Byron Dorgan

Mr. DORGAN

Mr. DORGAN. Mr. President, it is Thursday and most of the week we have seen amendments and offerings from the majority party that do little or nothing for the vast majority of Americans. The Gregg amendment before us, however, is an amendment that would do something. It would prevent accountability. It would say that patients have no right to expect accountability on the part of HMOs and the insurance companies. USA Today, in an editorial, says there are ``100 Million Reasons that the GOP's Health Plan Fails.'' That is the number of people not covered by our opponent's health plan. The majority of the American people with private insurance are not helped by their proposal. Now, some of my colleagues say that doesn't matter because the States cover these folks. Mr. President, 38 States don't guarantee access to specialists; 48 States don't hold plans accountable; 29 States don't provide for continuity of care; 39 States don't provide for omsbudsmen; 27 States don't provide a ban on financial incentives to limit care. The fact is, the argument that the States do this is a specious argument. Let me go back to a couple of cases I have described in the past to illustrate my point. I know some here in the Senate say this debate is not about individual cases, but I disagree. Ethan Bedrick was born in circumstances that were devastating, the umbilical cord wrapped around his neck causing partial asphyxiation. Consequently, he was born with cerebral palsy and was a spastic quadriplegic. He began to get therapy. At age 14 months, the HMO said: We are going to cut back on Ethan's therapy. The doctor said: You shouldn't cut back on the therapy. Ethan has a chance to be able to walk by age 5. The HMO says: A 50 percent chance of being able to walk by age 5 is minimal or insignificant. Therefore, we won't pay for it. Now, is somebody going to protect Ethan? Does anything proposed by anyone on the other side of the aisle in the last 3 days solve this problem? The answer is no. In nothing they proposed can they say they will have solved this problem--not just for Ethan but for all the other little Ethans in our country. They will deny him the rights that he ought to have. What about Jimmy Adams? We had a big debate yesterday about emergency care. One of my colleagues stood up and said little Jimmy would be covered under their amendment. That is not the case. Jimmy Adams got sick with a 104 degree fever in the middle of the night. His mother and father called the HMO. They were told to go to the Scottish Rite Hospital way across the city of Atlanta. Where is it? the mother asked. Find a map, she was told. So they got in the car at 2 in the morning and headed for Scottish Rite Hospital. They passed the first hospital, they passed the second and third hospitals--because they were not authorized to go to these emergency rooms by their HMO. An hour into the trip, they pulled into Scottish Rite Hospital, having passed three emergency rooms because the HMO wouldn't have paid for Jimmy's care there. At that point, Jimmy Adam's heart had stopped. They were able to get his heart restarted. They intubated him. He was a very sick young man. He survived. However, gangrene from that episode caused Jimmy to lose both of his hands and his feet. This is young Jimmy without hands or feet. He passed three emergency rooms because the HMO said: You have to be in a car an hour to go to the emergency room we will pay for. Is there anything offered by anybody on the other side yesterday that would have solved this problem? The answer is no because Jimmy's family is enrolled in an HMO that would not be covered under our opponent's proposal. No emergency room proposition offered by anyone over there, even though it was described in wonderful terms, would have done anything to help the Jimmy Adamses in a good many States in this country. If you think that is wrong, I challenge anyone to tell me how you will receive this protection if you are among the 100 million not covered under the majority's bill and live in a State that doesn't have this coverage. That is the problem with the proposal by the majority party. Let me give another example. This case deals with the issue of who determines what care is medically necessary, doctors or insurance company bureaucrats. This example was used by Dr. Greg Ganske, a Republican Congressman from Iowa, who happens to be a reconstructive surgeon. This is a picture of a child with a very serious medical