Ted Kennedy

Mr. KENNEDY

Mr. KENNEDY. On my time.

Mr. KENNEDY. I yield 5 more minutes to the Senator from North Carolina.

Mr. KENNEDY. As the Senator knows, they have independent review. We have it under the Medicare proposal. It works. It works very effectively. It works pretty well. It is somewhat different in scope than was included in the Daschle proposal. I favor this one here, but there is an independent review. But not only in that measure, we have some 23 million Americans who are working for State and local governments that have the kind of protection that is favored in the Daschle proposal, and it is working very effectively. One of the very important programs that has the kind of protections the Senator has favored and that I favor is what they call the Calpurse Program in the State of California, which has well over a million individuals who are part of that program with the kind of protections that are supported by the Senator. What they have found out--we will have a chance to get into this, hopefully, at the time we get a debate on it--is that the cost of that whole program has not increased as much as the increase in health insurance nationwide, or even in the programs in California that do not have that protection. Do you want to know why, Senator, I believe that is so? For the same reason we had the expert witnesses who appeared before Senator Specter's Appropriations Committee; and that is, because the HMOs take more time and attention to make sure the patients are going to get better kinds of health care and health care coverage. That basically means they are able to get a better handle on the cost. So it makes a major difference in terms of the quality of health care, and it makes a major difference in terms of the protections of individuals. I thank the Senator for his response.

Mr. KENNEDY. Mr. President, will the Senator yield on that point?

Mr. KENNEDY. The Senator has correctly stated the current situation. It isn't only Medicare. It is also in Medicaid, as well as the Federal Employees Health Benefits Program. Every Senator has these protections. The interesting question I ask the Senator, if these protections were such burdens on the delivery system, doesn't the Senator think he would have heard? These protections are available today, for those who are covered with Medicaid or Medicare. The other side in opposition to the Daschle proposal is always saying these protections are burdening the system, and we can't protect all Americans because it will burden the system? The Senator has made the correct point. We do it today in Medicaid. We do it in Medicare. We do it for Federal employees. Most of the good HMOs do it. It is the bad apples that are threatening the well-being and the health of many of the citizens in our States whose procedures we need to address.

Mr. KENNEDY. Mr. President, with regard to just one fact that the Senator has mentioned, I have the GAO report to which the Senator refers. The fact that the Senator refers and is talking about is on page 4 of the report. It says: If premiums increase by 1 percent only for some insurance types (for example, HMOs), then the coverage loss predicted by the Lewin Group to . . . Not the GAO, it is the Lewin Group that makes the estimate referred to in the GAO letter. To the contrary, if you read on, GAO says: Because many factors can affect the number of individuals covered by private insurance, it is difficult to predict the impact of an increase in insurance premiums. For example, new mandates may increase premiums but may also change individuals' willingness to purchase insurance. Therefore, there might be more people covered. This is the kind of thing we ought to be debating out here. This is just the type of thing we ought to be debating. We have a lot of distortions and misrepresentations. The insurance companies themselves have spent $100 million in distorting our proposal. What we want to do is to try to clarify the Record on this.

Mr. KENNEDY. If I could just mention one other point, the Senator talked about what we wanted to do last year with regard to the Patients' Bill of Rights. I have in my hand the majority leader's unanimous consent request. Here it is. This is an offer from last June 18, a little over a year ago, when we were trying to bring this legislation up. I ask unanimous consent that prior to the August recess . . . Isn't that interesting? June of last year; they are saying ``prior to the August recess.'' . . . the majority leader after notifying the minority leader shall turn to the consideration of the bill to be introduced by the majority leader . . . It doesn't tell us what that is going to be. . . . or his designee regarding health care. I further ask that the Senate proceed to its immediate consideration. And following the report by the clerk that Senator Daschle be recognized to offer as a substitute the text of S. 1891, which really wasn't the all-inclusive legislation, the majority leader is trying to tell the Democratic leader which bill he ought to put in. I further ask that during the consideration of the health care legislation it be in order for Members to offer health care amendments in the first and second degree. I further ask consent that the Chair not enter a motion to adjourn or recess for the August recess prior to a vote or in relation to the majority leader's bill and the minority leader's amendment, and following those votes it be in order for the majority leader return to the legislation to the calendar. To the calendar--not send it over to the House of Representatives--to the calendar. Let's be clear about who is serious about bringing this up. Here is their consent request. They are going to return it to the calendar. Even if we win the vote, under their proposal, that could be the end of it. Then it says: Finally, I ask consent that it not be in order to offer any legislation, motion, or amendment relative to health care prior to the initiation of this agreement and following the execution of the agreement. Therefore, you can't offer a health care measure for the rest of the Congress. If the Senator from Vermont can say with a straight face that it is the Democrats who are trying to lock this thing up when the Senator has his own leader making a proposal like this, he is defying any kind of rational understanding of what a unanimous consent rule is.

