Ted Kennedy

Mr. KENNEDY

Mr. KENNEDY. I want to address the Senate this afternoon because of my continued concern that we are not addressing one of the most important areas of concern for American families, and that is the legislation which is known as the Patients' Bill of Rights. I and a number of our colleagues have cosponsored Senator Daschle's legislation. I had hoped that we could debate and reach conclusion on this legislation. I believe the overwhelming majority of our colleagues on this side of the aisle are in support of this legislation and, if we had an opportunity to debate this issue, I think we would have support as well from Members on the other side. Basically, it is a fundamental issue that I think all Americans can understand. This issue centers around whether doctors are going to make decisions with regard to the treatment of patients in our country, or whether we are going to have those decisions made by accountants--whose primary interest is enhancing the profits of the HMOs rather than the health of its patients. That is really at the heart of the Patients' Bill of Rights. There are other important protections, but that is at the heart of it. This issue affects about 160 million American policy holders. Our legislation is supported by more than 180 leading health care organizations--virtually all of the major doctors' organizations, nursing organizations, and consumer organizations. I have read the comments of some of our colleagues on the other side of the aisle. They distort the provisions of this legislation and talk about it as legislation which is unnecessary and legislation that will complicate the current practice of medicine. But, listen to the doctors. They say it will simplify the practice of medicine. It does seem to me valuable to consider what the doctors say about this, what the nurses say about this, and what the overwhelming, virtually unanimous sense of the health professionals is about it, and they say that they strongly support our legislation. They are opposed to the Republican legislation. But all of them are asking when will the Republican leadership yield and permit us--permit us meaning the Senate--to take up this legislation and debate it and reach a resolution on these various issues. That is the matter I am addressing here this afternoon. Over the period of the last 2 weeks in the Senate we have had votes on the salting legislation. I bet if we asked the Americans who are listening or watching this afternoon what the salting legislation is really all about and where it fits on their list of priorities, many of them would not know what it is all about. It is basically a technique which is used--and used effectively and legitimately according to the Supreme Court with its unanimous vote--to permit the organization of workers in sites across this country. But some of our Republican friends desired to repeal that legislation. So we had votes on that. We have had votes on the bankruptcy legislation which affects about 1,200,000 of our fellow citizens. We have had votes on the so-called Child Custody Protection Act. We have now been debating in the last day or two the Vacancies Act. We are also considering the Internet tax provision. The majority leader has talked about financial services legislation. And then we are going to come into a situation, perhaps next week, where we are going to have the opportunity to address the tax cut proposal of our Republican friends in the House of Representatives. They want to use tax revenues which have been paid into the Treasury, which are Social Security revenues, to provide tax breaks for the wealthiest individuals in our country. But we understand the surplus this year and in future years is the result of funds that have been paid in by workers to fund Social Security benefits. When you exclude these Social Security benefits, you see that we really do not have a surplus. What we have is money raised by working families to pay for Social Security. Our Republican friends want to take some $80 billion of that and use it for tax breaks that would primarily benefit the wealthiest individuals in our society. I see one provision in their plan will decrease the estate tax for millionaires. Let me tell every taxpayer who might be watching that you will have an interest in this provision only if you intend to leave more than $600,000 to one of your children. This Republican-sponsored provision will permit you to leave $1 million. It affects only 2 percent of the taxpayers, but it will cost some $18 billion--$18 billion out of funds that are paid in by workers to pay for Social Security. The majority plans to take that money out and use the $18 billion to offset the revenue losses that will result if the Republicans pass their particular proposal to expand the estate tax. We will have a chance to debate that issue. But, Mr. President, where in this agenda is the issue of the Patients' Bill of Rights, something that is of fundamental concern to virtually every working family? Are we trying to suggest that the salting legislation or the Vacancies Act or even the Internet tax issue is of nearly the consequence or importance of the Patients' Bill of Rights? Not so. But still the majority leader refuses to permit us to debate and discuss it in the Senate. The Republican leadership didn't permit it last Friday when most Americans were out working and the Senate effectively closed down at about 11 o'clock. There were Members who spoke after 11 o clock, including myself, and we pointed out that we could have been debating HMO reform on Friday afternoon. We could have been debating it on Monday--when most of the afternoon was taken up in quorum calls before the vote in the late afternoon--or even debated it on Monday evening. Mr. President, I am not going to take the time to review with the Senate the amount of hours we have spent in quorum calls over the period of the last 2 weeks. We could have debated this, taken votes on these measures, and resolved these matters in a way that I think would have