problem, a cleft lip. Dr. Ganske contacted his colleagues in reconstructive surgery, and Mr. President, he found that 50 percent of them had cases such as this denied. In cases dealing with reconstructive surgery, 50 percent had cases denied because they were not medically necessary. Think of that. Think of being the mother or father of this young child and being told reconstructive surgery is not medically necessary. Ask yourself whether you think that is reasonable. Yet it happens in this country and will happen again under the Republican bill because they do not allow a patient's doctor to determine what is medically necessary. Let me show you another picture of a child with the same cleft lip problem. Now let me show Members what happens when reconstructive surgery gives this young child a chance, an opportunity. Here is the same child. Take a look at what someone decides is ``medically necessary'' and what it will mean to this young child's life. This picture demonstrates what reconstructive surgery can do for this wonderful child. As these real cases illustrate, this debate is not about theory. It is not about arguing the terminology in some half-baked plan that doesn't do much. It is about providing assurance and guarantees to people in this country. Help this young child. Provide protection for Jacqueline Lee who fell off a cliff 40 feet, fractured her body in three places, and unconscious, is helicoptered to an emergency room. She is unconscious, out cold on a gurney. She survives and then is told by her HMO that she did not get prior approval for her emergency room visit and therefore they will not pay it. Or Ray, the father who, with tears in his eyes, told about Matthew, his 12-year-old son, who lost his battle with cancer because they were forced to fight both the cancer and the insurance company to provide for the treatment necessary to try to save him. Ray says, ``We could not fight cancer and the insurance company at the same time, and it is not fair to ask us to do it.'' I say this to you, those who say you are providing wonderful protection --you are not. This editorial says you are not and we know you are not and you know you are not. Mr. President, 100 million people are left out of your plan and you say: Yes, they are left out of our plan but the States cover them. They do not and you know they do not. Medical necessity? Emergency room? OB/GYN? Go down the list and then tell the American people, tell these children, tell the women, tell the families why you do not think they ought to be covered. This last amendment says to patients, we do not think you ought to be protected, but we certainly think we ought to provide protection to the insurance companies. We certainly think insurance companies ought to be given protection and patients should be denied the right to hold them accountable. My colleague talks about lawsuits. It is interesting. Texas passed a statute allowing consumers to hold HMOs accountable a couple of years ago. There has been one lawsuit, I understand--perhaps by now two or three. Where is the blizzard of lawsuits our opponents predict when you make health care providers accountable? Every Medicare patient in this country has the basic protections we are proposing in our Patients' Bill of Rights. Every Medicaid patient in this country has the same protections, and every Federal employee and every Senator sitting on this floor has these protections. But we have folks in this Chamber who decide it might be good enough for Senators, they voted for it for Medicare, but it is not good enough for the rest of the American people. And the result is too many cases, too many children, too many Jimmy Adamses whose parents decide they have to comply with the rules because they do not have the money. I remember the first time I saw an entertainer use the moon walk. It made him look as if he was moving forward when instead he was moving backwards. I see that on the floor of the Senate in this debate. People offer proposals when they want people to believe they are making progress, but in reality, they are not doing anything or maybe even moving backwards. That is not going to work in this debate. This debate is not about theory. It is about people's lives, about their medical treatment. It is about providing protection for hardworking Americans who have insurance and think they are protected with decent health coverage--only to discover at 2 a.m. that they do not have access to an emergency room.