Mr. KENNEDY. I would be glad to yield for a question.

Mr. KENNEDY. How much time do I have?

Mr. KENNEDY. The Senator is absolutely correct. We have had constant examples of abuses that have taken place. Senators have printed in the Record these human tragedies. The Senator understands fully that this is not only something from last year or something from last month. The situation the Senator has outlined is happening today. It has happened this morning; it has happened this afternoon; it will happen tomorrow. It will continue to happen unless and until we pass this legislation.

Mr. KENNEDY. Two minutes 50 seconds?

Mr. KENNEDY. Given that this patient is denied the treatment that can make all the difference in restoring his health or well-being, and given that we have heard examples where, as a result of denying that treatment, a decision made by the health maintenance organization despite the recommendations of the medical professional--can the Senator tell me the remedies available? What remedies are available to a family whose loved one dies or whose loved one sustains a permanent injury because a judgment was made by the insurance company or the HMO, in conflict with the recommendation by the treating doctor. What remedy is available to that family that loses its breadwinner or has to care for an individual who is permanently injured for the rest of their life? What remedy is available for the family who loses a loved one due to the negligence or the clear malfeasance of the insurance company or the HMO?

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

Mr. KENNEDY. Not only am I saying that, but most important is that the directors of the Lombardi Cancer Research Center, located here in Washington, DC, one of the major centers in the country in cancer research programs and clinical trials, is saying that as well. The director says they employ eight professionals who work 18 hours a day combating health maintenance organizations to help enroll women in breast cancer clinical trials. Doctors have recommended patients for clinical trials, with treatment that can probably save their lives, but due to resistance and denials by the health maintenance organizations, those women are effectively denied treatment that may save their lives. That is happening today. As the Senator knows, all we are trying to do with this particular proposal is follow sound medical guidelines, the medical guidelines that your doctor--who may be an oncologist acting on behalf of a victim of breast cancer--believes, given the clinical trials taking place, providing you a real chance of surviving if we enlist you in the clinical trial; this is in your medical best interest. Your bill says your physician's medical determination is going to be the controlling judgment. It isn't going to be an accountant in the HMO who says: We don't believe that treatment is justified and we are not prepared to pay for it; I am making the medical judgment--even though I am trained as an accountant.

Mr. KENNEDY. Senator, I will speak from a personal point of view. My son was 12 years old when he was diagnosed with osteosarcoma, bone cancer. Chances of survival were 15 percent; the mortality rate was 85 percent. We were able to enroll my son in a National Institutes of Health clinical trial, which only 22 children had gone through successfully. He was in that program for 2 years. By the time he finished, they had more than 400 children taking part in that program who survived osteosarcoma, with a breakthrough new treatment for osteosarcoma. Seven thousand children are affected every single year. At that time, the loss of a leg was a matter of course; it is not at the present time. There is no question that not only my son but many of the other children would not likely have survived had they not participated in the clinical trial. That treatment for osteosarcoma is now the standard treatment and is saving countless children's lives. There are many other examples. Our greatest progress in cancer research and in treating cancer has been a direct result of clinical trials.

Mr. KENNEDY. The Senator is absolutely correct. If I could add to what the Senator has said, we have made great progress in dealing with cancer, especially children's cancers, over the last 10 years. The principal reason for this progress is the large number of clinical trials. We should take the time to spell out what has actually happened in the clinical trials and why that is an important provision of the leader's Patients' Bill of Rights.

