Byron Dorgan

Mr. DORGAN

Mr. DORGAN. The answer to that is, of course, they do. This issue is not an issue of urban versus rural. The issue of health care and medical treatment exists all around this country. We have talked on the floor at great length about the specifics of it. Yesterday I told the story--I will tell it again, because it describes something more than a Patients' Bill of Rights--does someone who was taken a 40-foot fall and has been helicoptered to a hospital and thrown into an emergency room unconscious with fractured bones in three parts of her body, does that person have a right to emergency room treatment? Or does the HMO have a right to say: We won't cover your emergency room cost because you didn't get prior approval to get to an emergency room? How do you get prior approval when you are unconscious on a gurney being wheeled in from a helicopter, medivac'ed from the mountains where you were hiking? Does a patient in this country who has health care coverage have a right to expect emergency room treatment in those circumstances? Of course. That is what the Patients' Bill of Rights is about. Not just that, but the right to keep the same doctor, and cancer treatment, a whole series of issues like that. Does that affect rural America? Of course, it does. But I want to go back to the point made by my colleague. The agriculture appropriations bill does not come to the floor of the Senate with an ag crisis response because it was not deemed appropriate by those who decided they didn't want to put it there. We are going to try to put it there at some point. I hope perhaps we can do that on a bipartisan basis. I know the scope and the depth of the problem in rural America. The problem is that it costs about $4.50 to produce a bushel of wheat. They drive to the country elevator and the grain trade says wheat is only worth $2.70 a bushel. That is a quick way to go broke. We have a lot of families who are experiencing broken dreams of being able to continue in family farming because the hungry world and the grain trade of the hungry world have said: Your food doesn't have value. It is not in the bill now, so don't be in such a hurry about the underlying bill. We need to add to the underlying bill the farm crisis package that Senator Harkin and others are going to push. In the meantime, we will insist on our rights to try to offer a Patients' Bill of Rights on the floor of the Senate.

Mr. DORGAN. Absolutely.

Mr. DORGAN. It was a partisan vote except for one.

Mr. DORGAN. The only reason I stood up to respond is because there is information from the GAO and elsewhere that suggests that the Patients' Bill of Rights may actually encourage more health care coverage. You may have more people buying health insurance understanding that in their HMO they have rights. They have the right to demand information on all the potential treatments available to them, not just the cheapest, for example. They might well believe that is a pretty good thing. The GAO and others say this may well increase the coverage. The assumption that a couple million people will opt out, I do not believe that. The second thing is, we are going to need to solve the farm problem with folks around here from both sides of the political aisle. The Presiding Officer is from Kansas, a big State in dealing with the farm issue. I would never suggest that somehow he doesn't care about farmers. I have served with him in the House and the Senate and know too well how much he cares about family farmers. We need, at some point, to get together on a solution to deal with the farm crisis. I understand that. I have not said--and I could, I suppose--all right, you took $6 billion that you created someplace and gave it to defense. So my contention is this: You gave the Defense Department money they didn't ask for that should have gone to farmers. I could come out here and make that case, I suppose. But I am not doing that. I have said I thought if there was $6 billion, we should have a debate about the priorities. We didn't. The Defense Department got it, and I am sure they will use it for security needs, readiness, and other things. My point is, on the underlying bill, I don't think we should be too quick to pass it, because it doesn't have the fundamental resources to deal with the farm crisis. In any event, last week the Democratic leader informed the majority leader: If you don't give us the opportunity that we insist upon as Senators, to bring these issues to the floor, such as the Patients' Bill of Rights, then we intend to offer it as an amendment to whatever vehicle is on the floor. Anybody who is surprised by that simply wasn't awake last week. So we will get through this. I think the way we will do it is to have a full debate on the Patients' Bill of Rights at some point, with the ability to offer amendments, as we should, and I hope we will also have a robust debate on the issue of the farm crisis response.

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

Mr. DORGAN. Mr. President, I ask unanimous consent for 10 additional minutes.

Mr. DORGAN. Reclaiming my time, I offered the amendment the other day on behalf of the Senate Democratic leader. It was an amendment that we said last week we would offer to any bill on the floor of the Senate. This is not going to delay the agriculture appropriations bill. The Senator from Idaho well knows that.

Mr. DORGAN. I will in a moment. But let me point out, we are also going to debate the Patients' Bill of Rights. It is not going to be some gatekeeper who is going to tell us what our rights are on the floor of the Senate. Someone will stand over there and say: Well, we have reviewed this amendment. We think we'll allow you to offer that. We are not going to do that. That is not the way the Senate rules exist. The Senate rules exist in a way that says to every Senator: You have a right to offer amendments. I understand that we are not in the majority and we do not set the agenda. The other side sets the agenda. But when they decide that the agenda will be to enhance all of their interests and shut off any debate of interests on the other side, they miss, in my judgment, the history of the Senate. That is not what this body is about. We have rights. We intend to exercise those rights. We are going to talk about education. We are going to talk about health care. Yes, we are going to talk about the farm crisis. And we are going to insist on it. The debate at the moment is our insistence that we be able to have a fair opportunity to offer amendments with respect to our Patients' Bill of Rights, that we have a full debate on them, and to have them voted on. We insist on that. I am happy to yield for a question.

