Byron Dorgan

Mr. DORGAN

Mr. DORGAN. Mr. President, I ask unanimous consent that the Committee on Rules and Administration be authorized to meet during the session of the Senate on Wednesday, June 27, 2001, at 10:30 a.m., to receive testimony from the U.S. Commission on Civil Rights regarding its latest report on the November 2000 election and from other witnesses on election reform in general.

Mr. DORGAN. Mr. President, I ask unanimous consent that the Select Committee on Intelligence be authorized to meet during the session of the Senate on Wednesday, June 27, 2001 at 2:30 p.m., to hold a hearing on intelligence matters.

Mr. DORGAN

Mr. DORGAN. Mr. President, this is a well-intentioned amendment, but it must be defeated because it is aimed right at the heart of this patients' rights bill, right at the core of the bill. The question is, Who is going to make the decisions? Who will make decisions about medical care? An MBA or an MD? Who do we want to make the decisions about medical care? The McCain-Edwards-Kennedy bill allows doctors and patients to make fundamental decisions about their care. It will be based on medical necessity and appropriateness and supported by valid, relevant scientific and clinical evidence. In other words, if an HMO makes an arbitrary decision about some kind of a treatment they believe is not medically necessary, based on its own inadequate definition of ``medical necessity,'' the reviewers would be able to overturn that and advocate treatment. Under this amendment put before the Senate, the patient would be bound to the HMO's decision and have literally no options; the independent reviewer would have no authority whatsoever to recommend treatment if it was needed. The Senator from Massachusetts read a list, and he was challenged on that list. But the fact is, the list he read is absolutely correct. Let met do this in English, if I can. The amendment, as I understand it, allows an HMO or managed care organization several different approaches to deal with the issue of what is medically necessary. How do you define medically necessary? Several different ways. One is a mechanism described by the Senator from Massachusetts. He read some of those definitions. He was accurate about that. But there are two other mechanisms by which an HMO could describe what is medically necessary. Do any of us think the HMO will pick the more stringent approach? Of course not. They will pick the least effective approach, the approach that poses the least cost to them. They will pick the weakest of the options. That is what the Senator from Massachusetts was saying. Give the HMO the opportunity, and they will pick the least possible option, the least costly option for themselves. That is why we are in this Chamber with this patients' protection bill. This amendment strikes a blow right at the heart of the patients' rights legislation. The reason we are in this Senate Chamber is to work on providing patients' rights, not take them away. Let me do this in a bit more dramatic way. One of our colleagues has used this photo from time to time. This photo shows a young baby with a cleft lip and cleft palate, which is a very severe problem. We are told that about 50 percent of the time fixing this would be described as ``not medically necessary'' by an HMO. Can you imagine a health care plan saying: ``No, fixing this disfiguring defect is not a medical necessity, therefore, we will not cover it''. Let me describe what this child will look like with that problem fixed. This photo is of a child with reconstructive surgery. This other photo is of a child with the severe problem before it is repaired. Fifty percent of the time managed care organizations have told those requesting reconstructive surgery for a cleft lip or palate: ``No, you are wrong. This is not medically necessary. And we will not cover it''. Is that how we want our health care system to operate? It will be allowed if this amendment is adopted. Let me describe another case. I am going to describe how this case relates to this amendment. This is a photo of Ethan Bedrick. We have spoken about Ethan before. Ethan was born on January 28, 1992. He had a partial asphyxiation during birth, a very significant problem in delivery. He has suffered from severe cerebral palsy and spastic quadriplegia, which impairs motor functions in all his limbs. At the age of 14 months, his managed care organization abruptly cut off coverage for all of his speech therapy, and limited his physical therapy to 15 sessions in a year. A doctor from his managed care organization performed a ``utilization review.'' He said that there was only a 50-percent chance of Ethan being able to walk by age 5, which is ``insignificant'' and, therefore, they would restrict coverage. So let me say that again. A 50-percent chance of being able to walk by age 5 was ``insignificant'' and, therefore, they would not cover the therapy. His parents went to court 3 years later. A judge said: The implication that walking by age 5 . . . would not be ``significant progress'' for this . . . child is simply revolting. But in the meantime, it took 3 years, and this child did not have the therapy he needed for 3 long years. My point about this is, young Ethan Bedrick, or a young child with a cleft lip and a cleft palate, running into a plan that has a provider service saying: ``These are not medically necessary procedures, and we will not cover them,'' will have no ability to have an independent reviewer overturn that under the amendment that is offered today.

Mr. DORGAN. I am happy to yield.

Mr. DORGAN. Mr. President, how much time remains?

Mr. DORGAN. Let me continue by saying, I understand that those who have framed this amendment will not agree with my assertion. But I also understand that they are trying to craft something that defines what is medically necessary in a manner that would give a managed care organization three different options to restrict care. In my judgment, the managed care organization will clearly select the option that has the least amount of coverage or the least cost to them. That is precisely why we are here in the first instance. We are trying to see if we can create a Patients' Bill of Rights that allows a doctor and health care professionals to make judgments about what kind of treatment is appropriate. We have story after story after story about health care professionals making a decision about what kind of health care is necessary for a patient only to be told later that someone 1,000 miles away an insurance office decided, no, this was not medically necessary at all, and we won't cover it. We don't agree the physician's decision or recommendation for treatment. The reason the AMA and nurses and others support this legislation of ours is they believe very strongly that health care professionals ought to be the ones practicing medicine. The American Medical Association is very strongly opposed to this amendment. I ask unanimous consent to print a letter the AMA has sent objecting to this amendment in the Record.

Mr. DORGAN. They are opposed precisely because they understand this amendment absolutely unravels the central and vital section of this bill dealing with medical necessity. Our patients' rights legislation provides a structure by which doctors make decisions and then you have the opportunity for independent review if needed. But in the circumstance as proposed in the amendment up for debate, if we create definitions that allow diminishment of the level of care in terms of what is medically necessary, the independent reviewer will have their hands tied and patients will not get the care they deserve or need. This is a very carefully drafted bill. I am not in any way ascribing mal-intent to anyone who offers this amendment. This amendment will unravel the bill in a very significant way. We must defeat this amendment. We should defeat this amendment and preserve the patients' protections legislation that we have brought to the floor of the Senate. This has been going on 5 years. This is good legislation. We ought to pass it and defeat the amendment. I yield the floor.

Mr. DORGAN. Mr. President, that cannot be the case. The Senator from Massachusetts allotted 8 minutes to me. At that point, he had 10\1/2\ minutes remaining. It cannot be the case that we have exhausted our time.

Mr. DORGAN. Mr. President, I yield my time to the Senator from Massachusetts.

