To provide the text of Senate Bill 326 (106th Congress), as reported by the Committee on Health, Education, Labor, and Pensions of the Senate, as a complete substitute)

Mr. DASCHLE

Mr. DASCHLE. I thank my colleagues for their cooperation and indulgence. I appreciate very much the opportunity to go out of order. This should not take very long. Mr. President, I want to just take a couple of minutes to talk about why I believe this amendment is needed, primarily for the Record, but also for those who may be interested in knowing of a problem that I think is a serious one that has to be addressed. After 4 years of delay, the National Park Service tentatively approved applications to locate two cellular antennae in Rock Creek Park on April 8 of this year. These antennae will be located in areas that are already developed; namely, the Park Service Maintenance Yard and the Fitzgerald Tennis Center. Engineering tests show that the antennae cannot be seen by park users. In March of 1999, the Park Service completed the environmental assessment and concluded that these antennae pose no significant environmental impact. Federal law directs agencies to make their property available to communications facilities so long as they comply with the National Environmental Policy Act, which these antennae do. Unfortunately, even though the decision was approved on April 8, even though we have now waited 4 years, the National Park Service has yet to announce its final decision. This amendment would simply require them to finish the process within 1 week of enactment--now after 4 years. The U.S. Park Police has testified repeatedly that communication antennae are needed in Rock Creek Park because large sections of the park lack a reliable communications service. The police rely on commercial wireless communications for their own protection and to respond to the public's calls. Joggers, emergency medical groups, and other park users also testified these antennae will provide key links to police and rescue personnel. When someone is injured, rapid response may mean the difference between life and death. The U.S. Park Police reported in Rock Creek Park over 3,500 safety incidents, including 348 violent crimes, 1,600 criminal offenses, and 1,664 traffic accidents in that 4-year period, from July 1995 to April 1999. When these incidents occur, there is no way for a victim or a Good Samaritan to call 911. Our amendment ensures the intention of the Telecommunications Act is simply carried out. The act recognizes that Federal property should be available for locating the antennae so essential services for wireless communication can be provided. In many locations in the D.C. area, Federal property holdings are extensive and afford the only reasonable location for such antennae. This amendment supports these initiatives. When the consideration of applications determines that the antennae meet applicable Federal environmental and other requirements, neither the Federal agencies nor local administrations should have any cause to block them. This amendment clarifies the current law for the Washington region like other jurisdictions and requires approval of these facilities if they meet all the Federal requirements. That is an explanation of my amendment. I hope that, and I appreciate very much, under the unanimous consent agreement, we will have a voice vote on this matter. I certainly hope it can be maintained in conference, because I think this is a critical issue for public safety and also for the need for Federal responsiveness on issues of this import. I yield the floor.

Mr. DASCHLE. I ask unanimous consent reading of the amendment be dispensed with.

Mr. DASCHLE. Mr. President, I have an amendment at the desk, and I ask for its immediate consideration.

Mr. DASCHLE. Mr. President, I move to reconsider the vote.

Mr. DASCHLE. Mr. President, I thank the manager of the bill, the Senator from Texas, and my colleague, the Senator from Illinois. Amendment No. 1224 (Purpose: To strike Federal funding for the District of Columbia resident tuition support program)