Mr. DORGAN. Mr. President, I take this opportunity to respond just a bit to some of the discussion that has occurred with respect to both the Patients' Bill of Rights and also the agriculture appropriations bill. I just heard the discussion about the Kennedy position in the House and the Kennedy bill this and the Kennedy bill that. It is not what this issue is about. This is about a Patients' Bill of Rights. It is about the kind of health care the American people get when they show up with a disease or with an injury and need health care treatment, what kind of treatment do they get under current circumstances, and what kinds of protections are reasonable protections for them to expect in this system. We have been pushing, for a long while, to try to get a Patients' Bill of Rights enacted by this Congress and by the previous Congress, but our efforts have not met with great success. I will tell you why. Because as health care has reorganized, and the largest insurance companies have herded people into HMOs, they have decided they do not want Congress to pass a Patients' Bill of Rights. They want to be making health care decisions in their insurance offices, often 1,000 miles away from a hospital room or a doctor's office. They do not want Congress, in any way, to pass a Patients' Bill of Rights. They have gotten enough folks here in this Congress, and here in this Senate, to decide that they would block it. And it has been blocked forever. So it does not matter that it was the agriculture appropriations bill. It would have been any bill. The Democratic leader last week said to the majority leader: We intend to offer it. If you don't give us an agreement and an opportunity to decide that we're going to have a fair and free and open debate on the Patients' Bill of Rights, we're going to offer it. We are going to pass the agriculture appropriations bill. Before we pass the agriculture appropriations bill, we are going to have a debate on responding to the emergency of the farm crisis. That is not in this bill at the present time. We tried to put it in the bill in the subcommittee and were defeated in our attempts to do so. But we are going to have a debate that is much larger than just this bill. This bill deals with the funding of USDA programs, research, food stamps--a range of things--but it does not address the farm crisis that exists out there today that deals with income: The fact that farmers go to a grain elevator someplace and the grain trade decides that their food is not worth much, they do not get a fair price for it. Family farmers are in desperate trouble. We are going to debate that bill, but we are also going to debate a bill to try to respond to the farm crisis.

Mr. DORGAN

Mr. DORGAN. In answer, I think there is a leniency here in this system that is unforgivable. The case that the Senator from Vermont just mentioned is referenced in the newspaper today. That case is the grandmother who was trying to grab these children and get them off the streets as the bullets began to fly last Monday. It says in this same story this morning that Derrick Jackson, age 19, has been charged with the first-degree-murder death of Helen Foster-El by stray bullets on Monday night. He had walked away from a juvenile home in April. He had been placed there in connection with juvenile drug and stolen vehicle charges. I will bet you that if you and I take the time to try to get this person's record, we will find a record as long as your arm and that person ought not to have been anywhere near that neighborhood to be able to fire a gun. I will bet you that the record would justify, by any standard of any reasonable person, that this young man ought to have been in jail. But he was out on the streets with a gun. I don't have the record, but this is a guy who walked away from a halfway house or a juvenile home in April. Now it is almost the end of June.

Mr. DORGAN. Let me make one final point. There is one other part of this, the case I have described, the Leo Gonzales Wright case. I have always thought that in this country, in our criminal system, we ought to have two standards, one for violent offenders and one for nonviolent offenders. In every State, violent offenders should never get time off for good behavior. Your prison cell ought to be your address until the day your sentence ends, period, no time off. Leo Gonzales Wright earned nearly 5 years of time off for good behavior despite 33 violations in prison for assault, weapons, and drugs--5 years off for good behavior. He should not have been on the streets. I have a bill that is simple. I have never been able to get it passed. It says this: If any jurisdiction in this country lets a violent offender out of prison early and that person commits a violent crime during the time they would have been serving a sentence, then the government--the city, county, or State that let him out--is responsible to the victim or the victim's family and doesn't have immunity from a lawsuit. This bill would force them make a calculation before sending a violent offender back to the street as to, what might this cost us in terms of what that offender might do to a potential victim? I would like to see Congress pass that at some point. I am going to continue to try. Mr. President, I suggest the absence of a quorum.

