John Edwards

Mr. EDWARDS

Mr. EDWARDS. Mr. President, I say respectfully in response to my colleague from Oklahoma that there are two things about which I fundamentally disagree with him. No. 1, under our proposal, the State-- totally independent--chooses the reviewing body. If my colleagues are really looking for an independent review, I ask them whether they would agree to allow the State to choose the reviewing body instead of the health insurance company, instead of the HMO choosing the entity that chooses the reviewing body. I cannot imagine how they would disagree with that if they are looking for a truly independent review. Secondly, the entire issue revolves around what is medical necessity. I say to my colleagues, would they agree to change the language of this amendment so that the initial decision and every appeals decision of the appeals deciding body is not bound by the definition of ``medical necessity'' contained in the insurance written contract? Because so long as the appeals process is controlled by what the HMO wrote, what the health insurance company wrote at the beginning and all the way through the process, the patient does not have a chance. They will never have a chance. My question is to my colleagues----

Mr. EDWARDS. Am I allowed to respond?

Mr. EDWARDS. My question is, Can you point to specific language in the bill that requires that the reviewer, in order to be independent, not have an ongoing financial relationship with the health insurance company?

Mr. EDWARDS. Absolutely, doctors who have seen the patients. We believe doctors ought to make the decisions.

Mr. EDWARDS. The Senator is correct, and the patient would be stuck with that decision initially by the HMO and would be stuck with it throughout the entire appeals process and would have absolutely--it goes to the very heart of this debate: Do we want health insurance companies deciding what is medically necessary, or do we want health care providers, doctors, and patients making the decisions?

Mr. EDWARDS. You would have absolutely no opportunity and no opportunity to have the decision reversed. I might add, there is a double whammy in this amendment. The double whammy is that the only thing that can be appealed is the determination of what is medically necessary, and what is medically necessary, under the language of their bill is--and I am reading now from the bill--``when medically necessary and appropriate under the terms and conditions of the plan,'' which is what the HMO and the health insurance company's contract says. People are getting whammied twice: No. 1, you cannot appeal but one thing, which is: Is it medically necessary? No. 2, that determination is based on what the health insurance company or the HMO wrote into the plan.

Mr. EDWARDS. They pay the reviewer. We have said it now five different times, but talk about putting the fox in charge of the chicken coop. What we need to be doing is to have some truly independent body making these determinations. They need to be able to make the determination based upon what the patient, in my example the child, really needs, based on what the doctor says the child needs.

Mr. EDWARDS. That is absolutely correct. There is nothing that requires the independent reviewer to see the patient. You could have some doctor who is nothing but a bureaucrat, who has not seen the patient, does not know what the patient needs, making the decision. If I could add one thing, another problem with this so-called independent review process is the HMO, the health insurance company, are the ones that are determining. Remember, they choose this entity that chooses the reviewer. They determine who is biased or unbiased.

Mr. EDWARDS. That is absolutely correct. Let's suppose we had a young child who needed a particular kind of care and every physician who had treated that child recommended the care for the child. But there was a less costly procedure that could be used, so the care was denied. Throughout the appeals process, the determination of whether it ought to be reversed or not would be based on what is the least costly, because it is totally controlled by the definition written by the HMO. In the language the Senator from California has just read to me, where it says it shall be within the ``sole discretion,'' what that ultimately means is whatever appealing body is deciding, which is bound by that definition, which they are by this amendment--if they are bound by that definition, every appealing body would be left with no alternative but to affirm the decision because the contract says it is left within the sole discretion of the HMO. It goes to the very heart of the Senator's amendment. It goes to the very heart of this debate. The whole question is, Are health insurance bureaucrats going to make health care decisions or are health care decisions going to be made by doctors and health care professionals?

Mr. EDWARDS. Under the definition the Senator has just read--and I might point out the appeals process that is contained in this amendment is completely controlled by the HMO or health insurance company's definition of medical necessity. Throughout the process it is totally controlled by it.

