Byron Dorgan

Mr. DORGAN

Mr. DORGAN. Will the Senator from Oklahoma yield?

Mr. DORGAN. Will the Senator yield?

Mr. DORGAN. I say to the Senator from Illinois, that is exactly the case. In fact, one of the proposals we offer as an amendment that is prevented by the majority leader would provide an $8 million exemption for a small business or small farm.

Mr. DORGAN. Yes, I yield.

Mr. DORGAN. I say to the Senator from Illinois, it is exactly as he states. With the wonderful economy we have had and the surpluses that are expected, there is a certain amount of revenue available. The priority, for the majority side, is to repeal the estate tax, including that top half of the estate tax that applies to the wealthiest estates in the country. If we follow this priority, that will crowd out the ability to do other things. This is a question of making judgments about what is important, what is the priority of this Congress. Should we provide a prescription drug benefit for Medicare? Should this Congress make the investments in education that we should make? Should this Congress decide we should pay down the Federal debt? Should this Congress decide college tuition should trigger an increased tax credit that helps kids go to college? These are all priorities, and there are more of them that we ought to measure against this proposal to repeal the estate tax for the largest estates in the country. As I said, it is a matter of priorities, and it is also a matter of will. What do we have time to do in the Senate? We are told by the majority leader that we do not have enough time to deal with Patients' Bill of Rights, prescription drugs for Medicare, the minimum wage, closing the gun show loophole. We do not have time for those things, we are told, but we have plenty of time for the things the majority wants to do. We have plenty of time to decide to repeal the estate tax completely, including repeal for the largest estates in the country. Do my colleagues know what that will do on average to an estate above $20 million? It will provide about a $12 million tax cut for the estate.

Mr. DORGAN. I am happy to yield to the Senator.

Mr. DORGAN. The Senator from Illinois is correct. Let me correct something I said a moment ago. The majority leader yesterday tried to bring up H-1B legislation, not the estate tax. I was mistaken about that. I should have known better. I was on the floor at that time, as a matter of fact. But it is true that the majority leader wants to bring up the estate tax and say to half of the Members of the Senate: You don't have a right to offer amendments, and if you don't like it, tough luck. That is what the issue is about. The Senator from Illinois asked the question, Shouldn't this proposed repeal be measured against other priorities, and shouldn't this suggest what is important in the Senate? It sure does. There is not the time or the energy or the inspiration on the part of those who control the agenda in the Senate to have a real debate about protecting people against HMOs, and to try to pass a Patients' Bill of Rights. No, there is not time for that. Can we work to put a prescription drug benefit in the Medicare program? No, not quite enough time for that either. In fact, the other side understands that is an important issue, so they have cobbled together a goofy proposal that says OK, the senior citizens are having trouble affording prescription drugs, so let's give a subsidy to the insurance companies. Even the insurance companies see through that. They have come to my office--and I assume to the Senator's office--and said: We will not be able to offer a prescription drug plan. We would have to charge $1,200 for a plan that has $1,000 in benefits. The point the Senator from Illinois makes is we have other priorities. Those other priorities somehow don't get to the floor of the Senate because the big priority at the moment is to give an estate tax repeal to the largest estates in the country. As I said, I think we ought to provide a significant exemption so that every family farm and every small business can be transferred to the kids upon the death of the parents, with no estate tax at all-- none, zero. However, when a billionaire or someone with $500 million in assets dies and there is an estate, is it not unreasonable to have some transfer here, some estate tax, in order to use those resources for other purposes, such as reducing the Federal debt, providing middle income tax relief--a whole range of urgent needs? Is that not a reasonable thing? That is what we ought to measure this against.

Mr. DORGAN

Mr. DORGAN. I am a little uncomfortable with the discussion here. The discussion is: Under what conditions will the majority leader allow us to consider this bill? I understand that amendments are inconvenient, but the rules of the Senate allow people to be elected to the Senate and offer amendments and consider legislation. The unanimous consent request offered by the majority leader was to take up this bill and pass it without any discussion or any amendments. Now there is a negotiation here saying: Maybe I will allow it to be brought to the floor if the Senator from Nevada would, on behalf of his side, agree to no more than five amendments. The fact is, it seems to me if we fretted a little less about what someone might do when they bring something to the floor and started working through it, it would probably take a whole lot less time. I happen to be supportive of the H-1B legislation, but I am not very supportive of some notion of anybody in the Senate saying: Here are the conditions under which we will consider it--and only these conditions-- and if you don't like it, we won't consider it. I hope the Senator from Nevada--if the majority leader insists on his unanimous consent request--will make a unanimous consent request following that similar to the one suggested by the Senator from Massachusetts, a unanimous consent request to bring the issue to the floor under the regular order at this time.