Mr. DORGAN. There are 120 million people, roughly, not covered. And we have 38 States--if the proposition is ``but if we don't cover them in our bill, the States do,'' there are 38 States that do not cover them either. Many of these children will simply not have access to a specialist. Those are the facts.

Mr. DORGAN. Mr. President, I guess my favorite Will Rogers quote is the old one that we all know. He said, ``It ain't what he knows that bothers me. It is what he says he knows for sure that just ain't so.'' I heard a lot of discussion today about facts and about whose side is right. In fact, we just heard the two stages of denial on the central argument of the Republicans against our real Patients' Bill of Rights. The first stage is that States provide all of this protection, so we shouldn't have to do it. And when informed the States don't do it, they say, well, that might be true, but the States could do all of it if they wanted to. That is the second stage of denial, of course. Let me talk again about some of the people involved in this debate, if I might. This is, after all, fundamentally about patient care. It is not a debate about theory. I want to talk about Ethan Bedrick once again. This young boy pictured here was born under very difficult circumstances. During his delivery, the umbilical cord wrapped around his neck and consequently, he was born with cerebral palsy and a condition called spastic quadriplegia. He can't get the rehabilitation services he needs to help him because his HMO says there is only a 50-percent chance of his being able to walk by age 5 and that chance is insignificant. The HMO called a 50-percent chance of being able to walk by age 5 a minimal benefit. His parents appealed and appealed. Guess who they appealed to--the same people who turned them down. We know that in 31 States there is no right to an independent, external appeal. The Republican plan says that Ethan Bedrick and citizens in 31 States are denied coverage. Denied. That is the fact. Dispute it if you can, but those are the facts and they are stubborn. Or what about Jimmy Adams. Jimmy Adams doesn't have hands or feet today because his folks had to pass three hospital emergency rooms before they got to the fourth hospital where the HMO would pay for his emergency care. On the hour-long trip to the further hospital, his heart stopped beating. They were able to revive him, but too much damage had already been done by the lack of circulation to his limbs. This young child lost his hands and feet due to gangrene. Our opponents say, young Jimmy Adams can stop at any emergency room under the Republican bill. Sorry; not true. The Republican bill doesn't cover over 100 million people, and there are 12 States that have no protections with respect to emergency room care. With respect to Jimmy Adams, or a Jimmy Adams of the future, the Republican plan says this: Denied. What about this young fellow born with a severe deformity? Dr. Greg Ganske, our Republican colleague over in the House, does reconstructive surgery. He surveyed his colleagues, and 50 percent of them had HMOs deny reconstructive surgery for young patients with birth defects such as this. Here is the picture Dr. Ganske used when he described the kind of circumstances these children live with. What about an appeal for this young fellow? What about the access to the specialist services needed? The Republican plan says ``denied'' to this young child--denied. Under the Republican plan--and in 38 States-- there is no provision for access to specialists for reconstructive surgery. Those are the stubborn facts. Let me show you the bright morning of hope for a young child who was born with a cleft lip who has had access to the appropriate reconstructive surgery. This is the same child I just showed you. Here is the way this child looks with reconstructive surgery. What a world of difference this makes in a young child's life. This is called patients' rights. Some say it doesn't matter; we don't need it. We say these rights are critical to the health of the people in our country. This is about children, men, women, families. Would anyone in here, if this were your son or daughter or your parent, really stand up and say let the States protect his or her. Would you really vote against these basic protections, such as access to specialists, if it were your child's health on the line? You know the answer to that. Of course, you wouldn't. We just heard a fill-in-the-blank speech from about three people. You could fill in the blank. Over and over, in debate after debate, year after year, the subject changes, but the mantra remains the same: Let the States do it. During the debate to create Medicare we heard the same thing: We don't need Medicare; let the States do it. On minimum wage--Let the States do it. On protections for residents of nursing homes--Let the States do it. On efforts to create a safer workplace or prevent child labor--Let the States do it. That speech has been given in this Chamber for 150 years, and it is so tired, rheumatoid, and calcified that I don't want to hear it anymore. We have had to fight for every step, for progress on such issues as creation of the Medicare program, a safe workplace, and minimum wage. Tonight we are fighting for something called a Patients' Bill of Rights. All along the way, we see people digging in their heels saying for lots of reasons that they don't want to do it. We need to do it for these children. No longer shall we deny them the rights they deserve in our health care system.

Mr. DORGAN

Mr. DORGAN. I think there are two other questions on that point: Not only how much does it cost, but because this is a tax provision, is it not the case that this clearly is a blue-slip provision? A tax provision cannot start in the Senate.

Mr. DORGAN. Constitutionally you must not start a tax provision in the Senate; it has to originate in the House. Second, is it offset? If so, how would one pay for this tax incentive? I think those questions should be asked as well. I wonder if we could get an answer to that.

Mr. DORGAN. Obviously, the Senator is talking about the budget that was passed by the Senate on a partisan basis. I did not support that. It is not the right approach to have substantial veterans' health care cuts. The Second World War veterans are reaching a time when they need maximum health care that was promised them. The right approach is not to cut veterans' health care. The need is to increase it. Getting back to the point, we have an amendment that was offered, which we had not previously seen, that suggests it will provide some protection. In fact, it denies that protection to the majority of the American women. It doesn't guarantee it, in any event, and provides tax cuts that are not paid for.

Mr. DORGAN. Talking about health care.