Mr. DORGAN. Mr. President, I want to call the attention of the Senate to a couple of items that relate to an appropriations bill we will be marking up this afternoon in about half an hour in the Senate Appropriations Committee. We are going to mark up three bills. I will be there as a member of that committee. One of the bills deals with the District of Columbia. I have spoken on the floor in recent weeks about an issue dealing with the criminal justice system in the District of Columbia. I want to comment on it again in light of a news story in today's paper, this Thursday morning's Washington Post. Some while ago, a young boy was rollerblading in the District of Columbia--a matter of weeks ago--and he was hit and killed by a car that then sped away. That car allegedly was driven by a man who was arrested, Shane DeLeon. He was arrested and put in jail and then, of course, let out of jail, as is so often the case these days. Shane DeLeon, it says in the paper today, walked away from custody. It says: The man charged in the hit-and-run death of an American University student walked away from a District halfway house Tuesday and remained free last night. . . . I want to read a couple of paragraphs because it describes, I think, the chronic problem in the criminal justice system in the District of Columbia and, I should say, elsewhere as well. Shane Simeon DeLeon failed to return to the Community Correctional Center on New York Avenue NE by his 11 p.m. curfew, according to D.C. Department of Corrections officials. [He] was allowed out of the facility from 7 a.m. to 11 p.m. to remodel the basement of his girlfriend's home on MacArthur Boulevard in Northwest Washington. . . . This is the third time [this fellow] has broken curfew. The first two times, he was under home detention. Now he walks away again, this fellow who is facing second-degree murder charges. I have spoken on the floor a lot about a case that was in the news a couple of weeks ago. I spoke about this case some years ago on a number of occasions and then again a couple of weeks ago. It is the case involving the murder of a young woman, Bettina Pruckmayr. Bettina Pruckmayr was a young attorney here in Washington, DC. She was abducted late at night and forced to go to an ATM machine and forced to withdraw money; and then her murderer, Leo Gonzales Wright, stabbed her over 30 times in a brutal murder. It turns out, a couple of weeks ago, after this murderer was sentenced to Federal prison--3 years later, they discovered he had not been put in Federal prison, he was still out at Lorton. The Federal judge was justifiably angry, wondering, why couldn't they even get that right to send this murderer to Federal prison? My understanding is, he is in Federal prison now. But the story in today's paper about a fellow facing second-degree murder charges simply walking away--he was allowed, by the way, while facing second-degree murder charges, to go help remodel the basement of his girlfriend's house from 7 a.m. to 11 p.m.--why is a fellow facing murder charges walking around, remodeling his girlfriend's basement? It is the same story as that of Leo Gonzales Wright. What was he doing walking around on the evening that he eventually murdered Bettina Pruckmayr? Here is a man who robbed a convenience store and shot the convenience store owner; he robbed a cab driver and murdered the cab driver; and then he was sentenced to prison for a minimum of 20 years-- not to be let out before 20 years--and he was let out nearly 5 years early, despite the fact that in prison he had 33 different violations for assault and drugs and weapons. Then he was let out on the streets 5 years before his sentence ended, and, while on the streets, he committed theft and tested positive for drugs. When he was brought before the parole board, this fellow, who was a twice-convicted murderer, was told: No; you can stay out on the streets on parole. Taking drugs as a violent offender is not serious enough to put you back in prison. Theft is not serious enough to put you back in prison. So the message is: The authorities say that a violent offender can commit a theft, can take drugs, can remain on the streets, and remain on the streets in a manner that allowed him, on that fateful evening, to kill this young attorney named Bettina Pruckmayr. A couple of weeks ago, 3 years after this man was sentenced to Federal prison, the Federal judge found out he was not in Federal prison at all--he was in Lorton--and the judge said: What on Earth is going on? I looked into it in order to find out what happened. It is a mess. At every step along the way, this inspector's general report--which is some 50 pages long--shows one massive problem after another. This system is completely devoid of common sense. It is a system that says to the fellow who was up for second-degree murder: You go ahead and fix your girlfriend's basement. We'll give you every day, all day, from 7 a.m. to 11 p.m. to do that. Then he walks away on them, and they are surprised. Or a system that says to another fellow: Yes, we know you are violent, we know you are a murderer, but it is fine if you are on the streets taking drugs, and it does not matter if you are convicted of theft or charged with theft. That is a system, in my judgment, that is defective. I intend to raise some questions at the markup today with respect to the District of Columbia. I notice my colleague from Illinois has come to the floor. He has raised questions that go directly to these issues. This is the District of Columbia that says: We have a lot of money we want to offer for tax cuts. They do not have enough money, apparently, to have prison space to keep people convicted of murder in prison. The Senator from Illinois has asked the questions now a good number of times publicly: What about that? What about your priorities? What about your responsibility to the memory of Bettina Pruckmayr, who was murdered by someone who should have never been on the streets to murder anybody? He should have been in prison, but he was let out early. This fellow Leo Gonzales Wright was in Lorton Prison. Do you know why he was let out early from there? Because he apparently was allowed into the prison system to change his own records; so when they looked at his records, they had all been altered to say he was a good guy when, in fact, he was a bad guy. It is just unforgivable what is happening on the streets in this country, especially in the District of Columbia. And one additional point: It is not just there. There is a county adjacent to the District of Columbia in which two fellows are, I believe, on trial to be convicted for the murder of a couple people in a Mr. Donut shop. I asked my staff to look at the backgrounds of those folks. It seems the same two people carjacked a fellow on the interstate around this beltway, the same two people just months ago carjacked someone in a violent carjacking out on the streets so they could murder a couple people at a Mr. Donut late at night. Day after day we read this, especially in the District of Columbia. I am sick and tired of it. I will offer a couple amendments. I will consult carefully with my friend from Illinois, who is the ranking member on that subcommittee. One of the amendments is, if you are on parole in the District of Columbia for a violent crime and you are picked up on the streets as having taken drugs, you ought to find that your next address is back in that same jail cell. We ought not have violent criminals on parole taking drugs and then have parole officers say that is alright; that it is a minor infraction. If you are a violent offender on parole taking drugs, my friend, your address ought to be a jail cell, once again, to the end of your full term. I intend to offer that amendment. I hope that is the sort of thing we can get passed. I yield to the Senator from Illinois.