Mr. DORGAN

Mr. DORGAN. Mr. President, I rise today to speak about a bill, the Railroad Competition Act of 2001, which, along with Senator Burns and Senator Rockefeller I hope will introduce a bit of competition and better service in our railroad industry. The truth is that our rail system is completely broken, deregulation has only led to a system dominated by regional monopolies and both shippers and consumers are paying the price. Since the supposed deregulation of the rail industry in 1980, the number of major Class I railroads has been allowed to decline from approximately 42 to only four major U.S. railroads today. Four mega- railroads overwhelmingly dominate railroad traffic, generating 95 percent of the gross ton-miles and 94 percent of the revenues, controlling 90 percent of all U.S. coal movement; 70 percent of all grain movement and 88 percent of all originated chemical movement. This drastic level of consolidation has left rail customers with only two major carriers operating in the East and two in the West, and has far exceeded the industry's need to minimize unit operating costs. But consolidation has not happened in a vacuum. Over the years, regulators have systematically adopted polices that so narrowly interpret the pro-competitive provisions of the 1980 statute that railroads are essentially protected from ever having to compete with each other. As a consequence rail users have no power to choose among carriers either in terminal areas where switching infrastructure makes such choices feasible, nor can rail users even get a rate quoted to them over a ``bottleneck'' segment of the monopoly system. The negative results of this approach have been astonishing. In North Dakota it costs $2,300 to move one rail car of wheat to Minneapolis (approx. 400 miles). Yet for a similar 400 mile move between Minneapolis and Chicago, it costs only $310 to deliver that car. And move that same car another 600 miles to St. Louis, Missouri and it costs only $610 per car. Looking at it another way--An elevator in Minot, North Dakota pays $2.99 to the farmer for a bushel of wheat. The cost to ship that wheat to the West coast on the BNSF is $1.30 per bushel. At that rate, rail transportation consumes 43 percent of the value of that wheat. Not only is that totally unfair to the captive farmer, but in the long run it is unsustainable. How has this happened? Since the deregulation of the railroad industry, it has been the responsibility of the Interstate Commerce Commission, later renamed, the Surface Transportation Board, to make sure that the pro-competitive intent of the law was being upheld. It is the STBs charge to protect captive shippers through ``regulated competition.'' That clearly hasn't happened. In 1999 the GAO reported on how complicated it is for a shipper to get rate relief under the ``regulated competition'' approach at the STB. The GAO found that this process takes up to 500 days to decide, and costs hundreds of thousands of dollars. Hundreds of thousands of dollars and about approximately two years--that's hardly a rate relief process. But it's about the only relief shippers have under the law. The Railroad Competition Act of 2001 will reaffirm the strong role the STB should play in protecting shippers by: jump-starting competition by requiring railroads to quote a rate on any given segment; facilitating terminal access and the ability to transfer goods among railroads in terminal areas; simplifying the market dominance test; eliminating the annual revenue adequacy test; bolstering rail access by making the rate relief process cheaper, faster and easier through a streamlined arbitration process, and requiring the railroads to file monthly service performance reports with the Department of Transportation, similar to what we require of the airline industry, so that rail customers have access to the information then need to make good railroad and transportation choices. All Americans, whether they are farmers who need to ship their crops to market, businesses shipping factory goods, or consumers that buy the finished product, deserve to have a rail transportation system with prices that are fair. It is time for Congress to stand up for farmers, businesses, and consumers by making it very clear that the STB has to be a more aggressive defender of competition and reasonable rates.

Mr. DORGAN

Mr. DORGAN. Mr. President, I rise today to speak about a bill, the Railroad Competition Act of 2001, which, along with Senator Burns and Senator Rockefeller I hope will introduce a bit of competition and better service in our railroad industry. The truth is that our rail system is completely broken, deregulation has only led to a system dominated by regional monopolies and both shippers and consumers are paying the price. Since the supposed deregulation of the rail industry in 1980, the number of major Class I railroads has been allowed to decline from approximately 42 to only four major U.S. railroads today. Four mega- railroads overwhelmingly dominate railroad traffic, generating 95 percent of the gross ton-miles and 94 percent of the revenues, controlling 90 percent of all U.S. coal movement; 70 percent of all grain movement and 88 percent of all originated chemical movement. This drastic level of consolidation has left rail customers with only two major carriers operating in the East and two in the West, and has far exceeded the industry's need to minimize unit operating costs. But consolidation has not happened in a vacuum. Over the years, regulators have systematically adopted polices that so narrowly interpret the pro-competitive provisions of the 1980 statute that railroads are essentially protected from ever having to compete with each other. As a consequence rail users have no power to choose among carriers either in terminal areas where switching infrastructure makes such choices feasible, nor can rail users even get a rate quoted to them over a ``bottleneck'' segment of the monopoly system. The negative results of this approach have been astonishing. In North Dakota it costs $2,300 to move one rail car of wheat to Minneapolis (approx. 400 miles). Yet for a similar 400 mile move between Minneapolis and Chicago, it costs only $310 to deliver that car. And move that same car another 600 miles to St. Louis, Missouri and it costs only $610 per car. Looking at it another way--An elevator in Minot, North Dakota pays $2.99 to the farmer for a bushel of wheat. The cost to ship that wheat to the West coast on the BNSF is $1.30 per bushel. At that rate, rail transportation consumes 43 percent of the value of that wheat. Not only is that totally unfair to the captive farmer, but in the long run it is unsustainable. How has this happened? Since the deregulation of the railroad industry, it has been the responsibility of the Interstate Commerce Commission, later renamed, the Surface Transportation Board, to make sure that the pro-competitive intent of the law was being upheld. It is the STBs charge to protect captive shippers through ``regulated competition.'' That clearly hasn't happened. In 1999 the GAO reported on how complicated it is for a shipper to get rate relief under the ``regulated competition'' approach at the STB. The GAO found that this process takes up to 500 days to decide, and costs hundreds of thousands of dollars. Hundreds of thousands of dollars and about approximately two years--that's hardly a rate relief process. But it's about the only relief shippers have under the law. The Railroad Competition Act of 2001 will reaffirm the strong role the STB should play in protecting shippers by: jump-starting competition by requiring railroads to quote a rate on any given segment; facilitating terminal access and the ability to transfer goods among railroads in terminal areas; simplifying the market dominance test; eliminating the annual revenue adequacy test; bolstering rail access by making the rate relief process cheaper, faster and easier through a streamlined arbitration process, and requiring the railroads to file monthly service performance reports with the Department of Transportation, similar to what we require of the airline industry, so that rail customers have access to the information then need to make good railroad and transportation choices. All Americans, whether they are farmers who need to ship their crops to market, businesses shipping factory goods, or consumers that buy the finished product, deserve to have a rail transportation system with prices that are fair. It is time for Congress to stand up for farmers, businesses, and consumers by making it very clear that the STB has to be a more aggressive defender of competition and reasonable rates.