Mr. DORGAN. Reserving the right to object.

Mr. DORGAN. Reserving the right to object.

Mr. DORGAN

Mr. DORGAN. I also thank the distinguished Chairman and Ranking Member for their attention to this important matter. In light of their assurances, I, too, will withdraw my amendment, and look forward to working with them to ensure that the B-52 is given a close look for the EW mission during the ongoing study.

Mr. DORGAN. I think it should be noted that operation Allied Force demonstrated that our nation is short jamming assets for even one major war. An ``EB'' version of the B-52 would be a cost-effective solution to the problem, since the aircraft are already paid for. As a matter of fact, I understand that during Operation Allied Force, General Wesley Clark asked if any other platforms could be equipped with offensive electronic gear to augment the over-tasked EA-6Bs against Serbia's air defense system, and that an ``EB-52'' variant was under consideration. That concept warrants full consideration, as a supplement to the EA-6B aircraft now in service with the Navy.

Mr. DORGAN

Mr. DORGAN. I want to make it clear that funding to assure the timely and accurate processing of Medicare claims also is a high priority for me and the beneficiaries in my state. I am concerned that HCFA projects a 3.5 percent increase in claims volume next year and yet our budget flatlined funding for Medicare contractors. However, I am even more concerned that the House has cut the Medicare contractor budget by $79 million from current levels. The Senate, at the very least, must assure that this important program is not cut. Additionally, I would like to work with Senator Craig to secure additional funding for the Medicare contractors, if funds become available.

Mr. DORGAN

Mr. DORGAN. I understand the Senator's answer, which is that the substitute offered by Senator Nickles provides coverage for only about 48 million Americans. It is the same approach they have used previously. One can suggest that all of these protections I am proposing are covered elsewhere. If that is the case, why does the Senator object? The Senator from Oklahoma seems irritated we have raised this issue again. Let me tell you what Congressman Norwood, a Republican serving in the House who is a sponsor of the House legislation, said on May 25, and I quote: I am here to say the time's up on the conference committee. We have waited 8 months for this conference committee to approve a compromise bill. Senate Republicans have yet to even offer a compromise liability proposal. They have only demanded that the House conferees abandon their position. This is a Republican saying the time is up on the conference committee. Let me also point out that the Senate passed, in my judgment, a poor piece of legislation. It has the right title but it doesn't include the right provisions. The House passed a good piece of legislation, but the House leadership appointed conferees to the conference that voted against the House bill. Their conferees voted against the House bill. So the conference isn't even on the level. If month after month after month goes by and you don't want to have a Patients' Bill of Rights because you don't believe the Federal Government ought to be involved in this, just tell the patients that. Say to the patients: We don't believe Congress ought to do this. You should go ahead and fight cancer and fight your HMO at the same time. Go ahead and do that. The fact is, we can do better. The proposal we are offering today is very simple. We believe that a Patients' Bill of Rights establishing basic rights that patients ought to be able to expect in dealing with their insurance company is a proposal that ought to get 100 votes in this Congress. There are some who say, when asked the question, Whose side are you on? Let us stand with the insurance companies. We believe Members ought to stand with the patients. There is a genuine and serious problem in this country with patients not getting the treatment they expect, need, or deserve. Patients find themselves having to fight cancer and their insurance company. That is not fair. The question is whether this Congress will do something about it. The question is not whether this Congress will pass a national health care plan. That is nonsense. That is not what is being debated. I see more shuffle and tap dances going on around here on this debate. The fact is, if you want to pass a good Patients' Bill of Rights, do what the House did. Understand that Dr. Norwood, a Republican Congressman, knows what he is talking about. This conference hasn't moved. This conference isn't accomplishing anything. That is why we have offered this amendment. I yield the floor, and I reserve the remainder of my time.

Mr. DORGAN. I will yield for about 15 seconds.

Mr. DORGAN. Mr. President, I yield myself such time as I may consume. I have listened to this discussion, and it is pretty interesting. It seems to me that if you don't want to pass a Patients' Bill of Rights-- perhaps for the reason the Senator from Wyoming suggested, which is that the Federal Government ought not to have any involvement in this issue--then just say so. Don't come out here and describe an alternative as if it is doing something that it is not really doing. According to my colleague, we have a 258-page amendment. It kind of reminds me of the ``Honey, I shrunk the plan'' approach, this suggestion that what we should go back to covering 48 million people rather than 161 million people. The Senator from Tennessee talked earlier about emergency room care and a number of the patient protections we have proposed. I hope he will respond to my inquiry. Is it not the case that the emergency room care provisions in the Senator from Oklahoma's amendment applies only to about 48 million people. Isn't it so that two out of three people will not be covered with the kind of protection the Senator suggested was covered in their proposal? It seems to me it would be a much better approach to simply say we don't support a Patients' Bill of Rights.