Mr. DASCHLE

Mr. DASCHLE. Mr. President, today, with my colleagues Senators Kennedy, Harkin, and Dodd, I announce the introduction of the Genetic Nondiscrimination in Health Insurance and Employment Act of 1999, a piece of legislation designed to stop genetic discrimination. The advent of testing for genes that indicate a predisposition to disease has presented us with a new series of opportunities and challenges. While prior awareness of susceptibility to disease offers millions the chance to take preventive measures that will help them live healthier and longer lives, there also exists the possibility that genetic information will be misused. It is for that reason that we Democrats feel strongly that measures must be taken to ensure that health insurers may not discriminate against patients on the basis of predictive genetic information, and that employers may not discriminate against employees in the provision of health insurance or by withholding job benefits as a result of the improper use of genetic information. When the Patients' Bill of Rights reaches the floor after the July recess, we hope to offer this bill as an amendment to the bill under consideration. This issue, like many others, exposes a fault line between the Republican and Democratic approach to health insurance reform. Scientific advances now make it possible to identify genes that indicate a predisposition to disease. For example, tests for genes associated with hereditary breast cancer are commercially available. Genetic information may prove highly beneficial in areas related to prevention, treatment, diet, or lifestyle. While this is profoundly good news for patients, it also raises fears regarding how genetic information will be used in the workplace. Advances in genetic and screening, accelerated by the Human Genome Project at the National Institutes of Health, increase physicians' ability to detect genetic mutations. These technologies and their resulting genomic data will enhance medical science, but may also lead to discrimination. Regrettably, many employers may not hire individuals whom they believe will require time off or medical treatment at some point in the future due to a genetically transmitted disease. Equally disturbing, employers may simply deny insurance coverage to employees who they believe are predisposed to genetic disease. This discrimination could result despite the fact that genetic testing only indicates that an individual may be predisposed to a disease--not necessarily whether that disease will develop. This issue is already touching the lives of many Americans. For example, a survey last year by the American Management Association of over 1,000 companies indicated that 5% of responding employers currently do genetic testing of their employees. While that number may sound small, its more than the number of companies who test for HIV status. And of those companies who do genetic testing on their employees, 19% have chosen not to hire an individual and 10% have dismissed an employee based on the genetic test results. Anecdotal evidence suggests that fear of discrimination already has inhibited people who may be susceptible to disease from getting genetic testing. In some cases, this means that gene carriers will miss out on early diagnosis, treatment or even prevention. If consumers avoid taking advantage of available diagnostic tests out of fear of discrimination, they may suffer much more serious--and more expensive-- health problems in the long run. That is why our proposal to ban employment discrimination is clearly supported by the American people. A recent national poll by the National Center for Genome Resources demonstrates that an overwhelming majority of those surveyed--85%--think that employers should be prohibited from obtaining information about an individual's genetic conditions, risks, and predispositions. We will pay the price in more than increased health care costs if we allow genetic information to be used in a discriminatory manner. Discrimination based on genetic factors can be as unjust as that based on race, national origin, religion, sex or disability. In each case, people are treated inequitably, not because of their inherent abilities, but solely because of irrelevant characteristics. Genetic discrimination that excludes qualified individuals from employment robs the marketplace of skills, energy, and imagination. Finally, genetic discrimination undercuts the Human Genome Project's fundamental purpose of promoting public health. Investing resources in the Human Genome Project is justified by the benefits of identifying, preventing and developing effective treatments for disease. But if fear of discrimination deters people from genetic diagnosis or from confiding in physicians and genetic counselors, and makes them more concerned with job loss than with care and treatment, our understanding of the humane genome will be for naught. Because genetic information could be used unfairly, Congress must expand the scope of its anti-discrimination laws to include a ban on genetic discrimination. Our bill has three major components: (1) it forbids employers from discriminating in hiring or in the terms and conditions of employment on the basis of genetic information, (2) it forbids health insurers from discriminating against individuals on the basis of genetic information, and (3) it prevents the disclosure of genetic information to people who have no legitimate need for the information: health insurers, health insurance data banks, or to employers. Now, before the use of genetic information becomes widespread, we must make sure that dramatic scientific advances do not have negative consequences for the public. We have an historic opportunity to preempt this problem. I hope that my colleagues will join me in supporting this important legislation.