Mr. DORGAN. I am fully aware of that debate and in full support of the statements the Senator from Illinois has made. Let me put up a chart that shows what has sparked my ire. I am not someone who comes to the floor to beat up on the District of Columbia, nor is the Senator from Illinois. I have simply had a bellyful of this behavior by folks in the criminal justice system in the District of Columbia. This headline ran a couple of weeks ago: Killer Sent to Wrong Prison after Second Murder. This headline is referring to Leo Gonzales Wright who murdered Bettina Pruckmayr. Three years after he was sentenced by the Federal judge, they still couldn't get him in the cell that he was supposed to be in. The point is, the inspector general report--I urge all my colleagues to read it--shows a system that is totally corrupt. It portrays a system that says to a violent murderer: You are out on parole. You are out early. You can take drugs. You can be charged with theft, and we don't care. You get to stay on America's streets. A city that can't keep violent offenders off its streets and behind bars is a city that can't keep its streets safe. American citizens deserve better, especially in America's Capital, Washington, D.C. The recommendations of the inspector general are really interesting. I read this at home the other night. When I finished reading it, I shook my head and said: This is such an incompetent system. It doesn't take rocket science to know what you have to do. When someone holds up a convenience store and shoots the owner, when the same person then decides to rob and murder a cabdriver, and then when that person is let out of prison early and decides to take drugs and steal, does that person belong on our streets so that this wonderful young attorney Bettina Pruckmayr can show up at an ATM machine one night, only to be savagely murdered by this animal? Does this person belong on the streets? Of course not. Who was responsible for putting this person on the street? The criminal justice system. Person after person after person failed, and the result is a dead woman, a dead, innocent, young woman, full of promise, who met a killer on the streets of our Nation's Capital. I say again, when we come to the floor--I will go to the Appropriations Committee in 15 minutes--I will offer two amendments, one of them dealing with drugs. I would have thrown this man back in prison immediately, and he wouldn't have been anywhere near Bettina Pruckmayr to be able to murder her that evening. I would have said: If he is found with drugs, as he was repeatedly, having been a formerly convicted murderer, that man goes back to a prison cell. That is just common sense. Do you know, the policy of the District of Columbia was that drug use by someone on parole was not a serious enough offense to put them back in prison? What on earth can they be thinking? They are going to give a tax cut, but they don't have enough money for prison cells to keep violent people behind bars. Shame on those people. Shame on those people who make those judgments. The murder of a young woman and so many others are on their shoulders.

Mr. DORGAN. I am happy to yield.

Mr. DORGAN

Mr. DORGAN. Mr. President, reserving the right to object, and I shall not object, my understanding is there is a conference occurring on the other side that the two Members of the majority party in the Chamber wish to attend. We want to allow that to happen. I point out, under my reservation, it is my hope that when we reconvene with the hour of morning business, whatever transpires beyond that will be an agenda that allows Members on the floor of the Senate to come and discuss the issues they want to discuss. I will not object with that caveat.