Mr. DORGAN. Mr. President, I send an amendment to the desk and ask for its immediate consideration.

Mr. DORGAN. I am happy to yield for the purpose of a question.

Mr. DORGAN. Mr. President, I yield 5 minutes to the Senator from Rhode Island.

Mr. DORGAN. Mr. President, I yield 2 minutes to Senator Edwards.

Mr. DORGAN. All right, Mr. President. Let me take the 5 minutes at this point and close debate. Mr. President, this has been an interesting discussion, but it has not been about what is on the floor today. We have had now a debate about the 1993 Clinton health plan. We have also had a discussion about ``Hillary care.'' If you have the interest in debating that, hire a hall, get your own audience, speak until you are exhausted, and have a good time. But those are not the subjects on the floor today. We are debating the Patients' Bill of Rights. Some people do not want to debate that. They certainly do not want to talk about the facts, but this is what we are talking about: The Patients' Bill of Rights. Dr. Greg Ganske, a Republican Congressman from Iowa, was just on the floor of the Senate and he indicated that the 258-page missive that is now offered as a substitute will in fact weaken HMO laws in the following States: California, Texas, Georgia, Washington, Louisiana, Oklahoma, Arizona, and Missouri. That is not from me; it is from Dr. Ganske, a Republican Congressman. By the way, let me read something Dr. Ganske said some time ago in a discussion about all of these issues. He said: Let me give my colleagues one example out of many of a health plan's definition of medically necessary services. This is from the contractual language of one of the HMOs that some of you probably belong to: ``Medical necessity means the shortest, least expensive or least intense level of treatment, care or service rendered or supply provided, as determined by us.'' Contracts like this demonstrate that some health plans are manipulating the definition of medical necessity to deny appropriate patient care by arbitrarily linking it to saving money, not to the patients' medical needs. Some of my colleagues say we are playing politics with this issue? Why don't you tell that to some of these kids. Dr. Ganske described this child I show you a picture of, a child born with a severe cleft lip. Fifty percent of the medical professionals in Dr. Ganske's field report that they have been told that correcting this kind of condition is not a medical necessity. So tell that to the kids. Tell it to this young child, that it is not a medical necessity to correct this condition. Dr. Ganske also shared with us what a young child looks like who was born with this deformity--but who has it corrected by the right kind of surgery. Let me show you another picture of this child with the condition corrected. Does anybody want to tell this child it was not worth it? Or maybe you want to talk to Ethan Bedrick. Tell Ethan that this is just politics. Ethan was born during a complicated delivery that resulted in severe cerebral palsy and impaired motor function in his limbs. When he was 14 months old, Ethan's insurance company abruptly curtailed his physical therapy, citing the fact that he had only a 50-percent chance of being able to walk by age 5. So talk to Ethan about this. You think this is politics? Talk to Ethan. A 50-percent chance of being able to walk by age 5 was deemed, quote, ``insignificant,'' and therefore you don't get the medical help you need. And some people say: Well, it doesn't matter. Apparently, you don't deserve it. That is not the way health care ought to be delivered in this country. People ought to have basic rights. That is why we call this a Patients' Bill of Rights. The question, at the end of the day, is: With whom do you stand? Do you stand with the managed care companies that have developed contracts such as this, that say, ``Medical necessity means the shortest, least expensive, or least intensive level of treatment, care, or service as determined by us,'' which means that this young child is told: Tough luck? Or do you stand with the patients and decide that maybe we ought to do something, as a country, that responds to real problems and pass a real Patients' Bill of Rights? A fellow once told me, in my little hometown: You never ought to buy something from somebody who is out of breath. There is a breathless quality to some of the discussion I have heard tonight. We raise the issue of a Patients' Bill of Rights, and instead we hear a discussion about the 1993 health care plan. Then we have a substitute that is 258 pages that kills a lot of trees for nothing. You don't need to take up 258 pages to offer an empty plan. Offer one page, and say: We don't support a Patients' Bill of Rights. Just be honest about it. But do not try to fool the American people any longer. It is true we have had a few votes on this. It is also true that there is a conference committee that is supposed to be working. But it is also true, as Dr. Norwood and other Republican Congressmen said, that the time is up and the conference committee has not done a thing. No one ever accuses the Congress of speeding. I understand that.

Mr. DORGAN. Mr. President, we are debating my amendment, I guess. I have the right to close debate on my amendment; is that correct?

Mr. DORGAN

Mr. DORGAN. Yes.

