Pete Domenici

Mr. DOMENICI

Mr. DOMENICI. For the information of all Senators, the Senate will convene at 12 noon and immediately begin a period of morning business until 1 p.m. Following morning business, the Senate will begin debate on a motion to proceed to the intelligence authorization bill. As a reminder, a cloture motion on the motion to proceed to the intelligence authorization bill was filed on Friday. That vote has been scheduled to take place at 10:30 a.m. on Tuesday. The leader has announced there will be no votes during Monday's session of the Senate. Therefore, the first vote on next week will take place at 10:30 a.m. on Tuesday.

Mr. DOMENICI

Mr. DOMENICI. This is on behalf of the leader, and it is already concurred in by the minority leader. Mr. President, I ask unanimous consent that when the Senate completes its business today, it stand in adjournment until the hour of 12 noon on Monday, July 19. I further ask unanimous consent that on Monday, immediately following the prayer, the Journal of proceedings be approved to date, the morning hour be deemed to have expired, the time for the two leaders be reserved for their use later in the day, and that the Senate then stand in a period of morning business until 1 p.m. with Senators speaking for up to 5 minutes each with the following exceptions: Senator Voinovich, 15 minutes; Senator Baucus, 15 minutes.

Mr. DOMENICI

Mr. DOMENICI. I thank the Chair.

Mr. DOMENICI. Parliamentary inquiry. Is there any order subsequent to that?

Mr. DOMENICI

Mr. DOMENICI. I would like to use 3\1/2\ minutes, if I might.

Mr. DOMENICI. Mr. President, I want to clarify this from the standpoint of what a Democrat on the other side who is well versed in this had to say about this issue. On March 22, 1999, Senator Breaux, on a CBS newscast, avoided criticism of Clinton. Senator Breaux said: Some people want an issue of Medicare rather than solving the problem. They talk about wedge issues. Senator Breaux added that one of the problems is that some people want an issue out of Medicare rather than solving the problem. They talk about wedge issues. Are you going to have a tax cut or are you going to save Medicare? That is old politics, he said. I think the American people are tired of it. They want us to solve the problem, not give them political slogans. Now, to stand on the floor of the Senate and even imply that the proposed tax cuts in the budget resolution of $782 billion over a decade would in any way infringe upon the Social Security trust funds is to confuse the public of America, and it is exactly what the distinguished Senator from Louisiana is saying--sloganizing, making an issue by slogans. Secondly, if there is any implication that there are not sufficient reserves in our budget to take care of Medicare, that is an absolute error and an untruth. There are huge amounts of money left over after the tax cut. In fact, it approaches $450 billion that is not allocated to anything during the next decade other than what we choose to use it for in the Congress. I remind everyone, the President said we can fix Medicare with how much? Forty-eight billion dollars will give us prescription drugs, he said. We had $90 billion left over in our budget resolution that was unspent, and now, with the new estimates, there is more money there. We can fix Medicare, put this money in a lockbox, have the tax cut, do that by the end of this year, and fix things for American seniors on both fronts: Lock up the money that is theirs and fix Medicare. To talk about this trust fund as if it has something to do with fixing Medicare is an absolutely erroneous stating of the situation in the Senate and in the fiscal policy of America.

Mr. DOMENICI. Absolutely.

Mr. DOMENICI. Absolutely. The Secretary of the Treasury made some objections to the original bill because it was too rigidly drawn in case of emergencies. We took care of that. We also took care of the problem we had with reference to the end of the year and the way the surpluses come and go because of the way you collect taxes in large quantities in other parts of the year a little bit. We fix that, too.

Mr. DOMENICI. I thank the distinguished Senator.