yielded some very important and basic protections for families. I think we would have resolved this in favor of protecting children in our country. I think we would have carried overwhelmingly in the Senate the provisions that would have permitted families with a sick child to bring that child to the nearest emergency room. I think we would have won that in the Senate. I can understand why our Republican friends do not want to vote on that issue, and show the American people where they stand. I hope that at least a majority of them would have supported our provision, if they were given the opportunity. I think they would have supported our provision to guarantee specialty care for children who have dread diseases like cancer. I think they would have supported ensuring that a child with cancer should have access to an oncologist who is trained to work with children and with the cancer of the particular child. I think we would have done that, just as I think we would have provided additional specialty care protections for adults who have certain medical needs, whether it is physical or mental disabilities or challenges or chronic conditions like arthritis or diabetes. I think we would have won those. I think we would have been successful in debating and reaching a successful conclusion in ensuring access to clinical trials for women who have breast cancer and other patients with life-threatening diseases. With all the possibilities that are out there for breakthrough therapies, why are we continuing to deny women the opportunity to go into clinical trials? We guarantee that in our Patients' Bill of Rights. The other side does not. Why aren't we debating whether we are going to increase access to clinical trials for women or children who have cancer, or patients with other diseases that do not respond to conventional therapies? I think we should be able to debate that issue. I think we ought to be able to debate the issues around having access to the kind of prescription drugs that are recommended by doctors, instead of being limited to the medications preferred by the plan. We have had heard testimony from the mental health community that indicates that many of the individuals who need certain kinds of prescription drugs are required to take older, less effective drugs that are on the HMO's list. Before the plan will even consider giving them access to the drugs that the doctor knows is best, the accountant in that HMO says, No, you can't use that one until you have shown that the previous two failed to work. Mr. President, these patients are only given access to the drugs that the doctor knows are best after they have shown that the plan s drugs failed to work at least two times. I think we could have debated that. And I think we could have been successful in that debate as well. And the list goes on, Mr. President, including whether patients should have the right to a timely and independent review, if an HMO denies care. I think we could have won that particular measure, too. We also should address whether we are going to say that HMOs should be held accountable if their actions, as a result of negligence, result in the loss of life or grievous bodily injury. Who else is going to be the breadwinner for a family if an insurance company's negligent actions result in the loss of life of that individual? Why is the Republican leadership allowing the insurance industry to remain the only particular protected industry in the United States of America? If these companies are going to take certain action that is going to result in the death or serious disability to an individual, why should they be free from accountability? They should not be. We ought to be able to debate that in the U.S. Senate. These are just some of the points that are in the Daschle legislation which we wanted to debate. But, no. Instead, we are debating salting legislation, we are debating the Vacancies Act, the Internet tax, and we will soon be debating financial services legislation, but not the issues that affect the quality of life of our children, our parents, our loved ones, our families. Why? Because the Republican leadership refuses to do it. Why? Because evidently they think we may have the votes to pass it. We are still asked, is there enough time to pass this? Absolutely. Evidently our Republican leaders think there must be, too, because they continue to refuse to let us have the chance to debate this. Senator Daschle has requested time and time again the opportunity to debate these issues. ``No way,'' says the Republican leadership. ``No way.'' They even closed the Senate down a little over a week ago when they refused to let Members speak on the floor of the U.S. Senate. ``No,'' the Republican leader said, ``We set the calendar, we set the schedule, and you are not even going to have the time-honored process that is guaranteed under the rules of the Senate of being able to amend a piece of legislation, because if you are not going to behave yourselves''--in other words, ``if you are not going to accept our gagging you,'' as so many of the HMOs are doing in terms of gagging doctors from making recommendations about what is the appropriate kind of health treatment for the illness and sickness of the patients they are dealing with--``we are not going to even debate that bill. We are going to pull the bill. We are going to take it off the floor, and we are going to put it back on the calendar,'' as he has done. That is what is happening in the U.S. Senate these days. We were fortunate to have just had an opportunity to debate raising the minimum wage. We said that working men and women in this country, who work 40 hours a week and 52 weeks a year, ought to have a livable wage. We were not successful on the issue. We lost on that, but we had the opportunity to debate and go on record with our positions. What we are saying now is: Let us have a debate; let us have the debate on the questions of health care quality. This is something which is of enormous importance. Mr. President, as I