Mr. EDWARDS. I thank the Senator very much, and I reclaim the remainder of my time. Mr. President, there are two fundamental problems with this amendment that go to the very heart of this debate. First, as my colleague from New York pointed out, this review is not an independent review. It is not an independent review by any definition of independence. The reason is, No. 1, the health insurance company, the HMO, chooses the entity which chooses the reviewer. I want to be precise here. That is exactly what the bill provides. The health insurance company chooses an entity; that entity chooses the reviewer. So the health insurance company has control over who ultimately does the review. No. 2, the only requirement with respect to financial independence or professional independence is the requirement that I just read to the Senator from Pennsylvania, that the reviewing entity not have a financial or professional relationship with the very specific case under review, which means there is nothing to prohibit a reviewer, the so-called independent reviewing body under their amendment, from being somebody who has a longstanding, ongoing relationship with the health insurance company or with the HMO. Nobody in America, certainly none of my colleagues in the Senate, would believe that an independent review could be conducted by somebody who has an ongoing contractual relationship and receives money from the health insurance company. There is absolutely nothing in this bill which prohibits that. That is why the Senator from New York and I have proposed an amendment that makes it very clear that there is a truly independent reviewing body. That independence is critical and to the very heart of the review process. It is why we need it. I notice both the junior and the senior Senators from Pennsylvania are on the floor now. In Pennsylvania, these reviews are conducted by a State regulatory body. They are not conducted by some person chosen by an HMO or a health insurance company. Second, in terms of what can be reviewed under the State law of Pennsylvania, any consumer grievance can be reviewed. It is not, as this bill is, limited to what constitutes medical necessity. Third, under the law of the State of Pennsylvania, the review is de novo, which is absolutely not what this amendment provides. Let me go back and summarize where we are. No. 1, we don't have, under this amendment, an independent review. We don't have it for two fundamental reasons: No. 1, the health insurance company, the HMO, is allowed to select the body that picks the reviewer. No. 2, the reviewing body is allowed to have a longstanding professional or financial relationship with the HMO that has denied the claim. There is absolutely nothing to prohibit that under this bill. Our amendment, which will be considered at a later time, would not allow that. So there is no independent review. The second problem is--and this goes to the amendment offered by my colleague from California--this review process is meaningless so long as the reviewing body is bound by the definition of medical necessity contained and written by the HMO. It is absolutely bound by the language of the HMO. I will add, in committee--I see my colleagues from Massachusetts and Tennessee are here--Senator Kennedy asked a question to Senator Frist. The question was: Would the Senator accept language that mentions that the decision would be made independent of the words of the contract? The question Senator Kennedy posed was: Would you agree that in the appeals process, the determination could be made without regard to the HMO-written definition of medical necessity? Senator Frist's answer was: ``No, sir,'' in the committee. So he would not concur to not be bound by the language in the HMO or health insurance contract. So there are two fundamental problems, and they work in concert to be devastating and to make this amendment devastating to the whole concept of the Patients' Bill of Rights. No. 1, there is no independent review. The people are picked by the HMO, and they are allowed to have an ongoing financial relationship with the HMO. No. 2, they are bound by an HMO-written definition of medical necessity. That is the very heart of the amendment of my colleague from California, because what this debate is ultimately about is whether health care decisions are going to be made by medical professionals, doctors, or whether they are going to be made by insurance company bureaucrats.

Mr. EDWARDS. I am looking at page 30 of the actual amendment that has been offered. Looking under subsection (B)(ii), this is the designation of independent external reviewer, which goes to the very heart of whether the review is independent or, in fact, is not independent. In subsection (ii) it says there is a requirement that the reviewer ``not have any material, professional, familial, or financial affiliation with the case under review.'' My question to the Senator is--and I would like to see the language in the actual amendment, if he could point to it--what is it that requires that the reviewer not have an ongoing financial relationship with the health insurance company or with the HMO, which would in fact, as the Senator I am sure would recognize, make them not independent?

Mr. EDWARDS. Mr. President, if the Senator from Pennsylvania will respond to a question.