Mr. DORGAN

Mr. DORGAN. Mr. President, I have been closely listening to the debate this morning. I presided over the Senate for an hour this morning and was listening for that time to the debate with respect to the Patients' Bill of Rights. It reminded me of a story about the great debates between Lincoln and Douglas. I have mentioned this story on a previous occasion. Apparently during those debates, Lincoln and Douglas were having difficulty understanding each other's point. Lincoln finally said to Douglas: Well, tell me, how many legs does a cow have? Douglas said: Why, four, of course. Lincoln said: Well, now, if you call a tail a leg, how many legs would a cow have? Douglas said: Five. Lincoln said: No, that is where you are wrong. Just because you call a tail a leg doesn't make it a leg. What I have seen today is interesting. They have taken a tail, called it a leg, and spent 4 hours describing this new leg. There is nothing in the Patients' Bill of Rights or the Patient Protection Act that is designed to subject employers to lawsuits or to liability. In fact, this act, as described, specifically protects employers from the kind of suits that have been described for the last 4 hours. It is, I suppose, a classic response to something you do not like to try to change the subject, and that is what this amendment is all about, changing the subject. The central feature of the patient protection legislation is very simple. This legislation is about empowering patients who are confronted with a challenge too often in this country. That challenge is of large managed care organizations that in too many cases will not provide the treatment patients expect to have covered under their health plan. Under this act managed care organizations would be required to provide that treatment. We believe a patient has a right to know all of their medical options for treatment, not just the cheapest option. We believe a patient has that right. We believe a patient has the right to go to an emergency room and get emergency treatment if they have an emergency. Do you think every patient has that opportunity now? The answer is no. We believe a patient ought to have the right to see a specialist when they need to. That is not a right that exists today. Yes, we believe a patient ought to be able to hold their HMO or managed care plan accountable. Does that mean being able to sue? We are not interested in lawsuits. We are interested in accountability. If an HMO decides it is not going to provide the treatment that is necessary, then should someone be able to hold them accountable and take them to court? The answer is, you bet. I have spoken about Christopher Roe on a couple of occasions. Let me do it again because it is important in the context of the patient rights we talk about. Christopher died on his 16th birthday. He fought cancer and had to fight his managed care organization at the same time. That is not a fair fight. This young boy, according to his mother who testified at a hearing I chaired, waged a courageous fight against cancer but didn't get the care he needed or the treatment he needed to give him a shot at beating his cancer. He looked up from his bed and asked his mother: ``Mom, how can they do this to a kid?'' He died on his 16th birthday. It shouldn't happen. It need not happen. All too often in this country, for-profit managed care organizations have viewed a patient's care through the lens of how that care will affect their profit and loss. Is this something we are willing to stand for? No. We believe it is important to put into law a set of patient protections or patient rights to change that. It is interesting to listen to discussions about Dicky Flatt. It is interesting to hear letters from people who say if employees are allowed to sue employers, they will no longer have health care. The fact is, this legislation will not allow employees to sue employers. It is a classic opportunity to divert attention. That is what is happening with the current amendment on the Floor, offered by Senator Gramm. There are people who have never wanted a Patient's Bill of Rights enacted. When it comes time to answer the question of who they stand with, these people stand with the insurance companies and managed care organizations. They do not stand with nurses and doctors, all of whom support this legislation. They say they stand on the other side because they don't like this legislation. That is fine. That is all right. Everyone has a right to oppose this legislation. But there is not an inherent right to misrepresent what this legislation does. And this legislation does not allow wholesale opportunity for people to sue their employers who offer health insurance to their employees. That is not what this legislation is about. This legislation contains specific protections against that very thing. My hope is we will find substantial common ground in the coming week or so and be able to pass a Patient's Bill of Rights by a week from today. This bipartisan legislation has been 4 years in the making. I find it interesting to hear people say this has not been the subject of hearings. My Lord, we have had this piece of legislation or legislation like it on the floor of the Senate time after time after time. It has been around for 4 years. If one cannot read that fast, one can employ someone else to read that fast. This is not new legislation. The only problem is we have people who dig their heels in and do not want to deal with it. That is a classic response that has come to all changes that have made this a better and better country. Every single thing we have done to advance interests in this country has been opposed by those who do not want to do something for the first time. I understand that. There is the story of the old codger, 85, 90 years old, interviewed by the radio station announcer, who said: You must have seen a lot of changes. He said: Yep, and I've been against every one of them. We have people like that who serve in public life, too. That is just fine, except this change is necessary. This change is important. This change empowers patients and does not injure employers. It contains protections to make sure employers are not going to be subject to lawsuits. We will have more discussion about the protections for employers in the coming days, especially next week. I hope we can keep our eye on the ball and pass a patient protection act that offers protections that I think are needed and should be offered in this country. I yield the floor.

Mr. DORGAN

Mr. DORGAN. Mr. President, my colleague from Connecticut has covered the subject of needed patient protections well. Let me, in the few short remaining minutes, make a couple of comments--some I have made before. Let me narrow the issue down. It is about the right of patients to get the health care they deserve and that they think they have under their managed care plans. Often however, that care is actually denied them. Patients ought to have a right to understand all of their medical options for treatment, not just the cheapest. They ought to have a right to medically necessary care without arbitrary HMO interference. They ought to have a right to go to an emergency room when they have an emergency. They ought to have a right to see a specialist when they have a need to consult a specialist. They ought to have the right to a fair and speedy process for resolving disputes. Let me see if I can use a couple of pictures to describe what these rights mean. This young child was born with a horrible facial defect. A cleft palate which is a horrible defect of the top lip. Plastic surgeons say in about 50 percent of the cases, a managed care organization says this is something that is not medically necessary to correct. It's correction is not medically necessary? Imagine having this child and being told by a managed care organization that it is not medically necessary to correct this defect! I spoke yesterday about a young woman named Donna Marie McIlwaine. Donna is from New York. Her mother, Mary Lewandowski, testified before a hearing I held on managed care. This beautiful young lady is not with us any longer. Donna died. Her mother described the circumstances of her death. For want of a $750 lung scan, this young girl died as a result of a blood clot in her lung the size of a football. Donna's mother called the doctor and she called the hospital, but to no avail. This young woman died because she didn't get a $750 lung scan that would have shown a blood clot the size of a football in her lung. And she died. She died on the evening of February 8, 1997. Her mother, God bless her, Mary Lewandowski, has been to Washington at her own expense, as a missionary to say ``pass this legislation and don't let this happen to another child!'' I have described before, this young man, Christopher Roe, whom I learned about at a hearing I held in November--and if you are tired of hearing about him--I have talked about Christopher several times--if you are tired of hearing about him, tough luck because I will keep talking of his tragic circumstance. His mother held this picture high as she began to sob when she testified about this 16-year-old boy who died on his birthday. Christopher was fighting cancer, and fighting the managed care organization at the same time for the care he needed and didn't get. This young boy had cancer. He needed some treatment. He needed a chance. He needed some experimental treatment, a chance to get through this and successfully wage war against this dreaded disease. But time ticked away and the managed care organization said, no, no, no. And finally this young boy, flat on his back in bed, died on his 16th birthday. Before he died, his mother told us, crying: ``Christopher looked up at me and said, Mom, how can they do this to a kid?'' This is not some ethereal debate about what you think or what I think. This is about whether patients have the protections they believe exist in their managed care policies. Are we going to say that we stand on the side of patients? Are we going to stand on the side of doctors? Are we going to stand on the side of nurses who know that the only real good health care that is delivered is delivered by health care professionals in a clinic or in a hospital room? It is not health care delivered or decisions made in an insurance company or managed care office by some junior accountant 1,000 miles away. Yet all too often that is what is happening. It is why Christopher Roe is no longer with us. This young boy lost his battle fighting cancer and he lost his battle fighting a managed care organization. That, my friends, is not a fair fight. We know that. That is why we propose passing a piece of legislation called the Patient Protection Act or the Patient's Bill of Rights. There will be a lot of discussion and debate about this for a long period. At the end of the day, the only question is, Whose corner are you in? With whom do you stand? Are you with the patients, doctors, and the nurses? Or are you with the managed care organization and the insurance industry who say they don't want this? In the names of Christopher Roe and Donna, and so many others that I have discussed previously on the floor of the Senate, we ought to do what is right. We ought to do the right thing. This legislation has been four years in the making. This is a long gestation period. We have debated, debated, and debated again. We have compromised, compromised, and compromised on this legislation. It is now time for us to own up to this responsibility. Let's pass this bill. Let's do it now and do it right. I yield the floor.