mentioned, this isn't just something a number of us have been in strong support of. I want to mention an editorial in Sunday's Washington Post that cut through the Republican leadership's smokescreen of evasion and distortion on managed care. The editorial was entitled ``Double Loss on Managed Care.'' The author says: Mr. Clinton . . . took the lead months ago in proposing that Congress pass a ``Patients' Bill of Rights'' to limit how far managed care companies and other insurers can go in denying care in order to cut costs. Democrats in both Houses built on his proposals. The initial reaction of House Republican leaders was to say no bill was necessary. By July, that had ceased to be a comfortable position and, to give their members more cover, they allowed a mostly token bill to pass. In the Senate, the leadership also produced a token bill but refused to bring it to the floor unless the Democrats agreed to limit themselves to a handful of amendments, which the Democrats said would make a shell of the proceedings. To thwart the Democrats when they have tried to bring up their own bill, the Republicans have all but shut the Senate down. There it is, Mr. President. That isn't Senator Daschle saying that or myself saying that or any number of my colleagues--Senator Boxer, Senator Murray, Senator Durbin. You can call the roll on so many of our colleagues. That isn't any individual Member saying that. Here it is in a Washington Post editorial, which has captured in two paragraphs exactly what we have been saying day after day after day, week after week after week, month after month after month. They understand it, Mr. President, and the American people understand. The editorial goes on to say that it disagrees with some provisions of the Democratic bill but, in its words: That could be dealt with in the normal legislative process, if only the Republicans would allow the process to occur. For a combination of political and doctrinal reasons, they won't, anymore than earlier in the year, they allowed tobacco or campaign reform legislation to pass. They ought to be made to answer for their record, but so far they have not. There it is, Mr. President, clear as can be for all to see, and the American people are increasingly aware of the current situation. That editorial captures it. It is clear what is going on here. It is clear to the Washington Post. It is clear to every Member of the Senate. It should be clear to the American people. The American people want Congress to pass strong, effective legislation to end the abuses by HMOs, managed care plans and health insurance companies. The Patients' Bill of Rights, sponsored by Senator Daschle and other Senate Democrats, provides the needed and long overdue antidote to these festering and growing abuses. Our goal is to protect patients and see that insurance plans provide the quality care they promise in brochures but too often fail to deliver. Our bill has been on the Senate calendar since March. Earlier legislation was introduced more than a year and a half ago, but the Senate has taken no action because the Republican leadership has been compounding the HMO abuses by abusing the rules of the Senate to block meaningful reform. This record of abuse should be unacceptable to the Senate, and, certainly, unacceptable to the American people. One of the most indefensible gaps in the Republican plan is its failure to cover public employees. The GOP plan offers no protection for the 23 million people who serve the public by working for State and local governments. The Republican leadership is saying ``No'' to the police officers and the firefighters who put their lives on the line every day to safeguard the public; ``No'' to the schoolteachers who educate our children; no to nurses; ``No'' to social workers, doctors, and others who spend their days caring for people in public health agencies and State and county hospitals; and ``No'' to countless other professionals who serve the public through State and local governments. I will take just a few moments of the Senate's time to refer to three excellent commentaries that we heard today. I will have the full statements printed in the Record. First, we will hear from Jerry Flynn: My name is Jerry Flynn. I am a police officer with the City of Lowell, Massachusetts Police Department. I am also the National Vice-President of the International Brotherhood of Police Officers. . . . . . Unlike the sham being proposed by the Republican Leadership, [the Democratic leadership plan] is the only legislation that would actually protect patients and address the abuses of managed care. . . . Of particular concern to me, is the fact that the Senate Republican Leadership bill does not apply to public employees. This means all state and local government employees in Lowell, as well as millions of other public workers who are covered under managed care plans, would not be protected under the limited provisions of the Republican version of the bill. The fact is that the Republican bill leaves out more than 100 million Americans with private insurance. Of that group, we have some 23 million who are public employees. Let me continue with Jerry Flynn's comments: Don't public employees deserve the same protections as other Americans? Don't public employees deserve the same medical treatment as other Americans? It's high time Senate Majority Leader Trent Lott and the rest of the Republican Leadership stop treating public employees as second class citizens. As police officers, we know the importance of comprehensive medical coverage. Whether the injury is slight or life threatening, whether it involves a civilian or fellow officer, whether it involves an elderly person or a small child, the single most important factor is that we get the best medical treatment possible-- and that the quality of care be determined by need, not by cost. Mr. President, listen to Tom McEachin: . . . I am a fire fighter in Prince George's County, Maryland. Fire fighters and paramedics are the first responders to the overwhelming majority