Mr. EDWARDS

Mr. EDWARDS. I thank the Chair. Mr. President, I will briefly respond to the remarks by Senator Collins from Maine, for whom I have tremendous respect. She and I have worked together on a number of issues. I know she believes deeply in the cause she advocates this afternoon. I have great professional and personal respect for her. This is an issue on which I happen to disagree with her for a number of reasons. First, she suggests their plan--the plan she is referring to I assume is the Republican plan--is one that adequately protects patients' rights because of laws enacted in States across the country. If that is so, why is there such an enormous public outcry for reform? The American people believe deeply that patient protection legislation is desperately needed across this country. If these laws already exist and are already in place and are working, why in the world does anybody need to do anything? The reality is that these laws are not in place and they are not working. Let me give a few examples. For example, access to clinical trials, which is a critical component of our bill: 47 States of the 50 have no provision for access to clinical trials. External appeals, which are absolutely essential: 32 States have no provision for independent external appeals. Access to specialists: 39 States have no provision allowing people to designate a specialist as their primary care provider, and 36 States have no provision for standing referrals to specialists. Continuity of care: 30 States have no continuity of care provisions. This list goes on and on. The reality is, No. 1, that the majority of States have none of the protections we are talking about in the Democratic Patients' Bill of Rights. That is the reason there is an enormous public outcry. That is the reason we have a health care crisis in this country today, and it is the reason I respectfully disagree with my colleague, the Senator from Maine. The second reason is, to the extent a State has passed any kind of patient protection legislation and that legislation conflicts in any way with ERISA, it is preempted. It is absolutely preempted, under existing law, if we never pass anything. Even the laws that have been passed, to the extent those laws conflict in any way with the existing ERISA statutes, are preempted by ERISA. The bottom line is this: No. 1, if State laws adequately dealt with this problem, we would not have the public outcry, the horror stories which we have heard and will continue to hear in this Senate over the course of the next week. No. 2, the fact of the matter is, to the extent those laws exist--and they do not exist in the majority of States on the critical issues--to the extent they do exist, they are preempted by ERISA. I do want to mention one other thing on the issue of cost because there has been a lot of discussion about cost from the Senator from Oklahoma and the Senator from Maine. First of all, it is critically important to recognize that to the extent we get a patient to a specialist soon, and we do that in our bill, to the extent we allow women to go directly to an OB/GYN as their primary care provider, to the extent we allow patients who are in a critical emergency to go the nearest hospital and be seen by an emergency room department or physician and thereby save that patient's life or reduce the amount of long-term care that patient receives--in every one of those instances we are reducing long-term health care costs in this country. So I want us to recognize, first, that to the extent we are talking about increased costs, they are only talking about short-term costs, not long-term costs. The truth of the matter is that long-term costs will be reduced by passage of the Patients' Bill of Rights for the very same reason that preventive medicine reduces health care costs in this country, because we are going to get folks to the doctor they need to see sooner; they are going to get the care they need quicker. The net result of that is that they do not need the ongoing, chronic, long-term care that many patients, unfortunately, have to get because they do not see the physician they need to see as quickly as they need to see them. That is what the external review process does. That is what the internal review process does. I might add, those two things work in concert with the fact that, under our bill, an HMO can be held accountable in court for what they do. I want the American people to recognize what happens when an HMO cannot be held accountable, when they are treated as a privileged entity. And under existing law they are a privileged entity. They, among all the businesses and corporations and individuals in this country, get special treatment, treatment that none of our families or our children or our small businesses get. They are all held completely responsible. But HMOs, for some reason, are above the rest of us. They are a cut above the rest of us. They get special treatment. They cannot be held accountable in court. So what happens when an HMO makes an arbitrary and capricious decision and a child suffers a serious injury as a result and has a lifetime of medical care in front of them--for example, a 7-year-old child? If the HMO can be held responsible, the HMO bears that cost, as well they should bear that cost because they are responsible for it. But what happens if the HMO does not bear the cost? We know where the cost goes. It goes to us. It goes to the American taxpayer. Because those kids do not have the money to pay for chronic, long-term care over the course of their lives. They are paid out of Medicaid. They are paid with taxpayer dollars. The net result of that is that the cost an HMO or a health insurance company would bear has been shifted to the American taxpayer. That is wrong. We know it is wrong. That is one of the things we are trying to do something about in this bill. I have to add one other thing. The Senator from Oklahoma said over and over during the course of his argument that what our bill proposes is that the Government knows the answer, that the Government has the solution. My response to that, with all due respect, is existing law and the bill of the other side would say the HMO has the answer, the health insurance company has the answer. I say to the American people, and to my colleagues, we have tried that. We have tried leaving this in the hands of the HMO. We have tried leaving it in the hands of the health insurance industry. And it has not worked. With that, I conclude by saying I think it is critically important that we cover all Americans, that all Americans are covered by health insurance plans. That is done under the Democratic bill.