Mr. DORGAN. How much time remains in this block?

Mr. DORGAN

Mr. DORGAN. The Senator from New York probably remembers the hearing we held about a year ago, when a constituent from New York came to the hearing. Her name was Mary Lewandowski. Mary is the mother of the late Donna Marie McIlwaine who died when she was only 22 years old. Mary came to tell us the story about her daughter and her experience with the HMO. I will not soon forget Mary's testimony. Mary is not getting paid to come to Washington but she desperately wants the Congress to pass this patient protection legislation. Mary told us that her daughter passed away on February 8, 1997. Donna had been to the doctor four times in 5 days for an upper-respiratory infection. The doctors couldn't quite figure out what was happening, but her symptoms kept worsening. On the evening of February 8, she was in a tremendous amount of pain, her mother said. She called the hospital. The hospital said: No, you can't bring your daughter to the hospital unless it is absolutely life or death, or unless you have a doctor's referral. She tried in vain to reach Donna's doctor, and an hour later her daughter, Donna, collapsed into a coma and died. After she died, as my colleague from New York will remember, her mother told us that she discovered that Donna had a blood clot the size of a football in her lung. Donna's doctor later told her mother that a $750 lung scan would likely have identified that blood clot and saved her daughter's life. But the lung scan was not ordered because it could not be justified by the HMO. These are the kinds of problems that are raised related to the development of for-profit medicine. Too often the practice of managed care medicine becomes an enterprise of looking at a patient in terms of profit, rather than evaluating what doctors should provide in terms of needed medical services to patients. The Patients' Bill of Rights, or Patient Protection Act, is a piece of legislation that says you ought not have to fight your illness or your disease and have to fight the insurance company as well. You ought not have to lose your life because someone said it wasn't worth $750 to do a lung scan on a 22-year-old girl who had a blood clot the size of a football in her lung. That ought not happen to people. My colleague from Nevada, Senator Reid, and I held a hearing in Las Vegas, NV, for one day. I will never forget that hearing. A mother named Susan gave riveting testimony. She stood and held up a picture of her son, Christopher Thomas for us to see. Christopher Thomas died on his 16th birthday of leukemia. His parents' health plan denied him the investigational chemotherapy drug he needed. At the end of her testimony Susan held up a large colored picture of her handsome 16- year-old son. She was crying. She said Christopher Thomas had looked up at her from his bed as he lay dying of cancer, and said, ``Mom, I don't understand how they can do this to a kid.'' Do what? This young man never got the treatment he needed to help fight the cancer that he had. This young boy and his family were put in a circumstance of having to fight cancer and fight the managed care organization at the same time. That was not fair. That is what our patient protection legislation is about. This legislation is about empowering patients who expect to get the health care they are promised. When I heard my colleague from New York speaking, I simply wanted to come to the floor and say that we have had plenty of hearings. Discussion has gone on for some while on the issue of a Patients' Protection Act, or Patients' Bill of Rights. I will never forget the testimony offered at the hearing during which Mary, the mother from New York came and talked about her daughter Donna, and the hearing in Las Vegas when Susan came and talked about her son, Christopher Thomas Roe. I could stand here and cite examples from testimony after testimony of patients not getting the care they needed. I could discuss endless tragic stories and untimely deaths we have been told about. The sheer numbers of testimonies that reveal needless suffering make me so angry because none of it should have had to happen. People should have gotten the health care they deserved. They should have been able to get to an emergency room when they had an emergency, or been able to get the treatment they needed when they were suffering from cancer and trying to fight it. Yet in case after case, we discover that someone made a bad decision, and no one was held accountable for that decision. The patient wasn't given the medical treatment they deserved. Let me quickly say, if I might, to my colleague, that there are some wonderful organizations around this country--yes, managed care organizations, some insurance companies, and health care organizations--that do great work. God bless them every day. But there are some who look at patients as profit centers and decide against providing treatment that a patient thinks they are going to get. Sometimes it is too late when they discover the consequence of that. It was too late for Donna and for Christopher. We are trying, with a piece of legislation, to say it ought not be too late for any more Americans at any other time to not get the medical care they need. Let us pass this legislation, the Patients' Protection Act, so that people in this country can rely on getting the care that they deserve. When I heard the Senator from New York, Senator Schumer speak, I wanted to speak and to mention Donna because I know he knows her mother, Mary Lewandowski. I know that all of us have the same passion to want to do the right thing. We can do this. This will take some time. There will be people coming to the floor saying they don't want to do it. They will have objections to our Patients' Bill of Rights. Mark Twain was once asked if he would be involved in a debate. He replied: Yes; of course, as long as I can be on the opposing side. They said: We never told you about the subject matter. Mark Twain said: It doesn't matter. It doesn't take any preparation at all to take the opposing side and to argue it effectively. We will have some people in Congress say we should not pass this patients' protection legislation. They are naysayers. We know in our hearts that this is important legislation for the American people. We must do this now.

Mr. DORGAN. Mr. President, let me ask the Senator from Nevada to yield for a moment. Then I know the Senator from Iowa has a statement to make. Will the Senator from Nevada yield for a question?