of acute medical incidents in this nation. Every day we see the faces of those Americans that the Patients' Bill of Rights Act would protect. We see the look of fear on their faces as they react to the emergency situations their loved ones face. They're not only afraid for the lives of those they love, they're also afraid about what the accountants at their HMOs will say about the decisions they have just made. They're afraid they'll be denied coverage and have to find a way to pay astronomical bills or face long-term indebtedness. The way the system's set up now, they sometimes end up hoping that there's something seriously wrong with their loved ones, because they're afraid of what the bean counters will say if they decide it wasn't a true emergency. Listen to these last few lines, Mr. President. Fire fighters work in the worst of conditions. We go where the danger is the greatest, during careers that can last more than 20 years. Each year, more than half of us are injured on the job, and the environmental hazards we face have been proven to cause various forms of cancer, heart disease and other life-threatening diseases. All we ask in return for the risks we take is the simple guarantee that our health coverage will protect us and our loved ones when we need it. The Patients' Bill of Rights will do just that. The 23 million state and local public employees who are not covered by the Republican leadership's bill deserve better. The citizens we serve deserve better. The American public deserves better. As a fire fighter, all I'm asking for is that my elected leaders treat me as I would treat them or their family members if I had to rescue them in an emergency situation. It's only fair. Listen to that, Mr. President. This is from a firefighter. He is left out of the Republican bill, but protected in our bill. Let's debate whether he and his colleagues should be included or excluded. That is what we are saying to the Republican leadership. And we have silence over there. This is what Thomas McEachin said: The citizens we serve deserve better. The American public deserves better. As a fire fighter, all I'm asking for is that my elected leaders treat me as I would treat them or their family members if I had to rescue them in an emergency situation. It's only fair. Why can't we debate that? That is true with every firefighter in this country. It is true about every police officer in this country. It is true about every teacher in this country--all of them are excluded under the Republican bill. Can't we debate that? Twenty-three million Americans left out, left behind. We are not discussing this in the Senate--no, no. We have to debate the Vacancies Act. We have to debate Internet tax. We have to debate salting. We have to debate child custody. We have to debate all of those issues. We have to debate all of those issues, but we cannot debate the concerns raised by Thomas McEachin. We cannot seem to make every Member in this body accountable for their vote. I can understand why the Republicans do not want to go on record with their position. I can understand why they do not want to. But that is not a good enough answer. Mr. President, the statements keep coming. Here is one from Doris Brightful, a registered nurse, now retired after 32 years with the Baltimore City Health Department. And I will include, as I mentioned, in the Record all of these statements. . . . I am not just here today as a health care professional. Nurses are also health care consumers. Nursing is a dangerous profession, and nurses are often injured on the job or exposed to dangerous infectious diseases. We know that, sooner or later, we will need medical care. My family members and my loved ones also will one day need health care. Therefore, I am outraged that Senator Lott and other Republicans would exclude me, my family and some 23 million other state and local public employees from even those few protections that are offered in their health care proposal. School teachers, firefighters, public safety officers--and, yes, doctors and nurses working in public health facilities--work hard every day looking out for the well-being of our communities. Yet, the Republican bill would deny us many of the same protections that our patients would have under this plan. All they want are the same protections--``the same protections that our patients would have under this plan.'' Nurse Brightful concludes: In closing, I would just like to point out that the first guiding principle in the Health Care Consumer Bill of Rights, as set forth by the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry was this: All consumers are created equal. The Republican bill violates this principle, and should be rejected. Instead, the Senate should pass S. 1890, the Patients Bill of Rights, so that all Americans are protected. Here it is, Mr. President. These are the real stories of what is happening out across America. These are the comments of three of our fellow citizens--a firefighter, a police officer, a nurse--talking about the kinds of inequities that exist out there. There are 23 million Americans in their situation, and still we cannot get this legislation up on the floor. The Republican leadership says we have too many bills to debate but, Mr. President, the American families know what is going on here. The doctors know what is going on. The nurses understand what is going on. The newspapers around this country know what is going on. We are being denied the opportunity to have a debate of this bill and to try to pass something that would be worthy of the Senate's actions. Mr. President, this is just one aspect of the differences between the Democratic and Republican health programs. We have tried, over the period of recent weeks, to bring examples of those that would be affected by either the inclusion or exclusion of the various protections in the proposals, and to bring those examples to the attention of the Senate over the period of recent days and weeks. We will continue to do so. How much time, Mr. President?