Mr. DOMENICI. Mr. President, this is a very simple proposition. The American people, by overwhelming odds, would like us to take every single penny of the Social Security that belongs to the Social Security trust fund and lock it up so it can't be spent. The issue is not only a Republican issue; the President of the United States has said we should lock it up. He didn't say lock up something for Medicare; he said lock up the trust funds for Social Security, period. Senator Daschle, leader of the minority, said very recently that there ought to be some common ground. We ought to lock up the Social Security trust fund. What are we doing on the floor? We have six times tried to get an amendment up--not a bill, not a final action but an amendment, after which you can have amendments to your heart's desire. We can't get the other side to agree that we will do that. We will have limited debate on that amendment, after which they can have all the debate and all the amendments they wish. It is only the amendment that we would like to get voted on. Why? Because it is time that, rather than talking about making sure we don't spend under the pressure of emergencies and all kinds of other things, we don't spend the Social Security trust fund money. Now, the President of the United States came our way already. He said lock up 100 percent. At one time in his budget, he said lock up 62 percent. He came with us and said lock up every single penny. That is what we are trying to do. We are trying to get a vote on doing that, after which time, if the Democrats see fit, they can muddy the water and bring up amendments on other issues, and if we had time today, we could debate the foolhardy issue that even Democrats think makes no sense--that we should take the surplus that belongs to the people of the United States and put it into the Medicare trust fund with IOUs to be paid for by increased taxes on our children later on. We can debate that if you would like. But that is not the issue. The issue is Social Security money, the senior citizens' pension money. Time is wasting. The pressures to use it are growing. The opportunities to come to the floor and say let's spend it, with the passage of each day, are getting closer and closer. Somebody will say we need this for something. Who knows what. It could be agricultural policy for America or any kind of thing you can dream up. I say to my friends on the other side, let's get on with it and let's close the debate on the amendment. Then we can open the debate after that vote occurs on anything you wish. I yield the floor. Mr. THURMOND addressed the Chair.

Mr. DOMENICI. Mr. President, I suggest the absence of a quorum.

Mr. DOMENICI. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. DOMENICI

Mr. DOMENICI. Mr. President, I ask unanimous consent that notwithstanding the adjournment of the Senate, the committees have until 3 p.m. today in order to file committee-reported legislation.

Mr. DOMENICI

Mr. DOMENICI. Mr. President, I wish I had brought a prop with me. It would have been the front page of the New Mexico papers in 1997, because in 1997 across New Mexico there were front-page stories and headlines. Guess what they said: ``New Mexico Passes Patients' Bill of Rights.'' Six months later, in July of 1998, there could have been a comparable headline across New Mexico, my State, the State in which the Democrats want to cover every single person who has health insurance. There could have been another headline saying: ``Patients' Bill of Rights Now Effective in New Mexico.'' Maybe if I had brought that newspaper with me, some people from that side of the aisle would understand. They do not trust the States and even if the States already have protection through a bill of rights, they still want to take over nationally. Forty-two States have protections for some or all of the very same things that are in the Democratic bill that the editors across America, at least to the extent identified by the distinguished Senator from Massachusetts, seem to be supporting. They do not even say in our State we already have the protection, except they imply it in Texas by saying: How can it get to be so expensive when we already have it? I ask the question: If they already have it, why do we need to pass one? Our premise is that 42 States already have many of the protections being suggested here. Some of them are moving in the direction of covering more than is being proposed here. Why do we insist that they would be better enforced in Washington, DC? I submit to anybody who understands the bureaucracy in Washington, do you really want every State's protection under a bill of rights to be dependent on HCFA? HCFA cannot handle in any diligent manner, with any reasonable conclusion, the work we have given them on Medicaid and Medicare and benefits and figuring out who can pay what. And now they want to give HCFA, from every State in the Union, huge numbers of the very people the other side of the aisle is crying for but who are already protected. I do not know if we will ever get anybody, outside of those who hear what I am saying, to write that and check it out. It does no good to say the Democrat plan covers 161 million Americans. The question is, Why do we cover 161 million Americans? I will introduce as part of my remarks the entire list of patient protections and mandates that are already in New Mexico's law. It reads like a litany of the issues we have been debating: Emergency room, OB/ GYN, and how you get protection under it. Everybody in New Mexico, on all the issues we have been discussing, is already covered, except whom? Except those the Republican bill covers as we introduced it and have debated it, for it goes out into the land and says there are some people the Texas Bill of Rights does not cover because they cannot; it is not legal for them to cover them. Some people in New Mexico are not covered. I wish I could tell you how many, but nobody knows how many. Some have insurance, and we cannot cover them with New Mexico's rights. So we are covering them here. So it is a bill of rights for those who are uncovered in America. I do not know how we will ever make the point, but let me just say, if you do not need coverage under a bill of rights because you already have it, then how does anyone get by with coming to the floor and saying: We're covering it anyway, and the other side of the aisle isn't covering it and they don't care? How do you get away with that?