Mr. DORGAN. I did want to take the time to show the picture of the young 16-year-old man mentioned earlier, named Christopher Roe. The Senator from Nevada and I both told his mother, Susan, that her testimony would make a difference. This is the picture Susan held up at our hearing in Las Vegas, NV. As she held up this picture of her 16-year-old son, Susan described the difficulties obtaining treatment for Christopher through their managed care organization. Susan's family faced these difficulties in addition to the fight Christopher was trying to win in his battle against cancer. It was a battle this young boy lost, and it was a battle that had become an unfair fight because he had to fight cancer and he and his family had to fight the managed care organization at the same time. This is the boy who died on his birthday. This is the boy who looked up from his bed and said to his mother: Mom, I don't understand how they can do this to a kid--``this'' meaning, how could they not have allowed him to get all of the treatment that was necessary to give him a shot at beating cancer? He died on his 16th birthday. To his mother Susan, who also is a tireless fighter, and who believes also that there must be change, we say your son's memory, I hope, will give all of us in this Chamber the incentive and the initiative and the passion to do the right thing and to pass a Patients' Protection Act. I mentioned yesterday that I, too, have lost a child. And I get so angry--so angry--sometimes when I hear these stories. I didn't lose a child because of a decision by a managed care organization, but I lost a child to a disease. And you never, ever get over it. When I see mothers such as Susan, holding up a picture of her son, saying, ``this death should not have happened, I should not have lost my son, my son should have had a chance to live, my son should have been given the opportunity to fight this cancer that was invading his body'', then I say we ought to have enough passion and we ought to have enough determination and grit to stay here until we pass a piece of legislation that says no more Christopher Roes in this country will lie in bed dying of cancer having treatment withheld from them; it will never happen again because we will make sure it does not. Patients in this country have basic protections and rights, and they have the right to the treatment they need at the time they need it. They have the right to see specialists, and they have the right to know all their options for medical treatment, not just the cheapest. They have the right to go to an emergency room when they have an emergency. There are basic protections and rights that are in this legislation that every American deserves to have. We are going to see that we get Americans protected and their rights ensured by the time we finish the debate on this important legislation. I thank my colleague from Nevada. And again I say to Susan, and all of the other mothers and fathers who have testified at the hearings I have held, your testimony was not in vain. We have put together a record that demonstrates the need to pass this legislation, and we intend to do just that.

Mr. DORGAN. I wonder if my friend will yield.

Mr. DORGAN

Mr. DORGAN. Mr. President, I ask unanimous consent that Kathleen Dietrich, a fellow assigned in my office, be granted the privilege of the floor for the debate on the bipartisan Patients' Bill of Rights.