Mr. KENNEDY. Mr. President, I thank the Senator.

Mr. KENNEDY

Mr. KENNEDY. Mr. President, I was under the impression that we had time to speak in the time allocated under the cloture motion; am I correct?

Mr. KENNEDY

Mr. KENNEDY. Mr. President, this weekend, the New York Times reported on the latest data on Americans without health insurance. According to the Census Bureau, the number of uninsured has now reached 43.4 million of our fellow citizens--an increase of 1.7 million since last year. This increase is on top of the growth in the uninsured of one million last year. The proportion of Americans without health insurance is now higher than it has been for more than a decade. It is especially ominous that this increase in the number of uninsured has occurred at a time when the economy is strong and joblessness is low. Congress should be addressing this issue, but the Republican leadership is just not interested. What is important to average families is not important to them. Whether the issue is protecting patients against the abuses of managed care, or protecting the public against the tobacco industry, or saving social security, or raising the minimum wage, or improving education, or closing the loopholes in the campaign financing laws, the Republican leadership just doesn't think it is a priority. Their primary goal is to protect the special interests--not to protect American families. The plight of workers without health insurance--and of families that may be protected today but could lose their insurance tomorrow--is a particularly compelling example of the need for action. Under President Clinton's leadership, Democrats in Congress have repeatedly tried to address this problem four years ago--Republicans always say, ``no.'' Millions of Americans have suffered because we failed to act. Addressing this crisis is clearly a priority for Democrats and the nation, and it ought to be a priority for Republicans too. We have taken incremental steps in recent years. We have made it easier for workers who change jobs to keep their health insurance, and we have expanded coverage for children. These efforts were resisted every step of the way by the Republican leadership in Congress. The new Census Bureau report confirms what everyone who deals with this problem already knows--these limited steps, as important as they are, are not nearly enough. It should be unacceptable that 43 million Americans have no health insurance today. It should be intolerable that no American family can be confident that the health insurance they have today will be there for them tomorrow, if serious illness strikes. It is indefensible that this Congress is doing nothing to keep this problem from getting worse every year. The vast majority--85%--of uninsured Americans are workers or members of their families. These citizens work hard--40 hours a week, 52 weeks of the year in most cases--but all their hard work cannot buy them the health insurance they need to protect their families, because they can't afford it and their employers won't provide it. Every uninsured American is an American tragedy waiting to happen. Infants lose their chance to grow up strong and healthy because they do not get basic prenatal and post-natal care. A young family loses its livelihood because a breadwinner cannot afford needed medical care. Middle-aged parents see their savings swept away by a tidal wave of medical debt. Earlier this year, I proposed legislation that be an important step toward the day when every job carries with it a guarantee of affordable health care, so that every family can be confident that the quality of its health will not be determined by the amount of its wealth. Every business is expected to pay a minimum wage, and to obey the child labor laws. Every business is expected to provide safe and healthy working conditions, and to protect against injury on the job through worker's compensation. Every business is expected to contribute to retirement through Social Security, and to the health needs of the elderly through Medicare. It is long past time for businesses also to contribute to the cost of basic health insurance coverage for their workers. Some small firms may have special problems that call for special solutions. But there is no excuse for large firms to avoid their responsibility to provide affordable health insurance for their workers. Under the bill I proposed, businesses with 50 or more workers will be required to provide health insurance coverage. Approximately half of all uninsured employees and their families--15 million people--will gain the coverage they need and deserve. This legislation is a giant step toward the day when every American will be guaranteed the fundamental right to health care. Many--even most--businesses already provide insurance. The vast majority of large businesses fulfill this obligation. But too many others do not. In more and more cases, unfair competition from firms that refuse to provide insurance for their workers is compelling other firms to reduce health benefits or drop coverage altogether. Health insurance for working Americans does not have to mean complex regulations or excessive government intervention. The legislation I introduced was simple--less than ten pages. it will not cost taxpayers a dime. It includes no specific mandated benefits or burdensome red tape. it simply says that every business with 50 workers or more must offer its employees coverage equal in value to the Blue Cross/Blue Shield Standard Option Plan that is available to every Senator and Representative, and must pay at least 72% of the cost--the same proportion that taxpayers contribute for every member of Congress. The American people deserve health care for their families that is every bit as good as the health care they provide to every member of Congress. Shame on the Congress for ignoring this need. Shame on the Republican leadership for its misguided priorities. When the people go to the polls in November, they deserve to know who stands with the special interests and who stands with families who need affordable health coverage. When the new Congress returns next year, I will do everything I can to assure that health care for every American is as high on that Congress's priority list as it is on the priority list of American families. It is time to end the suffering. It is time for Americans to join every other country in the industrialized world and guarantee its citizens the basic right to health care.