Mr. DASCHLE

Mr. DASCHLE. Mr. President, today, with my colleagues Senators Kennedy, Harkin, and Dodd, I announce the introduction of the Genetic Nondiscrimination in Health Insurance and Employment Act of 1999, a piece of legislation designed to stop genetic discrimination. The advent of testing for genes that indicate a predisposition to disease has presented us with a new series of opportunities and challenges. While prior awareness of susceptibility to disease offers millions the chance to take preventive measures that will help them live healthier and longer lives, there also exists the possibility that genetic information will be misused. It is for that reason that we Democrats feel strongly that measures must be taken to ensure that health insurers may not discriminate against patients on the basis of predictive genetic information, and that employers may not discriminate against employees in the provision of health insurance or by withholding job benefits as a result of the improper use of genetic information. When the Patients' Bill of Rights reaches the floor after the July recess, we hope to offer this bill as an amendment to the bill under consideration. This issue, like many others, exposes a fault line between the Republican and Democratic approach to health insurance reform. Scientific advances now make it possible to identify genes that indicate a predisposition to disease. For example, tests for genes associated with hereditary breast cancer are commercially available. Genetic information may prove highly beneficial in areas related to prevention, treatment, diet, or lifestyle. While this is profoundly good news for patients, it also raises fears regarding how genetic information will be used in the workplace. Advances in genetic and screening, accelerated by the Human Genome Project at the National Institutes of Health, increase physicians' ability to detect genetic mutations. These technologies and their resulting genomic data will enhance medical science, but may also lead to discrimination. Regrettably, many employers may not hire individuals whom they believe will require time off or medical treatment at some point in the future due to a genetically transmitted disease. Equally disturbing, employers may simply deny insurance coverage to employees who they believe are predisposed to genetic disease. This discrimination could result despite the fact that genetic testing only indicates that an individual may be predisposed to a disease--not necessarily whether that disease will develop. This issue is already touching the lives of many Americans. For example, a survey last year by the American Management Association of over 1,000 companies indicated that 5% of responding employers currently do genetic testing of their employees. While that number may sound small, its more than the number of companies who test for HIV status. And of those companies who do genetic testing on their employees, 19% have chosen not to hire an individual and 10% have dismissed an employee based on the genetic test results. Anecdotal evidence suggests that fear of discrimination already has inhibited people who may be susceptible to disease from getting genetic testing. In some cases, this means that gene carriers will miss out on early diagnosis, treatment or even prevention. If consumers avoid taking advantage of available diagnostic tests out of fear of discrimination, they may suffer much more serious--and more expensive-- health problems in the long run. That is why our proposal to ban employment discrimination is clearly supported by the American people. A recent national poll by the National Center for Genome Resources demonstrates that an overwhelming majority of those surveyed--85%--think that employers should be prohibited from obtaining information about an individual's genetic conditions, risks, and predispositions. We will pay the price in more than increased health care costs if we allow genetic information to be used in a discriminatory manner. Discrimination based on genetic factors can be as unjust as that based on race, national origin, religion, sex or disability. In each case, people are treated inequitably, not because of their inherent abilities, but solely because of irrelevant characteristics. Genetic discrimination that excludes qualified individuals from employment robs the marketplace of skills, energy, and imagination. Finally, genetic discrimination undercuts the Human Genome Project's fundamental purpose of promoting public health. Investing resources in the Human Genome Project is justified by the benefits of identifying, preventing and developing effective treatments for disease. But if fear of discrimination deters people from genetic diagnosis or from confiding in physicians and genetic counselors, and makes them more concerned with job loss than with care and treatment, our understanding of the humane genome will be for naught. Because genetic information could be used unfairly, Congress must expand the scope of its anti-discrimination laws to include a ban on genetic discrimination. Our bill has three major components: (1) it forbids employers from discriminating in hiring or in the terms and conditions of employment on the basis of genetic information, (2) it forbids health insurers from discriminating against individuals on the basis of genetic information, and (3) it prevents the disclosure of genetic information to people who have no legitimate need for the information: health insurers, health insurance data banks, or to employers. Now, before the use of genetic information becomes widespread, we must make sure that dramatic scientific advances do not have negative consequences for the public. We have an historic opportunity to preempt this problem. I hope that my colleagues will join me in supporting this important legislation.

Mr. DASCHLE

Mr. DASCHLE. Mr. President, I want to take a few moments to congratulate one of our former colleagues and a dedicated public servant, Jim Sasser, who leaves Beijing this week as our longest- serving ambassador to the People's Republic of China. I commend him for his distinguished and accomplished record in that demanding post. I was proud to serve with Jim Sasser for eight years here in the Senate. I observed his fine work as Chairman of the Budget Committee, and as a key member of the Appropriations, Banking and Government Affairs Committees. He did much for the people of his home state of Tennessee, and for the people of this Nation. When Senator Sasser assumed the chairmanship of the Budget Committee in 1989, we faced growing budget deficits as far as the eye could see. When he left the Senate in 1995, he had worked to set us on a course of fiscal discipline that has created unprecedented economic prosperity and led to the largest budget surpluses in our history. He made the hard choices, he made the tough political judgments, and he displayed tremendous legislative skill in helping put an end to the huge budget shortfalls that plagued our country for far too many years. We were fortunate, them, when Jim Sasser again answered the call to public service when his third term in the Senate came to an end. As our ambassador to China, he has confronted important issues and major problems at a crucial time in our relationship. He traveled first to Beijing during the crisis in the straits of Taiwan in early 1996. He comes home in the wake of the accidental bombing of the Chinese embassy in Belgrade. In the three-and-one-half years in between, Ambassador Sasser has worked tirelessly to ensure that such incidents will not fundamentally alter the course of our relations with the world's most populous nation. During Ambassador Sasser's tenure, we have seen the exchange of visits between our countries' presidents and the very successful U.S. tour of Premier Zhu Rongji. Those exchanges highlight the hundreds of less prominent, but no less productive, meetings and negotiations that have taken place at various levels of government and business over these 40 months. Clearly, we have important differences with the Chinese. They existed before Jim Sasser went to China, and they will persist after his departure. But the interests that unite us--in trade, in a cleaner environment, in combating drugs and terrorism, in controlling the spread of weapons of mass destruction--also remain the same. By helping find the common ground on these issues, by maintaining a constructive dialogue based on those common interests even at the worst of times, Ambassador Sasser has strengthened one of our most important bilateral relationships. And he has done it with the personal touch and political skill those of use who were privileged to serve with him in the Senate know so well. So, today I say thank you to Jim Sasser. Thank you again for your service as a member of the United States Senate, and thank you for skillful diplomacy as our ambassador to China. I know all my colleagues will join me in congratulating Ambassador Sasser for a job well done, and in welcoming him and his wife Mary back home.