Mr. DORGAN

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

Mr. DORGAN. I wonder if the Senator from South Dakota will yield? When he talks about medical necessity, I am reminded of two specific issues. One, the doctor who testified at a hearing before the Congress who worked for a managed care organization, who said: I caused the death of a man. She said it to a near-empty hearing room when the television cameras were gone. She was the last witness of a day. I caused the death of a man, she said. I wasn't reproached for that. I wasn't issued any sanctions. In fact, my employer really felt quite good about it. I was rewarded for it. I withheld treatment that could have saved that person's life. She was dealing at that point as an employee of an HMO, and a patient apparently needed some kind of heart procedure that was very expensive. The HMO said it was not a medical necessity. The patient died. This lady left her employment and later testified before the Congress and said it was a matter of dollars and cents. I caused the death of a man, but I was lauded for that by my employer because, to them, it was a matter of dollars and cents. So that relates to medical necessity. What is necessary? The second item I was thinking about, I know the Senator from South Dakota was at an event one day; the Senator from California, Mrs. Boxer, was at the same event. Dr. Ganske, a Member of the House of Representatives, who is a Republican and has been a strong supporter of the Patients' Bill of Rights, held up a poster, a colored picture of a young boy. That young boy had no upper lip and no structure beneath his nose--a giant gaping hole. He was born with a very severe birth defect. It looked awful. One was hardly able to look at that young boy's face and not immediately say what incredible disfigurement this young boy has. Dr. Ganske, who was speaking that day, said: The HMO said there was not a medical necessity for this young boy to receive repairs. In dollars and cents, the repair of that horrible disfigurement did not make any sense to the HMO. But then he showed a picture of this young boy having gone through reconstructive surgery, and you saw a face, a wonderful face of a young boy which had been repaired and now that young boy had hope. One could sense the smile in that picture, and that is what medical necessity is. It is not convenience. It is not just dollars and cents. It is investments in human beings, giving hope to a young boy. I have one other person, if I may, whom I want to mention and whom I have mentioned before. He is a young boy born with horrible problems. The doctors said he would have a 50-percent chance of walking by age 5 if he had a certain kind of therapy. The HMO said: A 50-percent chance of walking by age 5 is ``insignificant,'' which means that in dollars and cents they withhold the therapy and the young boy is not able to walk. He doesn't have the chance to learn to walk. That is dollars and cents versus medical necessity. That is what is at issue. What is at issue is the ability to empower patients with the opportunity to get needed medical treatment, not necessarily the cheapest treatment, but the best treatment, not necessarily the treatment that someone in an insurance office a thousand miles away thinks might or might not be necessary, but what the doctor in the doctor's office thinks is necessary for that young boy's life, such as the reconstructive surgery of that boy's face. That is what I think about when the Senator speaks about medical necessity. This is not theory. It is not some abstract term. It is an important part of lives, and that is why the Patients' Bill of Rights is so critically important and why the difference between what we are talking about and others are talking about is so stark. We adopt the title, Patients' Bill of Rights, and then they say: We have one, too. Sure you have one. It is like picking up a turtle shell without a turtle in it. It is a shell. It does not mean anything. It does not provide the guarantees for people. That young boy would not have had his reconstructive surgery. The other young boy would not have had a chance to walk. And the list goes on. That is why these differences are so important. Medical necessity, guaranteed emergency room treatment, the gag rule, understanding all your medical options for treatment, not just the cheapest--all of these things are critical differences, and it is why I believe they do not want to allow the Senator from South Dakota to bring the bill before the Senate. We need to vote on these things, if not in total, then one by one, to find out where do my colleagues stand on it. Do they stand for the right of emergency room treatment? Do they stand for the right of reconstructive surgery for that young boy? Where do they stand on these specific issues? That is what is going to happen in the coming days. Like it or not, we are going to force them to face that, because the American people deserve the opportunity to have a Patients' Bill of Rights passed by this Congress empowering them.