Mr. DORGAN

Mr. DORGAN. Mr. President, I would like to speak today about the Patients' Bill of Rights, or the Bipartisan Patient Protection Act, which we are going to be turning to beginning tomorrow morning in the Senate. This debate revolves around the development of for-profit health care and the growth of big managed care organizations and what that has meant to patients and people around this country who seek medical help. For some 4 years now we have been debating what has been happening with the explosion of HMOs in our health care system. All of us understand the basics of medicine. That is, we understand that if you have a medical affliction, you need to go see someone who is trained in the field of medicine. Often, they perform certain tests, and if you have an acute problem, often they check you into a hospital to get the needed treatment in those circumstances. But things have changed in recent years in this country. The emergence of for-profit managed care organizations that are now in charge of health care for a good many Americans has changed the delivery of health care. The delivery of health care to individual patients now does not just involve the delivery of health care advice from a doctor to a patient in an examining room. It is more than that. In some cases, we now have someone in an insurance company office 1,000 miles away perhaps, who is making a decision about what medical care they will cover and what they will not cover with respect to this particular patient. In recent years, Congress began to get a great deal of mail from patients saying: I had a health care plan only to discover that, when I became very sick and needed the benefits of that plan, those benefits were not available to me. Not only was I required as a patient to fight a battle with cancer, I was also required, they write, to fight a battle with cancer and then a battle with my managed care organization to give me the treatment I needed. So we will soon have before us a bipartisan Patients' Bill of Rights, or Bipartisan Patient Protection Act. Yes, it is bipartisan. Democrats and Republicans are together bringing a bill to the floor of the Senate, saying we need to change what is happening in the delivery of health care in a way that provides fundamental rights to patients. Let me describe some of those rights. Patients ought to have the right to know all of their medical options for treatment, not just the cheapest medical option. Second, a patient ought to have the right to ``medically necessary'' care without some arbitrary interference by an HMO or a managed care organization. Doctors and patients, not health plan executives, ought to determine the care that is needed. Patients ought to have the right to choose the doctor they want for the care they need, including especially specialty care. Patients ought to have the right to emergency room care when they have an emergency. A patient ought to have the right to have access to prescription medicine that the doctors say are medically necessary for the patient. You ought to have the right to a fair and speedy process for resulting disputes with your health care plan or your managed care organization. And, finally, you ought to have the right to hold that managed care organization or health care plan accountable if its decision results in injury or even death. As this debate gets underway, we will hear a lot of things about this bill. We will hear that this is ``a trial lawyer's bill of rights.'' God forbid, they will say, that we should give patients the right to go to an attorney and seek redress against a managed care organization that didn't do right by them. I find this a fascinating description of this bill. I will talk a bit more about it later. But those who will come to the floor of the Senate and talk about their concern about lawyers being involved are concerned only for one side. They say: We don't want patients to have the ability to go to a lawyer to get legal help to demand that managed care organizations give them the care they need and the care they thought was guaranteed to them; let's not allow patients to have a lawyer. They don't say anything about the managed care organizations. Those big organizations have all kinds of lawyers working for them. If a patient doesn't pay a bill, or a monthly premium, guess what? The managed care organization can certainly go a hire a lawyer. Right? They have a battery of lawyers with whom to pursue their objectives. Those who oppose this legislation say the patient ought not have the right to seek redress. I would like to go through a few examples today and draw some conclusions. As I do that, I would like to point out that these examples are real people. I have used some of them before, and some are new. But let me describe the problems we are trying to address with this legislation through the patients and the difficulties these patients have been forced to go through in order to get the medical help they thought they were going to get under their managed care plan. Let me turn to James Adams. I have spoken of James Adams before on the floor of the Senate. This is a picture of James Adams, the happy and healthy little fellow tugging on his sister's shirt sleeve to get her attention. He lost both of his hands and legs. James Adams is now 7 years old. Because of his parents' HMO rules, what happened to him in March of 1993 when he was only 6 months old changed his life forever. He was suffering from a 105-degree fever. His mother took him to the family's HMO pediatrician, who diagnosed a respiratory ailment for this young fellow and a postnasal drip and prescribed saline drops, vaporizer use, and Tylenol. The pediatrician told the mother not to worry, that high fevers in young children don't necessarily mean a serious illness. Late that night, his temperature was still rising and he was in great discomfort. His worried mother called the HMO. The nurse on duty recommended bathing this young fellow in cold water. The pediatrician then placed a follow-up call advising the parents to bring James to an HMO participating hospital 42 miles away, even though there were 3 closer hospitals. On the way to the furthest hospital, which was the HMO hospital 42 miles away, this young boy suffered full cardiac and respiratory arrest and lost consciousness. The parents passed three hospital emergency rooms before they could finally reach the HMO hospital, which is where they would have coverage, according to their HMO. Upon James' arrival, doctors were able to return his pulse and breathing. But the circulation to his hands and feet had been cut off and could not be returned, causing irreparable damage to his extremities. The result? Both of his hands and feet had to be amputated. That rendered him into a situation he will have to live with for all of his life. The delay in care caused by driving almost an hour to an affiliated hospital took its toll. One asks the question: Is it a reasonable thing to have a young boy with a 105-degree fever go to a hospital 42 miles away and pass 3 hospitals on the way? That is the way some HMOs work. That is not the way a plan should work. Any emergency room ought to be available to this young fellow in an emergency. Let me describe another story, dealing with another person who was denied coverage to emergency room care. Jacqueline Lee lives in Bethesda, Maryland. A lover of the outdoors, she took a trip to hike in the Shenandoah Mountains in the summer of 1996. While walking on one of the trails, she lost her footing, and plummeted off of a 40-foot cliff to the ground below. Luckily for Jacqueline, she was quickly airlifted from the mountain to a hosptial in Virginia. Amazingly, she survived the fall, sustaining fractures in her arms, pelvis, and her skull. After she survived and went through a convalescence, her HMO refused to pay more than $10,000 in emergency room bills because it said this woman who was brought into an emergency room on a gurney, unconscious, did not get preapproval for using emergency room services. Because an unconscious patient falling off a 40-foot cliff, suffering substantial injuries, did not get preapproval, the managed care organization said it would not pay the emergency room fees. This is an example of emergency room care that is needed by a patient who had protection under her health plan only to be told later that she wouldn't be covered for emergency room treatment. Is that something patients should worry about? They shouldn't have to worry about that. Our Patients' Bill of Rights says emergency room treatment is available in emergencies under what is called a prudent layperson standard of defining what an emergency is. Let's not have more delay and all kinds of shenanigans by the managed care organization to see how it can withhold treatment. Let's say that if you have an emergency and you are covered by a managed care plan, you deserve the right to be treated at an emergency room. It ought to be true for Jacqueline Lee. It ought to be true for James Adams. It ought to be true for every patient covered under a plan who needs emergency room treatment. Let me describe the situation of Ethan Bedrick. I have spoken of Ethan before. The reviewing doctor never met with the family and never met with this young boy, Ethan. He simply said: Only a 50-percent chance of being able to walk by age 5 is a ``minimal benefit'' and therefore his insurance company would not continue the therapy. Ethan Bedrick was born on January 28, 1992. His delivery went badly, and as a result of asphyxiation, he has suffered from severe cerebral palsy and spastic quadriplegia, which impairs motor functions in all his limbs. Ethan was put on a regimen of intense physical, occupational and speech therapy to help him overcome some obstacles throughout his development. At the age of 14 months, Ethan's insurance company abruptly cut off coverage for his speech therapy, and limited this physical therapy to only 15 sessions per year. This change was recommended by an insurance company doctor performing a ``utilization review'' of Ethan's case. The reviewing doctor cited a 50 percent chance that Ethan could walk by age 5 as a ``minimal benefit'' of further therapy. Ethan's parents appealed to the courts. The courts said: It is as important not to get worse as it is to get better. The implication that walking by age 5 . . . would not be ``significant progress'' for this unfortunate child is simply revolting. Unfortunately, during the time of court action, Ethan lost three years of vital therapy. And even then, the Bedricks were left with no remedy for compensation for Ethan's loss of therapy. Does this child need patient protections? You bet your life. This child and his family need patient protections. Let me describe a young boy named Christopher Roe. I was holding a hearing one day in Las Vegas, NV, with my colleague, Senator Reid. Christopher's mother, Susan, came to the hearing, and she held, above her head, a picture the size of the one I have in the Chamber. Susan began to speak about her son Christopher and this subject of patients' protection. His mother said that Christopher Thomas Roe died October 12, 1999. It was his 16th birthday. The official cause of Christopher's death was leukemia. But Susan said the real cause of Christopher's death was that the family's health plan denied him the chemotherapy drug he needed. Yes, it was investigational, but it would have given him a chance at life; and it was denied at every step of the way. Christopher was first diagnosed with leukemia in 1998. He at first achieved remission, only to develop an early relapse. His pediatric oncologist recommended he receive a bone marrow transplant, which was his only hope for long-term