Mr. DORGAN. Mr. President, I had intended to speak about this amendment. But I am compelled to speak about the point that the Senator from Connecticut discussed at the start of his comments because it is so important, and it is timely. At this moment, I understand there are meetings going on right now somewhere in this building by a small group of people who are dealing with a piece of legislation that was cobbled together around 3 o'clock in the morning a couple of days ago dealing with the issue of imposing sanctions on food and medicine around the world, and whether that will be added to the supplemental bill that will be considered perhaps later today or tomorrow. If that is added, in my judgment, it is going to cause significant trouble. Here is why: The House leaders have done what I am reminded of as the ``Moon walk''. You know the Moon walk Michael Jackson used to do. It looked like he was walking forward, but he was actually going backward. That is what they have done with respect to this issue of sanctions. Senator Dodd from Connecticut, myself, and others are saying we ought to end the use of sanctions on food and medicine anywhere in the world where it exists. This country has imposed sanctions on the shipment of food and medicine. It is wrong. When we take aim at dictators, we hit poor people and hungry people and sick people. It is not the best of what America stands for. We ought to end all sanctions on food and medicine. Yet what was done in the House of Representatives 2 days ago, in my judgment, comes up far short. In fact, in some areas, it loses ground. I want to point out an article in the Washington Post. I will come later with the legislation itself. But the Washington Post describes this legislator from Florida who opposes eliminating sanctions. She said the agreement will make it as difficult as possible for such sales to take place with respect to Cuba. Why? Because they prohibit private financing of the sale of food to Cuba. What is that about? It has nothing to do with good or common sense. They are not trying to get rid of sanctions. It has everything to do with the irrational notion about Cuba, and that if we can somehow restrict the food and medicine going to Cuba, we will enhance America's foreign policy. It is crazy. It doesn't make any sense at all. Here is where we have sanctions: Cuba, Iran, Iraq, Libya, North Korea, and Sudan. These countries are countries that our Government has decided are not behaving properly. I support slapping them with economic sanctions. I do not support including food and medicine in those sanctions. I do not support using food as a weapon. We are trying very hard to get rid of this practice of using food as a weapon. Seventy Senators voted last year to stop using food as a weapon. We have a provision in the Senate agriculture appropriations committee bill that will come to the floor of the Senate within several weeks that includes an approach that will eliminate the use of food and medicine as part of our sanctions. I think we ought not give up here. We ought to fight on behalf of our family farmers and others to say that we want to abolish the use of sanctions that include food and medicine. The proposition that was cobbled together over in the House at 2 o'clock or 3 o'clock in the morning by some people who really do not want to do this, have made it seem as if they have made progress in this area. But, in fact, they have lost ground in a couple of cases, and especially with respect to Cuba in a couple of other circumstances. There will be no U.S. sales of food to Cuba. Canadian farmers can sell to Cuba. European farmers can sell to Cuba. Venezuelan farmers can sell to Cuba. Seventy Members of the Senate said we ought to get rid of sanctions on the shipment of food and medicine--yes, to all countries, including Cuba. But now we have cobbled together a deal sometime early in the morning by a group of people who are going to apparently put it on a supplemental bill so we will have a circumstance where we don't solve this problem. The proposal that fails to solve this problem was not debated in the House. It was not debated in the Senate. But it was concocted at 3 a.m. in the morning and apparently was stuck on a supplemental appropriations bill. It is the wrong way to do it. I just talked to a farm group that supports this. When I asked them a question about it, they admitted they had not read the language. They read the paper, I guess. The implication was that I was impeding the efforts to remove sanctions. Another major farm group has just come out in opposition to it, saying this doesn't solve the problem; let's fight to solve the problem. The problem is that we include medicine and food as part of our sanctions. The solution is that this country should not include food and medicine in sanctions that we impose on these countries. We should not use food as a weapon. It is a very simple proposition. Seventy Senators have already weighed in in the Senate saying let's stop it. If they would allow a vote in the House, they would get 70 percent in the House of Representatives as well. I hope we will not decide to cave in on this issue. Let's not make the perfect the enemy of the good. But let us at least continue to fight. We have some more months in this legislative session. We have a provision coming to the floor of the Senate in about 3 weeks that includes a real effort to stop using food and medicine as part of our sanctions. Let's fight for that. Let's not let a couple of people who run the other body decide for us at 3 a.m. in the morning what we were going to do in this circumstance. Let's stand up and fight for family farmers, and let's fight for the moral principles that this country ought to hold dear. We should not use food and medicine as a weapon any longer. This is not about Republicans and Democrats. Both administrations in recent years have used this approach, and they were wrong. The Senate was right last year with 70 votes that said let us stop it. And what was put together over in the House is now billed as some sort of a compromise. It is not a compromise at all. It falls far short of what we ought to expect. Those of us who are clearheaded enough believe we should not use food and medicine as part of economic sanctions in this country.

Mr. DORGAN. Mr. President, am I to be recognized for 7 minutes? Is that the order?