Mr. DORGAN

Mr. DORGAN. This morning, as chairman of the Democratic Policy Committee, I convened a hearing on the farm crisis. About 10 to 12 of my colleagues came to the hearing. We had a number of family farmers from across the country testify. We had Woody Barth, a farmer from Solen, ND, testify; Rob Lynch, a farmer from Zillah, WA; Glenn Brackman, a farmer from Lafayette County, AR. We had some folks from Illinois, Iowa, and Kentucky. We talked about the farm crisis and about public policies that ought to be employed by this Congress to respond to the farm crisis. I pointed out that a lot of people are not aware of the farm crisis. It is probably a circumstance that farmers working in quiet desperation, many of them threatened with losing their farms, are going through a period that most Americans do not understand and don't know about. Every day we hear the stock market is up or down, mostly up--the stock market has gone to 11,000, now back down a bit. But the fact is, this country generally hears good economic news about where the stock market is going, about new information technology, about the progress of new companies, about the new day, about the global economy. Yet the folks who stay at home and produce America's food on our family farms are in desperate trouble. Wendell Barry, a farmer from Port Royal, KY, testified today. He is also an author, a wonderful guy, kind of a philosopher-writer type. He wrote some things. In fact, he has written a book called ``Another Turn of the Crank.'' I will read a couple things he has written that I think really bear on this issue. I do it in the context of the bill that is to be on the floor. We did have the agriculture appropriations bill on the floor of the Senate. It will come back, hopefully, as soon as an agreement is reached with respect to the Patients' Bill of Rights. When it comes back to the floor, Senator Harkin and I intend to offer an amendment similar to the amendment we offered during the emergency supplemental appropriations bill. That amendment lost on a 14-to-14 tie vote in the conference. We also offered a proposal in the agriculture appropriations subcommittee. But this is the time, when the agriculture appropriations bill is on the floor, for the Congress to decide what it will do with respect to emergency responses to the farm crisis. There are some who might counsel we should do nothing, that it doesn't matter whether there are farmers in this country. They would say: Food will be produced anyway, and it doesn't matter much who produces it. We can farm America from California to Maine with corporate farms, and that is just fine. I do not happen to share that view. I think that is a view that is devoid of all common sense. It suggests there is no worth and no value at all to the culture of family farming, that family farming doesn't contribute to our country, that the fact there are people living out on the land is irrelevant. The fact that those people combine to make small communities and build our main streets and build our churches and create good neighborhoods is irrelevant; that kind of investment and that kind of creation in our country doesn't count. I guess those who think that way look through the lens of perhaps Wall Street or others who see only dollars and cents, only rows of columns. You add them up or you subtract them. You reach a balance, and that is the cost. It just eliminates, of course, the question of what is the value. Are family farmers contributing value to this country? Will the loss of family farmers matter to our country? The answer is yes on both counts. Mr. Wendell Barry from Port Royal, KY, writes: As we all know, we have much to answer for in our use of this continent from the beginning, but in the last half century we have added to our desecrations of nature a deliberate destruction of our rural communities. The statistics I cited at the beginning are incontrovertible evidence of this. He cited statistics about the loss of farms, the depopulation of our farm belt, and so on. But so is the condition of our farms and forests and rural towns. If you have eyes to see, you can see that there is a limit beyond which machines and chemicals cannot replace people; there is a limit beyond which mechanical or economic efficiency cannot replace care. I am talking here about the common experience, the common fate of rural communities in our country for a long time. It has been, and it will increasingly be, the common fate of rural communities in other countries. The message is plain enough, and we have ignored it too long: the great, centralized economic entities of our time do not come into rural places in order to improve them by ``creating jobs.'' They come to take as much value as they can take, as cheaply and as quickly as they can take it. They are interested in ``job creation'' only so long as the jobs can be done much more cheaply by humans than by machines. Mr. Barry writes, about liberals and conservatives, an interesting admonition: Long experience has made it clear--as we might say to the liberals--that to be free we must limit the size of government and we must have some sort of home rule. But it is just as clear--as we might say to the conservatives--that it is foolish to complain about big government if we do not do everything we can to support strong local communities and strong community economies. He is right about that. We must decide as a Congress whether we are going to support America's family farms. I spoke at the hearing today, when I questioned the witnesses, about where I come from. I have told colleagues often about that. I come from a rural county in southwestern North Dakota that is the size of the State of Rhode Island. That county had 5,000 people when I left, and there are now 3,000 people living in that county. The county next to it is about the same size and there are 900 people living in that county. We are fast depopulating rural America. Rural economies in small towns are shrinking like prunes. We now have prices for commodities, when the family farmer raises a crop and hauls it to the market, that are deplorable. The family farmer is told when he or she takes a truckload of wheat to the country elevator--the grain trade says: This doesn't have value. The food you produce is not of great interest to us. It is not worth very much. At the same time, we have people who come and testify before the Congress that the Sudan, for instance, old women climb trees to try to find leaves to eat. We know much of the world is hungry, and we also know that while much of the world is hungry, the grain market tells our farmers their food isn't worth very much. Something is not connected there, and this Congress must try to reconnect it. We only have two choices, it seems to me. One is an opportunity, on an short-term emergency basis, to pass an emergency farm bill. It seems to me the question for this Congress is: Are we going to pass a short- term emergency bill to try to help family farmers? Second, are we going to repair the farm program, and the trade agreements, and other things that conspire to injure family farmers? On the first issue, Senator Harkin and I intend to offer