Mr. KENNEDY. Further, is the Senator suggesting that this is the only area in civil law that a remedy is really being denied on the basis of real negligence, malfeasance? Are these the only companies in America that have this sort of privileged position of being free from what I think most Americans would understand as accountability? Is that what the Senator is suggesting?

Mr. KENNEDY. Will the Senator yield for a question?

Mr. KENNEDY. As the Senator knows full well, we can take one example. There are many, and we will come back to those later in the afternoon. But the Senator has been a strong supporter in terms of increasing the NIH research budget and has followed the various recommendations so that hopefully we are going to double the NIH research budget. Our Republican colleagues have supported this proposal. Senator Mack and Senator Specter have been leaders. Senator Harkin has been one of the important leaders. Many other Members have supported that proposal. Why? Because it is universally accepted that we are in the early morning sunrise period of major scientific breakthroughs on many of the kinds of diseases that affect millions of our fellow citizens. This year, more than 563,000 will die from cancer, and 1.2 million will be diagnosed. We have these enormous potential breakthroughs that can mean the difference between life and death. These breakthrough treatments allow individuals some degree of hope of being freed from Alzheimer's or Parkinson's disease or cancer. Every medical researcher understands that. That is why they support the access to clinical trials piece in our proposal. When they have the breakthrough in the laboratory, they want to get it to the bedside. The way that is done is through clinical trials. Under the Daschle proposal, we would continue the traditional support for clinical trials so that we can move these breakthroughs that are coming in the laboratory to the patients, to the mothers, and to the daughters, and to others.

Mr. KENNEDY. Mr. President, now we are back to where we were yesterday just about 24 hours ago. At the request of the Democratic leader, the amendment on the Patients' Bill of Rights was submitted to the Senate as an amendment on the appropriations bill yesterday afternoon. The majority leader then offered an amendment to that amendment, which was effectively the legislation that was passed out of the Health and Education committee some 3 months ago and the tax provisions from the Senate Republican leadership proposal. That is an amendment to Senator Daschle's proposal. We have this measure now before the Senate. Many of us over the last 2 years have tried to gain the opportunity to debate what we call the Patients' Bill of Rights. The underlying concept of the Patients' Bill of Rights is very simple and very straightforward. Our legislation has the strong and compelling support of over 200 organizations all across this country. Medical decisions that affect the members of our families ought to be made by doctors--by professional, trained medical personnel--and the patients. They ought to be the ones that make the decisions that are going to affect our lives and the lives of our families, our grandparents, and our children. Those decisions should not be made by an insurance agent, or by an HMO official. This is a very basic and fundamental concept, and all of the basic measures--the proposals--that are advanced in our Patients' Bill of Rights, which was introduced by Senator Daschle, reflect this concept. The Republican proposal does not address this critically important concept. I call the Republican proposal the ``patients' bill of wrongs.'' They use the right words in their title, but that's it. Their bill doesn't guarantee that these decisions are going to be made by the doctors and nurses and by the trained medical professionals. The Members of this body do not have to take what I say on this interpretation of the Republican proposal. The fact remains that we have been waiting and waiting and waiting for well over a year, or for close to 2 years, to hear from our Republican friends about the medical associations or the medical professionals that support their proposal. Let's be clear, we don't advance this proposal because we are Democrats. We advance it because it will protect consumers and families in this country. It isn't that I say it, or that Senator Daschle says it, or that any of our colleagues say it. It is because the doctors in this country say it. The American Medical Association says it. The American Nurses Associations says it. The consumer organizations that have been dedicated to protecting patients have said it. If you look over the list of those various groups that are supporting our particular proposal, you will find that virtually every organization that represents women's health care support our legislation, and for very good reasons, which we will outline today. Virtually every leading group that has dedicated itself to protecting the well-being of children in our society and the health care of children are supporting our proposal. Why? For very good reasons, which have been outlined before by Senator Daschle, Senator Reed and those of us who support helping children. You will find that virtually every organization in this country that is concerned about the needs of the disabled in our society is supporting our program. Virtually every group that is concerned about cancer and cancer research is supporting our particular proposal. And virtually none are supporting the opposition's proposal. This is something that the American consumers ought to understand. This is something the American consumers ought to realize. I see our leader on the floor at this time. I think all of us are looking forward to listening to his presentation. I yield the floor at this time and will come back and address the Senate.