Mr. EDWARDS. Thank you, Mr. President. Mr. CHAFEE addressed the Chair.

Mr. EDWARDS

Mr. EDWARDS. Thank you, Mr. President. Let me say, first, that there are two very important reasons that this has been an extraordinarily difficult issue for me. The first of those reasons is that I have extraordinary respect for the Senator from Arizona, the Senator from Connecticut, and the Senator from Oregon. They are friends of mine. They are good Americans. They are good people. They care about this country. They care about it deeply. I don't question their motives for one moment. I believe they are doing what they think is right. The second reason is that I began this process myself desperately wanting to support some kind of Y2K bill. The problem with the way the debate has been conducted is that the focus of my colleagues from Oregon, from Arizona, and from Connecticut has been on things we all agree on. We all agree--speaking for myself-- that we should create incentives for computer companies to solve these problems, that we should create incentives for people who buy computers to work with those folks to solve problems, and to mitigate whatever damage or loss they may sustain. We all believe there ought to be a cooling-off period. At least I believe there should be a cooling-off period. I do not think we want folks rushing to the courthouse the first time a problem rears its ugly head. I think we should have reasonable, thoughtful alternative dispute resolution. I think all of those things are good things. They are laudable. They accomplish important goals. They are things I support and believe in. On those subjects, and on the subject of preventing frivolous litigation, I am totally in agreement with my colleagues who support this bill. The problem is, we are not focusing on the single, most fundamental problem in this bill, which is that in 99 percent of the cases small businesses and consumers who suffer losses as a result of an irresponsible act by a computer company in respect to Y2K can recover nothing but the cost of their computer. They can't recover their lost wages. They can't recover their actual lost profit. They can't recover their overhead. If they are run out of business, they are just stuck. Unfortunately, what we have here is what I am afraid happens too often in Washington. The little guy loses, and the big guy wins. There is no question that the computer industry has a powerful voice in this body. The people who are going to be damaged and hurt by this bill don't even know it yet. They largely are completely unaware of it. The small business men and women of this country and consumers in small towns all over North Carolina and across the United States don't even know that they are going to suffer losses, that they are going to be put out of business. They do not know that. My question to my colleague is, Who speaks for them? We have heard the voices loudly, clearly, powerfully, and articulately for powerful, big business. There are many things I will support industry on that I believe are in the best interests of America. The problem is, the people who are going to be injured by this bill, the people who are going to be put out of business, the people who by all accounts--my colleagues from Oregon and Connecticut have just conceded--will have real and legitimate losses, who speaks for them? I am afraid the answer is that no one speaks for them. They don't give big money to campaigns. They don't even know what is going to happen to them yet. They are out there and are innocent victims. Who is the voice for the little guy in this debate? These losses we have talked about--I am eliminating frivolous lawsuits, I am eliminating causes that ought to be resolved, things that ought to be resolved by discussion between the seller and the buyer, all of those things that we are all in agreement on--I am talking about that little business guy or woman in Murfreesboro, NC, who bought a computer believing that it was Y2K compliant, having been told that it is Y2K compliant, and the computer is not Y2K compliant. They lose their business. They have lost thousands and thousands of dollars, and they are literally out of business. That loss--no matter what we do in this Senate, no matter what we do in this Congress, and, with respect, no matter what the President signs in the Oval Office--that loss will not go away. It will be there, and it will not disappear. There is a fundamental concept we all have to recognize when we come to the well later today to vote. Those who vote for this bill have made a conscious decision. As long as we are willing to recognize that decision, I will respect the vote. That decision is this: We have made a conscious decision that losses --which are real and legitimate, out- of-pocket losses suffered by small business men and women all over this country--that losses are going to be shifted. We are going to move them from the responsible party to the innocent party. In this case, the innocent party is a small business; is a consumer; is somebody who cannot pay their employees anymore; is somebody who has no cash-flow because their manufacturing operation has been shut down because of a Y2K problem. The bottom line is this: We are making a judgment on the floor of the Senate that