Mr. DOMENICI. I thank the chairman. Mr. President, I ask unanimous consent that I be permitted to speak for 30 seconds as in morning business.

Mr. DOMENICI. I thank the Senator from New Hampshire. Madam President, I want Senator Kennedy to know that I will not get red in the face today. My wife is watching, and she tells me I do better when I do not yell. Looking at America today, I ask this question: Is the best way to resolve the problem of somebody who is a patient and sick, and the kind of coverage and care to which they are entitled, to give it to the trial lawyers to resolve before juries in court cases? I cannot believe the best we can do to arbitrate and settle these disputes is to say: Let the trial court do it; let the juries do it. We already know, if you are looking for an egregiously inefficient way to resolve disputes, use the trial lawyers and use the courts of America. It just does not target the problem. It resolves issues in a very arbitrary way. I say to everybody here, I am convinced that letting the trial lawyers solve a medical problem is borderline useless. It will cost immeasurable amounts of money because every lawsuit will be worth something and because everybody will be frightened to death to try something before a jury, not because they are guilty but because jurors and the trial system are apt to award a gigantic verdict. Then every case is worth something. Can we not figure out a better way than that? Whatever the arguments in this Chamber, the issue is: When people are covered by managed care or private health care, to what are they entitled? It is not an issue of whether a doctor performs malpractice. That litigation is wide open. It is, if they are not getting what they are entitled to, how do you fix that? Frankly, I believe to fix it by throwing every one of those decisions into the lap of a trial lawyer who can file a lawsuit is, for this enlightened America, borderline lunacy. For an intelligent, bright America, it is ludicrous to suggest that as a way to settle disputes about coverage and quality of care. Think of this: You open this up to the trial lawyers, and whatever an HMO or a managed care or an employer's policy provides for people is going to be in question unless the patient turns out healthy, safe, and sound. If it turns out that they get sick or sicker, what do you think the case is going to be? They should have provided a different kind of care; I am in court; I am going to get an expert to say it should have been different; I am going to get a contract lawyer, an expert, to read into this contract what they think I should have. Then they are liable for wrongful death, they are liable for any kind of illness, because the patient did not get well. Frankly, I believe that is a giant mistake, and everybody should understand we are adding billions of dollars to the cost of health care through this and maybe will not get the kind of relief the people need. Whatever the Republicans' final package is, I hope and pray that as part of the external review process we put in something that is very tough on HMOs and managed care and other policies, that they will provide what an independent medical expert says they are supposed to do, and it will force them to do it, not in a jury trial but in the process run by the States and their policymakers and insurance carriers. Do we want the final decision as to the kind of coverage, the propriety of what was given to patients, to be decided by jurors in a courtroom with monstrous liability attached to it, or do we want it to be done by an expert as part of a review process with short timeframes and mandatory performance when they make a decision as to what they are entitled to? I believe an enlightened America should opt for the latter. I do not believe an enlightened America should even consider having contract disputes of this type determined by trial lawyers in courtrooms by jurors. Which do we want? Do we want health care or do we want a jury verdict? Do we want health care as it should be or do we want a trial in the courts of this country? I choose the former, and you can do it without putting these issues into the courts of America, Federal or State. I yield the floor.