Mr. DORGAN. One additional question: Wouldn't it be the case that if the Senator from Nevada brought to the floor a tax proposal, or a spending proposal for that matter, that costs $3 or $5 billion, our friend would chase you off the floor and say: If you are bringing something to the floor that is not paid for, come on, that violates all the rules of the Senate? Yet we just heard from our friend from Oklahoma that this provision provides tax incentives. It is going to cost billions of dollars. How are you going to pay for it? Well, we don't pay for it in this bill, but we have an intention to pay for it at some point along the way. Do you think our friend from Oklahoma would let you get by with that, bringing a provision to the floor that says we are going to have a tax incentive and you are not going to pay for it, but you will come up with an answer later?

Mr. DORGAN. Every group. And the proposal deals with care by specialists, emergency care, OB/GYN. It covers the vast array of the American people. Then we have amendment after amendment that is kind of like decoration. It is kind of like the paint and the chrome and the hood ornaments to try to dress things up and make it look like it is something, but it is a vehicle without an engine. The engine is what we have produced on the floor in terms of a bill that says we are going to do something real for patients who are not getting the health care they need. So we will give them some protection. The response we get is to come out here with some empty vessels and some dressing up of some empty vessels saying: We share your concern and so here is how we address it. On the issue before us, isn't it the case that when someone stands up and says: Women have a right to get treatment by their OB/GYN, except when they offer the proposal, it is a right for only some women, but a right that will be denied to most women? Isn't that the case?

Mr. DORGAN. This all reminds me of that old moonwalk that you have seen people do, where they look like they are walking forward, but, in fact, they are making no progress. A famous singer used to do that moonwalk. That is what I see on the floor of the Senate. We offer a proposal that has the support of virtually every health organization in this country and every consumer and patient group in this country.

Mr. DORGAN. I wonder if the Senator will yield for a question?

Mr. DORGAN. Will the Senator yield while waiting for an answer?

Mr. DORGAN. Instead of saying this helps women, this amendment should be characterized as saying it helps some women but not most women. Would that be accurate?

Mr. DORGAN. Will the Senator yield?

Mr. DORGAN. Mr. President, I ask unanimous consent that Marc Schloss be allowed privilege of the floor.

Mr. DORGAN. Senator Kennedy has been talking about the issue of the number of Americans who would be covered under these two competing proposals. The point I have made in the past in quoting the USA Today editorial is the same point that a number of us have made: The fact is, our opponents' plan does not cover most of the American people. They say: Well, the States provide protection for those their bill leaves out. But the facts do not bear that out. My preference would be that if they do not want to legislate in the area of health care, just say that. Do not make a pretense of coming over here and saying, we support all these issues, we support each and every one of them but then vote against the kinds of reforms that will really accomplish them. My understanding is that the amendment we just agreed to by Senator Snowe on the issue of breast cancer covers everyone in the country. Why cover all Americans on just that issue? Apparently you are willing to provide some protection for everyone on only that one issue but you are unwilling to cover everyone when it comes to all of the other issues. I do not understand that. I wish I had the time to again show you the pictures of real victims of our current system to illustrate that this debate is not about theory; it is about real people. Unfortunately, I do not have the time. But this debate is about what kind of treatment patients will get in a health care system that in some cases--not in all, but in some cases-- has put profits ahead of patients' medical needs. Some in this Chamber say these stories don't matter. We stand with insurance companies. We stand with profits, and we don't believe patients need protection. Others of us believe very strongly that it is time to provide the kinds of protections on a uniform basis that patients ought to expect when they purchase insurance or when they receive insurance through their employer. Again, to those who have spent this week fuzzing up this debate, if you don't like the Federal Government legislating in this area, just say that. Don't bring a bunch of empty vessels to the floor of the Senate and then pretend they do something because you know better.