those real and legitimate losses which everyone concedes are going to occur--that is the ``nut'' of this. Everything else we agree on. I agree with my colleagues about eliminating frivolous lawsuits, about alternative dispute resolution, about cooling off periods, about trying to do everything in our power to solve these problems. The nut of this problem is, what happens to the little guy who suffers a real loss? When this conference report passes on the floor of the Senate later tonight, we have made the judgment that we will shift that loss. We are going to shift it on to the people who have no voice, who don't even know they are victims. They are not sitting in our offices. They are not sitting there because they don't know they have been hurt yet. We are going to shift the loss to them. We are going to make sure it stays right with them. We are going to make sure that multimillion-dollar and multibillion-dollar businesses bear as little of that loss as possible. That is exactly what this bill does. It is that simple. For all of the rhetoric on the floor, it is not about lawyers. It is about the people who make computers. It is about the people who make computer chips. It is about the people who buy computers. Those are the parties to this transaction. The bill that came back from conference is worse than the bill that went to conference. It is worse for a very simple and fundamental reason: It creates multiple additional roadblocks to innocent people who get hurt by the Y2K problem. A job that was already extraordinarily difficult, for them to recover for what happened to them, has become almost impossible at this point. I say with complete respect to my colleagues who have argued vehemently on the floor that this is a 3-year bill, that it will sunset in 3 years, and for that reason it is not bad, that the argument is a smokescreen. Every Y2K problem that will come into existence will happen during that 3-year period--99 percent. By its very nature this problem will show its ugly head in the year 2000 or the year 2001. Essentially, we are going to cover every single Y2K problem that can come into existence. One bit of language that has been referred to in the bill that proponents claim helps improve this report over the Senate-passed version has to do with the issue of recovery of economic losses such as lost profits, lost overhead, lost income. A phrase reads: ``A party to a Y2K action making a tort claim other than a claim of intentional tort''--up until then it is fine--``arising independent of a contract.'' I have spent the last 20 years of my life as a practicing lawyer. This is what that phrase means. If a computer person walks into a small business anywhere in this country and makes a fraudulent misrepresentation, intentionally misrepresents the Y2K compliance of their product, lies, commits criminal fraud, and induces somebody to sign a contract on that basis, and in fact, if the contract itself contains fraudulent misrepresentations, what that person can recover is the cost of their computer. They are victims of criminal fraud. I want the American people to hear this. They are the victims of criminal fraud. What they can get back is the cost of their computer. This bill started with a good purpose. It is supported by Members of the Senate whom I have extraordinary respect for. I absolutely have no question about their motives. They are doing what they believe is right. They have made beautiful cases for it on the floor of the Senate. My concern has been and continues to be that there is a voice that is not being heard on the floor of the Senate. It is the voice of the victims; it is the voice of the consumers; it is the voice of the people who don't know yet that they are going to be put out of business. It is the voice of people who don't know yet that they have been lied to or misrepresented to, been induced to sign a contract under the specific language of this bill. As a result of this bill, they can recover absolutely nothing but the cost of their computer. It is wrong. It violates every concept of justice that exists in the United States and has existed for the last 200 years. We can do the things that my colleagues want to do: Get rid of frivolous lawsuits, induce people to solve these problems, get people to work together, not go into court. We can do all those things, and we can accomplish those things. But we can do it without gutting the right of the little guy who has a real and legitimate claim and has suffered a tremendous loss, been put out of business, without taking away that very fundamental right. Those people are going to be sitting in our offices. So I have one last question to my colleagues: When those men and women are sitting in your offices in February, March, and April of the year 2000, saying: I have been put out of business, who do I go see? Who do I go see about this? I am out of business. Computer people made fraudulent misrepresentations in my contract. They were reckless in the way they made their product. I never knew it. I am out of business. They are sitting on our couch in our offices, and they look in our eyes and say: Who do I go see about this problem? Maybe some of my colleagues have an answer to that question. Unfortunately, I do not. I yield the floor.