Mr. DOMENICI. I would like to finish and then answer any questions when I finish.

Mr. DOMENICI. So I decided the best thing I could do is come here to the floor and see if I could express, in as simple language as I could, why the Congress needs to pass a Patients' Bill of Rights. I think I have tried my very best today to say we probably need one for those who are not covered or cannot be covered in our States because, by operation of law, the States do not cover them and cannot cover them. Actually, I wish we could say that 200 times. Maybe we ought to. Every time somebody stands up, we ought to say: We're covering those who are uncovered in America. Now let's go on to the rest of the debate, and then put up a sign and say: We're covering 48 million--put it up there--because they are the only ones who either do not have this protection or cannot have it. These people are not covered because the law says you cannot cover them, the States simply do not have the authority to provide these rights to these people, vis-a-vis, the health insurance they have. Having said that, I believe that answers most the questions that have arisen in this debate. But, then I understand there remains--I see this as only four issues--another very interesting issue. Because at this stage of the evolution in the United States of America of settling disputes one goes to court and asks a jury to do it even though plenty of criticism exists from laymen and professionals on how inefficient, how lacking in rationale the decisions are that are rendered by juries and trial lawyers bringing cases. The Democrats insist that we put that in here as the mechanism, the means, the way to settle disputes over scope of coverage, whether you have given somebody what they are entitled to under an insurance policy or not, or given them the specialists they are entitled to. Can you imagine, we are making a major issue here out of whether the lawyers and juries and courtrooms ought to decide that? Can you imagine that we could stand up before a group of people and say, just as the millennium arrives, we have concluded that with all the knowledge we have, everything we know about arbitration, mediation, ways to avoid going to juries and courtrooms, that this was the way to resolve this issue, and if we do not do it, as our opposition says, we are denying people insurance coverage? What we need to look at before the day is over--and what I hope those who wrote editorials will look at--is did the Republicans have in their bill a method and means of resolving these disputes which are legitimate disputes? Do we have a method of resolving them that is apt to do it expeditiously, professionally, and is it apt to be right? I believe, with what has been added here on the floor and will be in the bill tonight, when we finally vote on it, that we can stand up and say, there is a way. We think enough of this issue that we have made it nationwide, as I understand it. There will be no insurance policies that do not have this approach to settling the solutions across the land. That is pretty fair. Because it is sort of generically necessary for whatever set of rights you are giving to people. So there are two issues. Frankly, for me, they are both very simple. I have explained the one on scope of coverage, and I have just explained the one on why in the world would you get lawyers and juries involved in the disputes between patients and health care systems on coverage. If doctors perform their service improperly, we still have medical malpractice. That is not being changed here. It is when you sit down and have an argument about a specialist, can you get a decision quickly. I have heard from our side, from some very good experts--and as a matter of fact, we on the Republican side are very fortunate. We have a great doctor helping us. Frankly, when he tells us about this, I am not even sure we need a second opinion. He seems to know the answers very well, and we seem to rely on him. We are very glad to have him. He suggested, along with Senator Ashcroft and others, that we ought to have a more straightforward, forthright, expeditious, and enforceable provision to handle the disputes between patients and their insurance coverage as to what they are entitled. Those are two of the issues. To tell you the truth, if those two issues could be resolved, we would be well on our way to having it done. There are some other issues that are around on the scope of what exactly we ought to mandate? They are not as important as these two. Who should we be covering? Should you let lawyers instead of doctors, lawyers instead of independent professionals, determine the scope of coverage and the entitlement of people to coverage under insurance, and the delivery of health care under new insurance approaches in the United States? My last point, those couple of editorials my friend from Massachusetts read were written by editorialists who said we should not be concerned about cost; we should only be concerned about care. Let me tell you, one of the reasons we do not have enough coverage in the United States is because health care is expensive. While there are some who think the money just flows down from heaven and we pay for coverage, most people know somebody is paying for it--a business. In my State thousands of small businesses are paying for it. If you think it is not important to them as to whether they maintain coverage, how much coverage they are going to pay for it, and whether their insurance costs go up 6.1 percent or not, then I guarantee you, you have not been reading the letters I am getting in my office from small businesspeople saying: You cannot give us too many mandates and you cannot have lawyers suing us because of the kind of coverage we have. You may be surprised, but businesses do not have to provide health care. That is the law in America. It is voluntary on the part of most businesses. I am very pleased that most businesses are moving as rapidly as they can to buy insurance. But I guarantee you, the other issue is, how much do we have to add to health care costs to get a reasonably good system for patient protection that is not now available in America? That is what we have been talking about, doing that where it is not available because of the operation of law. We could go into three or four more issues, but I choose to give my own summary and my own understanding of the real nature and philosophical difference between that side of the aisle, the Democrats, and this side of the aisle. Frankly, everyone around here knows I am not a Senator who votes one way all the time. I have been known to have a big argument with my friend from Texas, and he votes one way and I vote another. I will not chalk up the results, like that scoreboard: Domenici--6; Gramm--0. But in any event, we have had those disagreements.