Mr. KENNEDY. Mr. President, what is the business before the Senate at this time?

Mr. KENNEDY. I would like to reserve the last 20 seconds, Mr. President. Mr. President, to listen to my friends on the other side, you would think that you were hearing the talking points written by the insurance industry: It costs too much. Here is the CBO report: 4.8 percent for average premiums for employer-sponsored health insurance over 5 years. For the sake of this exercise, call it 5 percent. Say a families' premium is $5,000. That is $250 over 5 years. Allocate that in terms of employer-employee, and you will find that the cost paid by an employee is around the cost of a Big Mac each month. This is a buy to ensure that you are going to have the protections in our legislation. We hear about all the things that their program is doing. But the one thing that Senator Frist left out is that they are only covering a third of all of Americans. They are leaving out more than 110 million Americans. If this plan is so good, why not include everyone? For those that are so concerned about the cost, I hope they are going to explain where they are getting the money that the Joint Tax Committee says their proposal will cost. Their medical savings accounts alone--which are little more than a tax shelter for the rich--are $4.2 billion over the next 7 years. But they don't say how they will pay for it in their proposal. They are concerned about cost? Why are they expanding that tax loophole? Why aren't they at least jawboning the insurance companies to hold down the 6 to 10 percent increase that we see in the insurance premiums every year just to increase profits? Every single provision of the Republican bill is riddled with loopholes. It is a bill that only an insurance company accountant could like. As this debate proceeds, we will expose those loopholes. Mr. President, one of the ways you know a person is by who their friends are. Our friends in this debate are the 200 groups that represent the doctors and nurses--the health delivery professionals-- and consumers. Not a single organization supports the opposition. If our amendment is tabled, it is a vote against children, a vote against families, a vote against women; it is a vote against every individual with a serious health problem, and it is a vote in favor of mismanaged care and a vote in favor of placing insurance company profits ahead of patient care. I hope the motion to table Senator Daschle's amendment is defeated. I yield the remainder of my time.

Mr. KENNEDY. Mr. President, the issue that is before us with the proposal that Senator Daschle has advanced is a very basic and fundamental one: Who ought to be making the decisions on your health care? The whole concept behind the Daschle proposal is that we should let the medical professional guide that judgment--the doctor, nurse and patient together. That ought to be the basis of the judgment--not an accountant, not an insurance company official. That is really at the heart of this whole legislation. Our legislation protects that and preserves it. The other legislation that is reported out of our committee fails to do it. That is why we have the support of the health care professionals and they do not. I hope we will have the opportunity to at least debate these various issues in an orderly way. That is what this battle is about. I hope that we will be able to continue with a reasonable procedure to permit the Senate to make a judgment. Mr. NICKLES addressed the Chair.