survival. But before he could receive a bone marrow transplant, he needed to go into a second remission. Chris's oncologist felt that because of his early relapse, he needed an additional drug that the oncologist recommended. It was available at the Hughes Institute in St. Paul, MN, but it had already proven effective in fighting the specific kind of leukemia cells young Christopher had. The health plan denied treatment saying, no, this drug is experimental, even though it wouldn't have had to pay for the drug itself, only the blood draws, physician visits, and blood products it would have paid for had he received traditional chemotherapy. Chris's family immediately appealed. The review, which was supposed to have taken 48 hours, took 10 days. Meanwhile, as the appeal dragged on, Christopher's condition worsened, and his oncologist felt he had no choice but to start Christopher on the more traditional chemotherapy. But that did not work. The National Bone Marrow Donor Program found six perfect matches for this young boy, which is almost unheard of. Unfortunately, he was never able to make it to a bone marrow transplant because he was never able to achieve the second remission without the drug he needed in order to do that. At a hearing that I held with my colleague, Senator Reid, his mother Susan stood up and held this picture of young Christopher above her head, and she began crying as she described her son's death. She said: My son was 16 years old. And he looked up at me from his bed and said: Mom, I just don't understand how they could do this to a kid. This mother felt that her son deserved every opportunity, deserved a fighting chance against his disease. What she said was: My son and our family had to fight the cancer and fight the managed care organization at the same time, and that is not fair. She is right about that. We ought not have this happen in our country. I hope that, in the name of Christopher Roe and so many others, we can pass a patients' protection act in this Congress that says to them and others like them: You have certain rights as patients. Right now the odds are stacked. We have the big interests over here, and they have all the money and all the lawyers; and we have the patients over here who, alone with their families, are left to fight the battle. We had a hearing in Washington, DC, about a year ago. A mother from New York came to that hearing. Mary Lewandowski was her name. I will never forget her because she came up to me after the hearing and gave me a big hug, and we talked about her daughter Donna Marie. Donna Marie died February 8, 1997. Her mother Mary has made it a cause to try to see if she can prevent from happening to others what happened to her child. Mary comes to Congress at her own expense. Nobody pays her way here. Every chance she gets, she comes to talk about her daughter. The week of her daughter Donna's death, she had been to a doctor four times in 5 days. Despite her worsening symptoms, this young girl was told that she had an upper respiratory infection, and she had panic attacks, her doctor said. She was 22 years old. On the evening of February 8, Donna was in a tremendous amount of pain. Her mother called the hospital, and was told she could not bring her daughter to the hospital unless it was a life-or-death situation, or unless she had a doctor's referral. Mary tried in vain to reach Donna's doctor. One hour later, Donna lapsed into a coma and died. She died from a blood clot on her lung the size of a football. Donna's doctor later told her mother that a $750 lung scan might well have saved her daughter's life. But the test was not performed because it could not be justified to the HMO or the managed care organization. Now I would like to turn, just for a moment, to a couple of other issues in this debate. The question of whether care is ``medically necessary'' is often cited as a reason for lack of treatment by a managed care organization. This is a picture of a young baby born with a horrible problem, a cleft upper lip: A terrible disfigurement. Surgeons tell me that--in fact, one Member of Congress, who is an oral surgeon confirms this--it is not unusual at all to be told that fixing this is not ``medically necessary'' and, therefore, the health care plan will not cover it. It is not ``medically necessary'' to fix this. Can you imagine being told that as a parent? Let me show you a picture of what it looks like when you fix this problem. This picture shows what that young child can look like when that problem is fixed. After looking at the results, can one really say it is not medically necessary to fix this? This legislation begins to define what the rights of patients are with respect to what is ``medically necessary.'' Is it necessary for us to pass this legislation? In the name of all of these children, in the name of these patients and in the name of these people who have to fight dread diseases and their managed care organizations at the same time, the answer clearly is yes. We ought to give them those opportunities. And those opportunities exist in this legislation. This will be a long and difficult debate. I do not know whether the votes will exist at the end of this debate to pass it. But I do know this: This debate has gone on for nearly 4 years now. This is an iteration of an iteration of an iteration. It is a compromise after a compromise after a compromise. It is a bipartisan bill brought to the Senate Chamber to say: Let us provide patient protections against those HMOs that want to withhold needed treatments for patients. Let's change the odds. Let me hasten to say, not all insurance companies or HMOs are bad actors. Many of them are wonderful, and do a great job, and serve their patients very well. I commend them. There are some, however, who look at a patient in the context of profit and loss. A woman in the State of Georgia suffered a very severe head injury. She was put in an ambulance, and on the way to a hospital--she was not quite unconscious--she had the presence of mind to tell the ambulance driver: I want to go to the following hospital. And it was the farthest hospital away, about another 10 minutes. They took her there, but they later asked her why, with a brain injury, she would want to take the extra 10 minutes to go to a further hospital. She said: I know about the hospital that was closer. It is a hospital with a reputation for taking a look at a patient who is coming in and seeing the dollars and cents, the profit and loss. I didn't want my medical care to be the function of someone else's calculation of profit and loss. This is from a woman in an ambulance with a brain injury. My point is very simple. This country needs to have some basic protections for patients, and the patients want those protections. Especially with the growth of managed care organizations, many of whom do a fine job, but some of whom do not, we need these protections. We need to say, as a matter of public policy in this country, patients have certain rights. Yes, you have a right to know all of your options for medical treatment, not just the cheapest one the managed care organization might want to tell you about. Yes, you have a right to an emergency room when you have an emergency. Yes, you have a right to be able to see the specialist you need when you need to see one. Yes, you have a right, if your spouse is being treated for breast cancer and you have changed jobs, for your wife to see that same oncologist who has been working with for her for the last 5 years to fight her breast cancer. You ought to have that right, and this legislation will give you that right. We will have Senators who will assert that this is a bill about trying to create more lawsuits. It is not that at all. It is about trying to provide patient protections. As I said when I started, the managed care organizations have all the lawyers they need. They can hire all the lawyers they need and want unimpeded. No one is going to come to the Chamber from the other side and talk about limiting the rights of the big managed care organizations or insurers to hire lawyers, are they? I don't think so. But they will say: We don't want patients to have access to attorneys to hold managed care organizations accountable. This is all about accountability. The Red Cross can be held accountable. Boy Scouts can be held accountable. Everybody can be held accountable except, in these circumstances, managed care organizations. This piece of legislation says everybody ought to be held accountable. This is not about lawyers, this is about getting the right care to patients when they need it. I suspect we will debate this for a couple of weeks. We have had this debate before. This legislation has changed from that time. For example, we hear from small businesses, who are now getting mailings around the country, saying: If Congress passes this Patients' Bill of Rights, this is going to break our small businesses because we will be held accountable. That is not true. In fact, this has changed so that we use exactly the same language the majority party used in its substitute in 1999. This bill isn't in any way putting in jeopardy small businesses. We don't hold them accountable. They are not accountable at all in circumstances where they have not had direct participation in making decisions about patient care. They are not accountable in that circumstance and should not be accountable because they were not making the decision. This is about managed care organizations and patients and the relationship between the two and the rights patients ought to have. I have other pictures. I have other stories. I will at some point later describe more of them in terms of what is ``medically necessary'' because by deciding what is medically necessary is another very important way in which HMOs can withhold treatment. I am going to show a poster on the issue of medical necessity that is a little more subtle than perhaps the other one I used but just as important. Brenna Nay was born in 1987. She has abnormal facial features characteristic of what is called Hajdu-Cheney syndrome. The shape of her skull is distorted. She had no chin. The question is, is it medically necessary to treat this young lady? Let me show the result after surgery. They built this young woman a chin. After surgery, does that improve that young woman's life? Is this something you ought to expect would be covered in a health plan? In my judgment, it should. I have other pictures that are similar. I will use them later. This ``medically necessary'' issue is critically important. I feel passionate about these health care issues. I have lost a member of my family. I have sat in intensive care day after day after day and know what it is like to lose a member of my family in a circumstance I can hardly begin to describe. In my case, my loss didn't have anything to do with the managed care organization withholding treatment. But I understand the passion of parents. I understand the passion of people who are fighting for their lives, who are struggling and fighting mightily against dread diseases and illnesses they know can kill them and then discover they not only have to waste the emotional energy to wage war against cancer or heart disease or so many other problems, but they also have to try at the same time to fight a managed care organization that ought to be covering that which is in their health care plan. That is not right. That is not fair. These are the types of problems this piece of legislation is designed to try to address. If we can pass this legislation, the country will be a significant step ahead in dealing with patients' needs and protections. Mr. President, I yield the floor and suggest the absence of a quorum.