Mr. DOMENICI. Sure.

Mr. DOMENICI. I thank the Chair. (The remarks of Mr. Domenici pertaining to the introduction of S. 1379 are located in today's Record under ``Statements on Introduced Bills and Joint Resolutions.'')

Mr. DOMENICI. He will think it was the other way around. But in any event, the point of it is, it does not normally fall on this Senator to come to the floor and brag about our side of the aisle being right. But I can tell you, on this one I am very pleased with what has happened. I never have felt more comfortable than I have with this task force of Republicans who have handled this issue. They have been good. They have been sharp. They know the issues, and there has never been a shortage of Senators arguing on this bill. I have been very pleased that they are willing to answer questions far more than I am. They know much more than I do. I believe the issue is as I have painted and described it today. If it turns out that by beginning to cover a bunch of people who aren't covered, we only add eight-tenths of a percent to the cost, we don't inject into the system lawyers and courtrooms and jury trials to determine disputes between a provider and patient, and we provide for resolution of disputes in an expedited manner, as is going to be done in the bill we will introduce when we wrap this thing up tonight, I think we are on the right track. I don't believe the American people, contrary to what my good friend, Senator Kennedy, said, are going to be fooled by this. I don't think when it is over they are going to say: Boy, we would have had much better health care if the Democrats would have won their way. I think many are going to say it would have been a lot more expensive. I think many of them will say: We would be back in Washington every week trying to get the rules out of HCFA, which can't handle what it has now, much less handling all the States in terms of the Patients' Bill of Rights and the remedies available under it. I thank everybody who worked on our side as diligently as they have. I particularly say we are lucky in the Senate to have Dr. Bill Frist as a Senator. He is on my Budget Committee. I had trouble. I used to say his name ``First'' instead of Frist. It took me a while. He tried to correct me six or eight times, and I finally got it. I think we are very fortunate to have him here because when he tells us how this works, and he shares the opinion of how the medical people are looking at it and what the reality is, I end up thinking Tennessee did us a very special favor by sending him to us. I close by saying, I hope after all this work, the proposal that the Democrats offer will get defeated and that the final Republican bill, which will be explained again in depth by others, passes. Let's go to conference and see how it all turns out.

Mr. DOMENICI. I want to finish. It is the first time I have had to speak. I looked over and you spoke at least 10 times, and you did beautifully.

Mr. DOMENICI. How much time do we have remaining?

Mr. DOMENICI. Do you have any time?

Mr. DOMENICI. I think you just keep saying it, like they have been saying it. It can be nothing else. In fact, there are many States with broader bill of rights' protections today than the Democrat bill, if it were passed. So why do they need it?