Mr. KENNEDY

Mr. KENNEDY. Mr. President, yesterday marked the 35th Anniversary of the Senate's ratification of the Limited Test Ban Treaty in 1963. Unfortunately, we still have not achieved the larger goal of ratifying the Comprehensive Test Ban Treaty. In fact, the Treaty has languished in the Senate Foreign Relations Committee for a year with no debate, no action, and no results. As President Kennedy said about the Limited Test Ban Treaty in 1963, ``The conclusion of such a treaty * * * would check the spiraling arms race in one of its most dangerous areas. It would place the nuclear powers in a position to deal more effectively with one of the greatest hazards which man faces in 1963, the further spread of nuclear arms.'' Thirty-five years later, those words are truer than ever. Nuclear proliferation is one of the most serious national security threats we face. Earlier this year, the nuclear tests in India and Pakistan reminded us that we must do all we can to ratify the Comprehensive Test Ban Treaty as soon as possible. On Wednesday, at the United Nations, Prime Minister Nawaz Sharif of Pakistan announced his intent to sign the test ban treaty within the next year. The Prime Minister linked this decision to the lifting of sanctions imposed in the wake of last May's nuclear tests. Yesterday, India's Prime Minister Vajpayee followed suit and announced to the U.N. General Assembly that his nation would also sign the Treaty within the year. If both Pakistan and India sign the Comprehensive Test Ban Treaty, only North Korea will remain outside the worldwide group of nations in continuing to develop their nuclear program. Prompt U.S. ratification of the Treaty would not only demonstrate our support for Pakistan and India, but also encourage North Korea to join the world and reject nuclear testing. The recent tests by India and Pakistan are ominous proof that the greatest threat to humanity is still the danger of nuclear war. The CTBT would give the United States access to a vast worldwide network of nuclear monitoring stations. These additional stations would blanket the globe with sensors that can detect radiation, feel the ground shake from a nuclear test, or hear the sounds emanating underwater from a nuclear explosion. This network is possible only through the cooperative efforts of the CTBT, and it will clearly strengthen our national security. We face a unique opportunity in the Senate, an opportunity to help the world pull back from the nuclear brink and end nuclear testing once and for all. Other nations look to the United States for international leadership. President Clinton has done his part, in signing the Treaty and submitting it to the Senate for ratification, as the Constitution requires. Now the Senate should do its part, and ratify the Comprehensive Test Ban Treaty. Treaty ratification is the single most important step we can take today to reduce the dangers of nuclear war.

Mr. KENNEDY

Mr. KENNEDY. Mr. President, it is very interesting. I have seen those ads, but I believe they are going to be pulled very soon because what has happened, according to the most recent study by Bob Blendon at Harvard and the Kaiser Family Foundation, is that support for our bill has gone up, quite in conflict with the intentions of those who sponsored the ads that have been critical of the Patients' Bill of Rights. And so now the insurance companies and corporations that oppose the Patients' Bill of Rights are reviewing their television strategy because their campaign has had the reverse effect. They are sort of going back to the drawing board. But quite clearly, as the Senator implies, their ads certainly were not a fair representation of the legislation that we have introduced. As I mentioned, virtually every one of these proposals in our bill has either been suggested by the President's commission--which was bipartisan and reported its recommendations unanimously--as important for all patients, or included in Medicare at the present time and used in protecting our seniors, or have been embraced by the state insurance commissioners--which are the 50 commissioners around this country, Republicans and Democrats--or adopted voluntarily by the HMOs themselves through their trade association. This legislation reflects the best judgment of those groups that know this issue best. That is why we have a sense of confidence in this legislation. It has the strong support of those professionals who treat families and understand the kinds of protections that are necessary to give the best of health care to American families.