an amendment for $5 billion to $6 billion to try to provide short-term emergency help for family farmers on this agriculture appropriations bill when it is brought back to the floor. We will have a fight about that. I don't know how that will turn out. I hope Congress will say that family farmers matter. It was interesting to me that when the President sent a request down for military aid to restore and refresh the accounts in the Pentagon for conducting airstrikes in Kosovo, Congress said to the President: No, you are wrong about that, Mr. President, you didn't ask for enough money. We insist that you give $6 billion more. Mr. President, you shortchanged us in your request for defense, so we are going to give you what you ask for and we are going to add $6 billion more to your request for defense. Well, gee, that came from conservatives. I hope those same conservatives will agree that the effort to save America's family farmers is as important. Don't tell me there is not money. There was money to say to the President we want to add $6 billion above what the Pentagon said it needed. If there is money to do that, there is surely money to invest in family farmers in rural America. So my hope will be that we are able, on a short-term basis, to pass an emergency bill; and, second, having done that, we will then revisit the question of the underlying farm program. This farm program is not working. It ought to be apparent to everyone. The farm program that the Congress passed essentially said let us do whatever the marketplace says ought to be done. But there is not a free market in agriculture. There is not now, and has not been, a free market in agriculture. Our farmers look at trade, and what they find is that markets are closed to them in many corners of the world. So we raise a product we want to sell overseas and the markets are closed. Or if you raise, for example, beef, you will discover not only are the markets closed in some areas, but in other areas, such as Japan, you will pay a 45-percent tariff to get American beef into Japan, only to find out that the Canadian beef --both live cattle and hogs, and slaughtered beef and hogs--coming down is increasing at a very rapid pace. So we have grain and livestock coming in undercutting our markets. We find foreign markets are not open to us, and we have all of these trade negotiators running around doing trade agreements that have undercut our agriculture producers. We need a farm program that works and trades policies that make more sense than the current policies. I voted against NAFTA and the United States-Canada free trade agreement, and I voted against the GATT agreement. I did all of that because I think that, while we need expanded trade, we do not, and should not, embrace trade agreements that are fundamentally unfair to rural America. I recall when I was on the House Ways and Means Committee and the United States-Canada free trade agreement came to the committee, and the Trade Ambassador, who I won't name--Clayton Yeutter--said to us that the trade agreement itself would not result in a massive flood of Canadian grain coming across our border. I said, well, I think it will, and you know it will. ``Put it in writing,'' I said. The Trade Ambassador wrote to us on the committee guaranteeing that it would not happen. It wasn't worth the paper it was written on. It happened, and it happened quickly. Not only did it happen--massive quantities of durum and spring wheat came across our border flooding our market, undercutting the market for American farmers--but we were then neutered in our ability to respond to it because he also traded away the remedies. So we didn't have a remedy for it. That was in the United States-Canada free trade agreement. That passed the House Ways and Means Committee 34-1. I was the one. I didn't feel lonely a bit because I knew exactly what was going to happen with the agreement. Farmers' interests were traded away. In my judgment, we ought not accept trade agreements like that, whether it is United States-Canada, NAFTA, or GATT. Speaking of NAFTA, after the United States-Canada free trade agreement, they negotiated NAFTA. The economists were telling us what a great deal it was. After the trade agreement with Canada and Mexico, the trade surplus we had with Mexico turned into a big deficit in a short time. The trade deficit with Canada doubled in a short time. Instead of creating new jobs in this country, we lost massive numbers of jobs. All these economists who were predicting 300,000 jobs were just fundamentally wrong. We lost a lot of jobs as a result of that. They said if we just pass these agreements, we will get from Mexico the product of low-skill wages. Do you know what we got? The three biggest products coming in from Mexico are automobiles, electronics, and automobile parts--all products of high-skilled labor. We now have more automobiles imported into this country from Mexico than the United States exports to all the rest of the world. That is what we got with NAFTA--again, undercutting our interests, hurting a lot of producers in this country, and especially injuring family farmers. Well, the point I am making is this: We had testimony this morning from folks who came from across the country to say we have a very serious problem in rural America. We can't fix that problem on a partisan basis. We need Republicans and Democrats together to agree that, No. 1, there is a farm crisis, and, No. 2, they are willing to do something about it, to respond on an emergency basis, and then to repair a farm program that is fundamentally deficient, which doesn't value family farming, a farm program that says it doesn't matter who farms. That, in my judgment, misses a lot of what is important in American life. My hope is that in the next couple of days, as we offer amendments-- Senator Harkin, myself, and others--on an emergency basis, we will be able to strike a bipartisan agreement to do the right thing on behalf of family farmers. I know that it is a message that some get tired of hearing, perhaps, but I come from farm country and I care a lot about what is happening out in our part of the country. North Dakota is a wonderful State. It has a lot of rural counties, and the fact is that not just family farmers but machinery and equipment dealers, Main Street businesses, and so many other people are suffering so much through this economic distress, even at a time when the rest of the country seems to be doing so well. I had a letter from a young boy who talked about the distress his folks were going through while trying to hang onto their family farm. He said: My dad can feed 180 people, and he can't feed his family. He was talking about the fact that the family farm is so productive in this country, and they are losing so much money. You hear this over and over again. This Congress, it seems to me, must respond. We are going to try to force that response, first with respect to the underlying agriculture appropriations bill with an emergency package, and, second, hopefully, to revisit and readdress the entire structure embodied in the underlying farm bill. I yield the floor. I suggest the absence of a quorum.