Mr. EDWARDS

Mr. EDWARDS. Mr. President, I rise today to acknowledge the election of Ehud Barak to Prime Minister of Israel and his efforts to form a new government. I congratulate him, not only on his most impressive victory, but also for his commitment to reinvigorate the Middle East peace process. As Mr. Barak enters the critical stage in his efforts to forge a coalition government, I wish him luck. And I applaud his initial steps of talking with Egyptian President Mubarak and declaring his intent to form a ``peace administration'' of three negotiating teams, one each for Syria, Lebanon and the Palestinians, reporting directly to him. We must not risk losing momentum toward achieving a lasting peace. As Israel continues to take risks for peace, it is all the more important that America's commitment toward Israel be unquestioned. Our strong commitment helps Israel take risks and makes it clear to Israel's neighbors that Israel is a permanent reality that must be dealt with directly. Our dedication to Israel must take many shapes. We must continue aid to Israel. We must help Israel militarily. We must actively support the peace process. We must maintain our support for Jerusalem as Israel's capital. America's support for the peace process, for the security of this region, and for Israel itself must be unwavering. Israel, the only pluralistic democracy in the Middle East, deserves our continued strong support. Helping Israel survive and thrive is the right thing to do. In a particularly volatile part of the world, Israel is strategically important to America's interests. We cannot help but benefit by strengthened economic, political, military and cultural ties with Israel. I have the greatest respect for Israel, its citizens, and its founders. The creation of the state of Israel is a remarkable story of a great people who overcame the Holocaust, rebuffed repeated foreign hostility, and created an industrialized democracy in a desert. The story of Israel appeals to me because it is a story of faith and it is a story of justice. I respect all who stand up to powerful forces against great odds for a just cause. No issue is more important to our relationship than aid to Israel. It is one of America's most cost-effective foreign policy investments. The economic and military aid that America provides Israel serves the interests of both countries by promoting peace, security, and trade. Israel recently initiated an agreement with the United States under which the United States will gradually reduce the amount of economic aid in the coming years while ensuring an adequate amount of military assistance. I commend Israel for this initiative, and I believe that the United States should stand by it. The Middle East's unstable mixture of unconventional weaponry, advanced military technology, political instability, and radical fundamentalism threatens both Israel's security and America's vital interests in the region and around the world. I am committed to the expansion of the United States-Israel strategic cooperation that was formalized in 1983. In addition, it is our national interest to help ensure that Israel maintains her qualitative military edge. Furthermore, the Unites States should not sell sophisticated weaponry that could erode that edge to nations hostile toward Israel. And, of course, the United States must do all it can to stop the development or acquisition of nuclear, chemical, and biological weapons by rogue states such as Libya, Iraq and Iran. True and lasting peace between Israel and her neighbors can be achieved only through direct negotiations between the parties. Nevertheless, the United States has played a critical role with Israel and her neighbors in helping bridge the differences between them. We must continue to invest the time and energy necessary to help continue this very complex series of negotiations. Israel's capital of Jerusalem is important to Jews, Christian, and Muslims. I commend Israel for allowing all three faiths open access to worship at their holy places. Jerusalem is and ought to remain a united city under Israeli sovereignty. Israel is the only country where the United States chooses not to locate our embassy in that country's capital city. I support the Jerusalem Embassy Act that recognizes the united city of Jerusalem as Israel's capital and mandates the moving of our embassy from Tel Aviv to Jerusalem. Finally, I want to discuss Israel's special relationship with my home state of North Carolina. Since 1993, North Carolina and Israel have had one of the most comprehensive official exchange programs in the country. Both North Carolina and Israel have economies that depend on high technology, agriculture, and education. Both states benefit from their ongoing economic, social, and cultural exchanges. I look forward to doing all I can to promote this valuable relationship between Israel and the great state of North Carolina. Mr. President, I look forward to working with Israel's soon-to-be formed government to pursue our nations' many mutual interests. I wish Mr. Barak and his government the best as he pursues peace, security, and prosperity in the twenty-first century.