Mr. DORGAN

Mr. DORGAN. Mr. President, I ask unanimous consent to proceed using as much time as I may consume.

Mr. DORGAN

Mr. DORGAN. Mr. President, later this afternoon we will turn to the reauthorization of the Elementary and Secondary Education Act. I wish to take just a couple of minutes to talk about a couple of amendments to the education bill that I have offered with colleagues. These amendments have not yet been voted on but I expect both will be approved. Education is very important. I am pleased it appears we will now finish this bill. This Congress has a responsibility to address the issue of education in a thoughtful way. We understand there are plenty of challenges in our educational system. We have schools that don't do as well as we would like. At the same time, I want to be sure to say there are a lot of wonderful schools in this country and a lot of great teachers who are educating our children. More Americans have completed a high school education today than at any other time in history. At a time when we talk about the deficiencies in education, 84 percent of the American people are now completing a high school education. In France, only 52 percent of adults have a high school education. In the United Kingdom, 68 percent. In Japan, 70 percent. With respect to virtually every aspect of life in this country, one can take something and hold it to a light and say, isn't this ugly, and one can find a perfection that is ugly. But generally with respect to education, I ask this question: If public education in this country has not worked, how is it we have reached this position in our lives? The United States has done so much for so many over so long a period of time. The progress that has been made is remarkable. I came to the Congress many years ago to initially serve in the House of Representatives. I have told my colleagues a story about going into the office of the oldest Member of the House at the time named Claude Pepper, a great public servant. He was then in his eighties, and his office was virtually a museum of posters and photographs. Two pictures in particular that were hanging behind his desk in his office stuck out to me. One was a picture of Orville and Wilbur Wright making the first airplane flight. It was autographed to Congressman Claude Pepper by Orville Wright before he died. It was autographed to Claude Pepper: With deep admiration, signed Orville Wright. Beneath that picture was a picture of Neil Armstrong stepping on the Moon, and it was autographed by Neil Armstrong to Congressman Claude Pepper. I was struck by that. Here are two pictures: Of the first Americans to fly and then the first American to fly to the Moon. I thought about the relatively short timeframe that is represented by those pictures. What a breathtaking advance in technology and learning that allowed us to build aircraft that not only left the ground in airplanes that were primitive, but also flew all the way to the Moon for a lunar landing. What is that about? It is about education. We achieved these advancements in America's classrooms. Those young scientists and engineers and mathematicians, the young talents all across this country, starting 1st grade someplace, went through high school, and went to college. They created progress in so many areas. Yes, in space, but also in medicine and so many areas this country has progressed. Education is critically important. I wanted to say it at the front end. Those who somehow criticize our public educational system as a system that has failed America, in my judgment, are dreadfully wrong. This public system of education has empowered every young child in this country to be the best he or she can be. We have challenges, no doubt about it, and we should deal with those challenges. I propose a couple of things to deal with some challenges. I propose we have school report cards. Every young person in school occasionally comes home with a report card; that child's school and the teachers evaluate how students are doing and they grade them and give them a report card. Parents and taxpayers get no such report card that evaluates how the school is doing. What is their tax money buying? What is the level of achievement of that school? What kind of progress are those students making? How effective is this school at promoting learning among its students? My proposal is to give parents a school report card that provides the opportunity to understand how a school is doing versus a neighboring school, how a school in this county is doing versus schools in another county, or how schools in this State compare to those in another State, so parents and taxpayers can hold a school accountable. We need a school report card that is reasonably standardized across the country. Thirty-seven States have created school report cards, but there content varies widely and most parents have never ever seen one. I think we ought to be about the business of asking for report cards on the progress of our schools. I understand the report card language has been included as part of the underlying Manager's amendment, and I think that provision will represent some progress. The second amendment I offer with my colleague, Senator Enzi from Wyoming, who will be here later today, is an amendment that talks about establishing technology academies in the public school system. I am not talking about setting up separate buildings. I am talking about providing some assistance to allow public schools that want to offer an in-depth curriculum in technology to do so. Those young students who are adept at technology and want to pursue technology-related careers can, through a technology academy curriculum, come out of that school system with a much stronger background and be able to fill some of the jobs that go wanting in this country. Last year we had a debate about increasing the number of H-1B visas to meet our country's need for technology workers. Why do we need people coming into this country from other countries to perform that work? Because our schools are not producing the right kind of trained individuals in sufficient quantity to eliminate the need for the H-1B visas. So I supported those new visas. But it seems to me a smart thing for us to do is to strengthen the depth and breadth of the technology curriculum in those schools that want to do that. That allows those students who want to go into a technology job to be prepared for the future. Technology, obviously, is very important. The increase in information technology and telecommunications, the breathtaking advances in those fields, are quite remarkable. I come from a State that is a rural State. In the past, we have always been far from markets and therefore disadvantaged. But with information technology, with one click of a mouse, North Dakota is as close to the Hudson River as Manhattan. Distance is dead. If distance is dead, opportunity is born, especially if you come from a rural State. And if that is the case, then let us develop technology academies through the incentive I would provide in this amendment with my colleague, Senator Enzi, to allow public schools to strengthen their curriculum in technology. Those students who want to move in that direction and fill those jobs that are now going unfilled ought to have that opportunity by coming out of our school system much better prepared to do so. Those are two amendments I will be offering. My understanding is the first will be accepted as part of the underlying Manager's amendment, and the second will be adopted by a voice vote. I appreciate that. I think both of them will improve this bill. Let me also say my colleague, Senator Enzi, will, I believe, come to the floor to speak about the technology academy amendment at some later point in the debate. Finally, let me say this. Thomas Jefferson, in a famous quote, said about education: Those who believe that a country can be both ignorant and free believe in that which never was and never can be. Education is critical to the success of this country and its future. Education is just critical. It is the root of virtually everything else, the seedbed for progress in every other area. If we talk about defense, talk about social progress--everything we talk about has its roots in education. The issue of education is not complex. Education works when you have three elements: A teacher who understands how to teach, a student who wants to learn, and a parent involved in that student's education. When all those are present, education works, and works very well. When it works well and where it works well, which is in many school districts across our country, I am enormously proud of what we are doing. I have sat in schoolrooms with dirt floors in the country of Haiti, for example, where a very small percentage of the children are getting educated in a very primitive way. I have sat in schoolrooms across the world in other countries, and wondered why these children will not have the opportunity they should have. But I have also visited many classrooms in our country, and I would say from those experiences that I am enormously proud of what we have done. I am proud this country is the country that says every young child, regardless of origin, regardless of parentage, regardless of how much money they might have, is going to have an opportunity to be everything he or she can be. That is the way our school system works. That is not true in some other countries. Some countries pare the children down very quickly and send them down different routes and different paths, saying to some, you are not eligible to be on the path going towards college, you are going to go somewhere else. That is not the way we do things in our country. In our country, every young child sees that flame of opportunity that beckons: You can do it. I spoke at a college commencement ceremony this weekend with hundreds and hundreds of graduates. I looked out at those graduates who came from every corner, every conceivable background. Every single one who was announced was accompanied by a hoot, a howl, a hurrah, and a yeah from the audience because those families understood this is a big day and big achievement. So, too, is education success for our country. That is why I am pleased we are going to finish this bill and very pleased the two amendments I have offered will be included. I yield the floor.

Mr. DORGAN

Mr. DORGAN. I move to lay that motion on the table. The motion to lay on the table was agreed to.

Mr. DORGAN

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

Mr. DORGAN

Mr. DORGAN. I ask for 30 additional seconds.