Mr. DORGAN. I appreciate the Senator yielding. I was standing here listening and thinking of Mark Twain. He was asked to engage in a debate at one point. He said: Fine, as long as I can be on the opposing side. They said: We haven't told you what the subject is. He said: It doesn't matter. Being on the opposing side doesn't require preparation. There is no preparation here. We do not have a Republican on the floor at the moment. I am sorry, Senator Jeffords is here. You can fill in the blank. It would not matter if you talk about managed care, minimum wage, clean air. You can talk about Medicare, you can talk about child labor laws, and there will be the same folks coming to the floor saying: It is not the Federal Government's responsibility; let the States do it. The Senator from Massachusetts made the point that most of the people are left out of the Republican plan. If people wonder if it is us against them, here is a USA Today editorial. It says: ``100 million Reasons GOP's Health Plan Fails.'' That is how many people the proposal will leave unprotected. Judging from the health insurance reform package announced this week by Senate Republicans, at least the title is correct. The proposal is called the ``Patients' Bill of Rights,'' and if you are waiting for this perfunctory plan to protect you, you'll need to be patient indeed. Many of the plan's key protections are restricted to the 51 million Americans who get their insurance through self-insured plans, subject to Federal regulations, but another 100 million or so whose health plans are subject to state regulations are excluded. The same editorial points out, as the Senator from Massachusetts has, that most of the States do not have these protections. These folks who come to the floor and say the States already have the protection--access to nonnetwork providers, 35 States do not have that. I just do not understand. Instead of coming to the floor and being honest and saying: We have no interest in this bill, all we want to do is obstruct, we have no interest in passing anything similar to that. Instead of doing that, they come with all these fuzzy shells. You wrap a package. It looks to be the same package that is sitting across the desk, but it has nothing in it. That is what is happening. Amendment after amendment is an empty shell, a package with nothing in it. USA Today says it right: ``100 Million Reasons GOP's Health Plan Fails.'' Isn't it the case, I ask Senator Kennedy, because of this every single health organization in this country opposes the Republican plan and supports the Democratic plan? Is that not the case?

Mr. DORGAN. Will the Senator from California yield for a question?

Mr. DORGAN. I wonder if the Senator will include in her question why a proposal would have been offered by one Senator, Senator Snowe, that covers all the women. With respect to mastectomies, but the proposal offered on OB/GYN leaves out up to 50 million women.

Mr. DORGAN

Mr. DORGAN. I do not have it listed quite that way, but I can tell my colleague that the average compensation plus stock options for these 25 executives is $16.7 million.

Mr. DORGAN. Mr. President, I have not seen the specifics of this amendment, but I have heard the description. It is interesting to hear this discussion of costs because we already have experience on this issue. The President has implemented the Patients' Bill of Rights for the Federal Employees Health Benefits Program. This is already in place for Federal employees around the country. And we know what it costs; we don't have to guess. It costs $1 a month. CBO says the patients' protection bill will cost $2 a month. We know it costs $1 a month in the Federal employees health insurance program. The costs that are described by my friend from Oklahoma are inflated for reasons I do not understand. We know what it costs. It costs $1 a month in the Federal health benefits program, because it is already implemented, and the Congressional Budget Office says it will cost $2 a month for our Patients' Bill of Rights. Let's talk about costs from a different angle for a moment. I find it interesting that, when people talk about costs, they do not talk about the costs that have been imposed upon American citizens who need health care but are denied it by their HMO even though they have paid their premiums in good faith. What about the costs imposed on this young boy who was taken past three hospitals to go to the fourth because the family's HMO would not allow him to stop at the first. What is the cost imposed on that young boy who lost his hands and feet or the young boy I described yesterday whose HMO denied him therapy because it said a 50-percent chance of walking by age 5 is a minimum benefit? Or let's talk about other costs, costs on the HMO side. Let me read a table of the 25 highest paid HMO executives. I wonder if there is any interest or concern about their salaries while we are withholding treatment for people under the aegis of cost cutting. Let me list some of the 25 highest paid CEO executives. Annual compensation, 1997: one CEO makes $30.7 million, another has a $12 million salary, a $8.6 million salary, a $7.3 million salary, a $6.9 million salary--these are annual salaries--$5.7 million, $5.3 million, $5.2 million, $5.1 million, all the way down the list of the 25 highest salaries.

Mr. DORGAN. I will be happy to yield.

Mr. DORGAN. I will be happy to yield.

Mr. DORGAN. I ask unanimous consent that Mina Addo, Leah Palmer, Jana Linderman, and Deborah Garcia be given floor privileges today.

Mr. DORGAN. I have not. I have that on the next page. Let me describe that, starting at the top. Twenty-five companies: $61 million in unexercised stock options, on top of the salary, for one person in 1997, $32.7 million, $19.9 million, $19.0 million, $17 million--all the way down the list of 25. It is interesting when people talk about costs. Is there any interest in this, any interest in talking about $35 million, $37 million, $38 million in unrealized stock options?