Mr. EDWARDS

Mr. EDWARDS. Units. Not human beings but units. Under existing law, health insurance companies have proven time and time again they are motivated by one thing, and that one thing is the dollar bill. Profit is the bottom line. We have talked about doing two things in a patients' bill--not in an insurance industry bill. Since money seems to be what motivates these folks, we will do two things. No. 1, as the distinguished Senator from New York mentioned, we will create an independent body that can oversee the insurance industry, the HMO. When they make arbitrary decisions, when they decide even though it is clear a patient or child desperately needs a treatment or a test and that was an arbitrary decision, they can get a quick reversal from that truly independent board. That is one thing. In addition to that, we also say health insurance companies and HMOs, as every other segment of American society, will be treated the same. They can be held accountable. They can be held responsible. They can be held responsible in a court of law. Those two things together--a truly independent review, done swiftly so reversals can occur, combined and working in concert with arbitrary, money-driven decisions where if some child is severely injured as a result, they can be held accountable. I wonder if the distinguished Senator would comment on whether she believes those two things, working together, create a tremendous incentive that does not presently exist for HMOs and health insurance companies to do the right thing to start with, so we never get to an independent review board, we never get to a court of law; instead, insurance companies and HMOs are doing the right thing, not making arbitrary decisions, doing what the treating doctors are advising needs to be done in the very first instance when it is most important and could do the most good.

Mr. EDWARDS. I was thinking about the comments from the Senator from Illinois, the comments from the Senator from New York, and the comments made about the health insurance executive accounting, talking about human beings as ``units.'' I did understand the Senator correctly?

Mr. EDWARDS. If the Senator will yield for one other question, with respect to what my distinguished colleague from Illinois just pointed out, it is my understanding that under existing law we have this very privileged group of insurance companies--very wealthy insurance companies--that are singled out in American life as not being held accountable for what they do. You and I can be held accountable. Everybody in our State of North Carolina, and Illinois, New York, and California, can be held accountable. Every other business, small and large, can be held accountable. But the health insurance industry is special. It is different. It is better than the rest of us. It can't be held responsible. I want to know how the Senator from California would respond to a family, or to our children who we are trying on a daily basis to teach about personal responsibility, personal accountability, something that all of us believe in deeply, how do we explain that we have singled out this very well-to-do industry for privileged treatment, and, in fact, unlike our children, unlike our families, we are not going to hold them responsible or accountable?

Mr. EDWARDS. With respect to the instance described by our distinguished colleague, the Senator from Illinois, where obviously a catheterization would have saved this patient's life, will the Senator from California explain to the American public and to our colleagues, No. 1, when they decided initially, no, we are not going to pay for the care, and, therefore, they could not get the test done, and a lot of life-saving tests that needed to be done, what avenue or recourse does that patient have? Is there anything they can do under the circumstances under existing law if we don't pass a real Patients' Bill of Rights?