Mr. DASCHLE

Mr. DASCHLE. Mr. President, reserving the right to object, and I certainly won't, I want to reserve my comments on the overall agreement until after the majority leader has completed his unanimous consent request, which has one more piece. Let me say in regard to the comments made by the majority leader about our assurances, as he has indicated, that we would not pursue this matter further this year. He used the right phrase--``if the normal legislative process'' is followed. Obviously, we expect the normal legislative process to be one which will allow a good debate on an array of amendments, first and second- degrees with limits on time, and that we will have completed an adequate number of those amendments. This issue, of course, is the Patients' Bill of Rights. The agreement doesn't preclude debate and amendments on other health-related matters unrelated to the Patients' Bill of Rights. I am confident that if we have a good debate and if we have an opportunity to consider these amendments, there will be no need to pursue this matter further this year. The Senate will have spoken. I indicated privately in my conversation with Senator Lott that this certainly is my expectation, and we will decide at the end of that week how well we did. My expectation is the normal legislative process will be followed. I have no objection.

Mr. DASCHLE. I will be happy to yield to the Senator from Massachusetts.

Mr. DASCHLE. Mr. President, I want to publicly commend the majority leader for the effort he has made over the last several days to find a way to resolve this impasse. I believe this is a win-win. I think only through his persistence and willingness to consider a lot of different options were we able to reach this point. I am grateful to him and have, once again, enjoyed the opportunity to resolve what has been a very significant procedural difficulty for us all. I also want to thank the distinguished senior Senator from Massachusetts for the outstanding job he has done providing us real leadership on this issue, as he does on so many issues relating to health and education. I also thank the assistant Republican leader as well. I believe this is a good agreement any way one looks at it. It provides us with the opportunity to have a good debate. It provides us with the opportunity to have a series of amendments. It certainly provides us with the focus that we have been looking for with regard to the Patients' Bill of Rights. This is a very good agreement, agreed to, I think, with the direct involvement of a lot of people. So we are grateful. The majority leader mentioned a couple of other matters, one having to do with his desire to work full days. He has assured me we will work 9- to 12-hour days that week we come back because he recognizes the importance of giving this issue a full opportunity for debate. I appreciate his commitment in that regard. I also share his concern about how we might make the appropriations process work better. Democrats were opposed, of course, to the overruling of the Chair at the time it occurred. To take it back would be consistent with the position we took when the vote was taken a few years back. So I do intend to work with him to find a way to resolve this matter. That also, of course, is assuming we will have opportunities--I know we have talked about this--opportunities to have good debates with amendments on authorization bills. This will only work if we have the regular order on authorization bills. We certainly have to be sure that we have an opportunity on those occasions when authorization bills are presented to have a good debate with amendments as we have had now on a couple of bills this year. Again, I think this is a good agreement. I appreciate the cooperation of everybody but in particular the leadership of the majority leader and Senator Kennedy and others on our side.

Mr. DASCHLE. I yield the floor.