Mr. KENNEDY. May I just make this point? Access to emergency care, which is carefully protected in the leader's legislation, does the leader know that the provisions in his legislation were almost unanimously supported in the President's Commission on Quality Care? The one exception is the President's Commission did not make the recommendation that it be put in law, although they said every quality health maintenance organization ought to have it. Second, the American Association of Health Plans has recommended it. They do not mandate it, but they recommend it, saying it is essential in providing care. The National Association of Insurance Commissioners--not a Democratic group, the majority of Insurance Commissioners are probably Republicans--has recommended it for the States. They say, in the States, as a matter of good quality health care, they ought to have the provisions which are in our Patients' Bill of Rights. As the Senators have pointed out, it has been included in Medicare. So this proposal, which was offered and defeated in the Health, Education, Labor and Pensions Committee, should be a matter where we have an opportunity to present it and let the Senate make a judgment. As I mentioned, it has been recommended by the nonpartisan commission. It has been recommended by the independent insurance commissioners. It is in Medicare. We would like to hear on the floor of the Senate those individuals who are opposed, those individuals who say no to this particular protection. That is the kind of protection that is included in the Daschle proposal, which is of such importance. Mr. President, I see others want to speak on this proposal. In looking down this list of protections, you can ask yourselves: Where do these protections really come from? As I mentioned, the protections we have put into the Daschle proposal are effectively the ones supported by the President's commission, the American Association for Health Plans, and the Insurance Commissioners. It is in Medicare. It is working, and it is working effectively. We do not have examples that protecting those under Medicare is a burden, and I do not think those who are opposed to that particular proposal can make an effective case in opposition to this provision. I will take the time later to mention two or three more protections. Virtually every one of these protections is either part of a recommendation from the President's commission, part of the recommendations of the American Association of Health Plans, recommended by the state Insurance Commissioners, or is being implemented and protecting persons covered under Medicare. These are commonsense proposals. They are not protections we have suddenly grabbed from some way-out organization or group. They are fundamentally rooted in sound health care practices. That is the case we want to bring to the floor of the Senate. I see my colleague and friend on the floor now, wishing to speak. I will be back to address the Senate shortly.

Mr. KENNEDY

Mr. KENNEDY. Mr. President, I'm delighted that the managers' amendment includes the provision Senator Gordon Smith, Senator Leahy, and I sponsored to require the State Department to report on progress on the July 2000 referendum in the Western Sahara, and I commend Senators Helms and Biden for including this provision in the managers' amendment. Since 1988, the United Nations has sought to organize a free, fair, and open referendum on self-determination for the people of the Western Sahara, the former Spanish colony that Morocco has illegally occupied since 1975. The International Court of Justice, the Organization of African Unity, the United States, and many other nations throughout the world have not recognized Morocco's claim to the area. However, Morocco's occupation continues. Tens of thousands of the Sahrawi people languish in refugee camps in southern Algeria and have been denied the opportunity to determine their own future. A U.N. referendum was originally scheduled for 1992. It has since been delayed many times, primarily due to the resistance of the Government of Morocco. In the 1997 Houston Accords, achieved under the leadership of former Secretary of State James Baker, and in a U.N. plan last December, the international community called for the conclusion of the voter registration process and a referendum. Morocco subsequently agreed to allow the referendum to occur by July 2000. I know the Administration shares our interest in resolving this long- standing dispute. The State Department should make it clear to both parties to this dispute that our government expects the people of the Western Sahara to be allowed to exercise their right to self- determination in a free, fair, and open referendum by July 2000. Morocco has been a faithful ally of the United States for more than 200 years, but its refusal to allow the people of the Western Sahara to determine their own political future undercuts America's efforts to promote democratic principles worldwide. The United States can play a constructive role in promoting a resolution of this dispute. To promote that objective, the provision included in the managers' amendment would require the State Department to report on January 1, 2000 and again on June 1, 2000 on specific steps being taken by the Government of Morocco and by the Popular Front for the Liberation of Saguia el-Hamra and Rio de Oro (POLISARIO) to ensure that a free, fair, and open referendum in which the people of the Western Sahara will choose between independence and integration with Morocco will be held by July 2000. The reports will include a description of preparations for the referendum, including the extent to which free access to the territory for independent and international organizations, including election observers and international media, will be guaranteed. Human rights organizations and other international organizations must be allowed to observe the referendum. The reports will also include a description of current efforts by the Department of State to ensure that a referendum will be held by July 2000 and an assessment of the likelihood that the July 2000 date will be met. They will also include a description of obstacles, if any, to the voter registration process and other preparations for the referendum, and efforts being made by the parties and the United States Government to overcome those obstacles. Finally, the reports will include an assessment of progress being made in the repatriation process. A solution to the conflict over the Western Sahara will enhance security and stability in Northern Africa. After more than ten years of delay, the people of the Western Sahara should be permitted to determine for themselves who will govern them. I look forward to that day, and I commend my colleagues for including this provision in the bill.