Mr. EDWARDS

Mr. EDWARDS. Mr. President, I rise today to note with sadness the death this morning of the Chancellor of the University of North Carolina at Chapel Hill, Michael Hooker. Chancellor Hooker was a friend and someone whom I have known for a number of years. He was a man of vision, enthusiasm, energy, brilliance, and he had an extraordinary love for the State of North Carolina. His passing is not only a loss for those of us in the University of North Carolina family, but for all North Carolinians. By making a great university better, Michael Hooker made a lasting contribution to our entire State. The truth is that his death was both a shock and a blow. Just yesterday he was at work in Chapel Hill. He was diagnosed this year with non-Hodgkin's lymphoma and had been undergoing treatments at the National Cancer Institute in Maryland and also at the UNC Hospitals. While he was up here, I had the pleasure of seeing him a few times. Not too long ago, I ran into him and his wonderful wife Carmen, who is an extraordinary woman, right outside the Senate Chamber. He looked well and was feeling optimistic at that time about his health. He did take a brief leave from his job for treatment of the disease, but for most of the year, he was hard at work. I cannot say how sad I felt to learn this morning the news that his cancer had grown worse and that it took him at an early age--at the age of 53. My thoughts and prayers go out to Carmen, his wonderful wife, and to their children. Let me tell you, Mr. President, just a little more about Chancellor Hooker and what he has done for my State of North Carolina. He was the first person in his family to get a college degree--a philosophy degree from Chapel Hill in 1969. His father was a coal miner. He always credited his parents' belief in hard work and good education for his own success. After graduation, he left North Carolina to get a graduate degree and to enter the world of academics. He taught philosophy at Harvard. He was president of Bennington College and also president of the University of Massachusetts system. He was president of the University of Maryland at Baltimore County. He returned to North Carolina in July of 1995 to become UNC's eighth chancellor. And he really attacked the job. One year he visited every single county in North Carolina--and we have 100 counties in North Carolina--to make sure that every person in the State knew they were connected with their university. Then he made sure that the faculty and administration at UNC were connected to the State. He once took the new faculty and administrators from other States on a week-long bus tour of North Carolina. The truth of the matter is that men like Michael Hooker have long lists of accomplishments. They serve on many blue ribbon panels; they get lots of honorary degrees; they write great scholarly pieces; they are placed on many ``best of'' lists. I could go through a great deal of these with respect to Chancellor Hooker, because he accomplished all of those things. But in the end, I think Michael Hooker himself valued people most. I believe he would like to be remembered for all of the things he did to make people's lives better. He understood the need for education, not only because it expands men's and women's minds but because it makes our society better, stronger, more prosperous, and more equitable. He was an extraordinary and wonderful man. He said it best himself, if I could just quote him: There is only one reason to have a public university, and that is to serve the people of the state. That should be the touchstone of everything we do: whether it's in the interest of North Carolina and our citizens. Our litmus test is the question: Is what we do in Chapel Hill helping the factory worker in Kannapolis? The best tribute we can give him is all the good works performed in the future by those who were touched by him and his life. Chancellor Hooker was an extraordinary man. He will be missed by me, he will be missed by every single citizen in North Carolina, and he will be missed by all those who knew him. With that, I yield the floor, Mr. President. Mr. WELLSTONE addressed the Chair.

Mr. EDWARDS

Mr. EDWARDS. I thank the Senator.

Mr. EDWARDS. We discussed it briefly a moment ago, and that is the fact that doctors are finding it necessary to unionize or to make an effort to unionize because they are no longer able to prescribe the treatments and tests for their patients they know their patients need, in fact because they are not able to make determinations about what is medically necessary, whether a child--if the Senator would hold this photograph up one more time--whether such a child medically needs the surgical procedure the Senator talked about in the last few minutes, the fact that doctors find it necessary to unionize in order to do what they have spent their entire lives being trained to do, which is to provide the best possible medical care to their patients. Can the Senator imagine a more powerful indication and symptom of the medical crisis confronting this country today?

Mr. EDWARDS. Will the Senator yield for one last question?