Mr. DASCHLE

Mr. DASCHLE. Mr. President, let me explain briefly our situation. Early this year, the majority leader stated we would take up the Patients' Bill of Rights in June. We applauded that commitment. That is really what this fight is all about--maintaining the commitment that was made earlier. Democrats have been saying we will do everything humanly possible to ensure that the Senate engages in a full, meaningful debate on the central issues of managed care reform: Whether doctors or HMO bureaucrats determine what tests or treatments are medically necessary; Whether you or your child can see a qualified specialist; Whether patients have access to a timely, independent, external review to appeal HMO decisions to deny care; Whether HMOs should be held accountable for medical decisions to deny or delay care that injure or even kill patients; Whether an HMO bureaucrat, or your doctor, decides what prescription drugs you need; Whether you or your family member can participate in a clinical trial for a potentially life-saving new treatment; Whether all privately insured Americans deserve protection. The list goes on and on. Those are some of the issues, some of the questions. We have tried to reach an agreement with the majority to call up the bill separately. All we have asked is that we be guaranteed votes on those central issues. So far, the majority has refused. What we have done in the last few days is what we vowed we would have to do: We are offering our proposal as amendments on the floor, as is our right under the Senate rules. In my view, it is also our obligation to bring to the floor of the Senate the issues that matter most to the American people. While some have suggested there isn't time for this debate, others have stated quite clearly their real reason for refusing: They do not want to vote on these issues. Why don't they want to cast these votes? Because they are, frankly, on the wrong side of the issues. They do not want to have to defend their position. They said they want to get beyond the Feinstein amendment. They can. All they have to do is vote on it. The majority wants to accuse us of holding up the Senate, but nothing is stopping any member of the majority from moving to table the Feinstein amendment. They can do that tonight. We could have our vote and move on to another amendment. That is all that is required: Table the Feinstein amendment if you do not like it. But the majority appears not to want to table the amendment. They appear to be afraid to have that vote, afraid to let doctors make medical decisions, afraid to admit they are blocking that patient protection. I have never seen anything like the bob-and-weave tactics that have been employed to date to avoid this vote. So what are they afraid of? What is wrong with doctors making medical decisions? I believe this is gamesmanship at its worst. Last week we heard several Republican Senators talk about how good their Patients' Bill of Rights is. Then they voted to strip it from the floor. Now they are offering the Democratic bill--which they tabled just last week so they could avoid an up-or-down vote on the Feinstein amendment--so they can avoid a vote on whether or not to let doctors and other health care professionals determine what is medically necessary. Every day the majority makes these decisions, every day they avoid these tough votes, someone's child, someone's parent, someone's spouse is being denied medical care prescribed by a doctor because an insurance company accountant is saying it isn't really necessary or that it costs too much. Let me make one thing very clear. This dispute isn't about the Senate's time. In the time the majority has spent avoiding a single vote on medical necessity, we could have considered the entire Patients' Bill of Rights amendments. They have turned down every offer we have made to address this issue in an efficient manner. This dispute isn't about time, it is about actual votes on actual rights. We insist on having them--both the votes and the rights. Apparently our colleagues on the other side of the aisle want neither. Up-or-down votes--isn't that what the Senate is here to do, to vote on the issues that matter the most? If and when the majority is willing to vote on these issues, the Senate can move on. But it is our belief that the Senate should not move on until it has dealt properly with one of the most important issues facing virtually every American--their health care. I yield the floor. Mr. ASHCROFT addressed the Chair.

Mr. DASCHLE. Mr. President, will the majority leader be prepared to waive points of order on that particular amendment?

Mr. DASCHLE. Mr. President, I object.

Mr. DASCHLE. Mr. President, I object.

Mr. DASCHLE. Mr. President, until we have been able to clarify that, I will have to object.

Mr. DASCHLE

Mr. DASCHLE. Mr. President, will the leader yield for a question prior to proceeding?

Mr. DASCHLE

Mr. DASCHLE. Mr. President, I just want to reiterate our desire to see if we can find a way with which to address this issue. I will reiterate that, if we have the opportunity to present 20 amendments up or down, I will be prepared to go to my colleagues and say: Look, we can live with that. I want you to cooperate and find a way in which we can have a good debate with 20 amendments freestanding with up-or-down votes. We can live with that. We could even live with a time certain so long as we have a good debate on those amendments with a vote on those amendments prior to the time we reach the end date. But that is a simple request. It is a simple desire to find some resolution. Our colleagues have been more than willing to cooperate in that regard. I hope we can do it. Our door is still open. We will work to see if we can't find a way to accomplish that. I yield the floor.