Mr. DORGAN

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

Mr. DORGAN

Mr. DORGAN. Mr. President, it is the responsibility of the Senate Foreign Relations Committee to consider treaties submitted by the President as soon as possible after their submission. Normally, most treaties are considered within a year of being submitted. The President of the United States transmitted the Comprehensive Nuclear Test Ban Treaty to the Senate on September 23, 1997. The Senate Foreign Relations Committee has not held a single hearing on this important Treaty in the 639 days since the President sent the CTBT to the Senate for its consideration. In comparison, the START I Treaty was ratified in 11 months, the SALT I Treaty in 3 months, the Conventional Armed Forces in Europe Treaty in 4 months, and the Limited Nuclear Test Ban Treaty in 3 weeks. As of today, 152 countries have signed the CTBT, including Russia and China, and 37 countries have ratified the Treaty. The world is waiting for the United States to lead on this issue. I hope my colleagues will urge for this Treaty's rapid consideration.

Mr. DORGAN

Mr. DORGAN. The Senator is talking now about specifics, and Senator Daschle was asking about clinical trials. Let me ask another specific. Regarding emergency room treatment. Senator Kennedy makes the point there is the Patients' Bill of Rights on this side and the Patients' Bill of Rights on that side. But they are not the same. There is a big difference. Let me give an example regarding emergency room care. I told the story of a case of a woman named Jacqueline the other day. Jacqueline is a real person. She was hiking in the Shenandoah. While hiking in the Shenandoah, she slipped and fell down a 40-foot cliff. She fractured three bones in her body, including her pelvis. She was unconscious. She was medivac'ed by helicopter, taken to a hospital emergency room, and treated. She survived. The HMO said: We don't intend to pay for your emergency room treatment because you didn't have prior approval to go to the emergency room. This is a woman who was unconscious. The Patients' Bill of Rights that the AMA and so many other groups have endorsed--they have written in support--is different from the bill the majority party offers in the emergency room treatment in the sense that we require not only the ``prudent'' layperson standard in emergency care and emergency room, but we require also the poststability care that is necessary after you have been to an emergency room, and their bill does not do it.

Mr. DORGAN. Will the Senator yield?

Mr. DORGAN. I will respond, if the Senator will yield to me further, with the story I told on the floor of the Senate, about the woman who was also injured, whose brain was swelling and who was in an ambulance being taken to a hospital and who said to the ambulance driver, I do not want to go to X hospital. She named the hospital. I want to go to Y hospital farther down the road. This woman lying in the back of an ambulance with a brain injury said: I want to go to the hospital farther away. Why did she say that? Because she read that the hospital that was closest had made decisions about patients' care that were more a function of corporate profit and loss than they were about health care, and she did not want, with a brain injury, to be wheeled into the emergency room with the notion somebody was going to look at her and make a dollar-and-cents decision about her health care.

Mr. DORGAN. I just described a case of a woman being hauled into the hospital unconscious and being told: We can't pay your bill because you didn't get prior approval for emergency room treatment. That is absurd. That is the kind of horror story that requires all Americans to believe we must pass a Patients' Bill of Rights that has teeth and works to solve real problems. Isn't it the case, with respect to emergency room care, that we in this Congress have already given all senior citizens in the Medicare program exactly what is proposed in our bill with respect to emergency room treatment and poststability care? Isn't it the case that every Member of the Senate has already voted for that in Medicare, saying yes, that is the right thing to do; but when it comes to the Patients' Bill of Rights they say: We want to have a Patients' Bill of Rights, but on our emergency room care, we don't intend to offer that protection on not only emergency room care but also poststability care in a hospital after you get out of the emergency room; we don't intend to offer that, even though we have already done that and voted for it for Medicare patients. I don't understand the contradiction; does the Senator from Massachusetts?

Mr. DORGAN

Mr. DORGAN. One additional question. I will not belabor the point, except I was with Senator Daschle, along with my colleagues, last Thursday. He made it clear to everybody here in the Capitol what his intention was for this week. There would not have been a need to submit this amendment today on any bill had there been an agreement last week. But let me also say when we get to the agriculture appropriations bill, at some point there is going to be lengthy debate about the emergency response that we need to do with respect to this farm crisis. Let me finally make this point. We will, I assume, at some point have a full debate on the Patients' Bill of Rights. It will be a debate with amendments offered by both sides--not amendments cleared by anyone, not amendments in which someone is being a gatekeeper and which people have an opportunity to say here is how we feel about this issue. That is going to happen sooner or later.