Mr. KENNEDY. Mr. President, here we are, Friday at 11 o'clock. Most Americans are out working the fifth day of the week, and the Senate is in a quorum call while we have important business to attend to. None is more important, I think, than the consideration of the Patients' Bill of Rights. I took time yesterday on the floor of the Senate when we had a long quorum call, asking why we weren't debating the Patients' Bill of Rights, as I did the day before. And here we are midmorning on a Friday--a workday for most Americans--just going through the motions before recessing, with a cloture vote scheduled late Monday afternoon. We could debate this issue all day today, could debate the issue all day on Monday, and we could have some resolution to the kinds of protections that we are talking about in the Patients' Bill of Rights. We have written these protections into legislation and we have described these protections on the floor. We have challenged our friends on the other side, the Republican leadership, to permit us an opportunity to debate and vote on the kind of protections that are outlined in the legislation introduced by Senator Daschle. However, we have been denied the opportunity to bring up this legislation, and to debate these various protections. Instead, we have continued in the Senate to move forward on other pieces of legislation which, as important as they are, don't measure up to what I think most families are concerned with--and that is ensuring the protection of the health of themselves, their children, and their parents. Endorsements of various groups and individuals are important in some instances, less so in other instances. But I daresay that in this particular instance virtually all of the leaders in the health debate-- certainly the doctors, nurses, and patient coalitions--have endorsed our proposal. We have been asking the Republican leadership for the names of the organizations that endorse their program. And we are still waiting to hear from the other side which medical professional groups have endorsed or supported the Republicans in this debate. I do not think there are any leading groups that support their plan, while virtually all support our legislation. Still, we are denied the opportunity to debate these issues. Now, yesterday Senator Gramm took the floor for an extended period of time to attack our plan. He said that the Republican solution was a new kind of insurance policy called medical savings accounts. The fact is that our bill takes medical decisionmaking out of the hands of the insurance company accountants and puts it back where it belongs, with the patients and the doctors. The Republican program is a sham and it gives the appearance of reform without the reality. I was struck by the fact that my friend, Senator Gramm, accuses the American people of wanting something for nothing, of wanting a ``free lunch.'' I object to this characterization of the patients who want protections from the health insurance company abuses. That is what we are basically talking about. What is at the heart of the legislation that we support is ensuring that medical professionals--doctors, nurses, and the trained medical professionals--make medical decisions. Those who are opposed want to maintain the status quo. They want to permit, in too many instances, insurance company accountants to make medical decisions. Now, a number of HMOs work well. Managed care in its best form can be good for patients. There are even a number of HMOs that support our particular proposal. And portions of our legislation are drawn from standards adopted voluntarily by some plans. But the problem is the bad apples that reach their medical decisions not on the basis of what is necessary from a medical point of view, but what is necessary from a bottom line point of view or the profit point of view of the HMO. That is the fundamental, basic issue. That is it. The good HMOs are complying with the kinds of protections that we have here. But a great many of other HMOs are not. We want to make sure that the patients are going to get what they pay for and what they are entitled to, and that their medical decisions are made by medical personnel and not accountants for insurance companies. Now, that fact is not understood by the Senator from Texas. What he has basically done in his presentation yesterday is accuse the American people of wanting something for nothing--I use his words: ``a free lunch.'' Those are the words the Senator used. Mr. President, I object to the characterization of patients who want protection from health insurance company abuse as patients who want a free lunch. I don't think a cancer patient who needs access to a specialist or a cancer treatment center wants a free lunch. I don't think that a family with a child experiencing seizures is asking for a free lunch when they want to rush their child to the nearest emergency room, and their HMO, in an emergency, requires instead that they go all the way across town to another emergency room. That type of response can risk the life and the health of that particular child. I don't think those parents who are saying, ``Why can't I take my child to the nearest emergency room?'' are asking for a free lunch. I don't think a woman whose doctors say she needs to stay in the hospital after a mastectomy, even though her insurance company wants to send her home in pain, with tubes still dangling from her body, is asking for a free lunch. All of these examples I am using are examples we have presented to the U.S. Senate day in and day out over the period of the past many months. All of those particular situations are addressed in our Patients' Bill of Rights. I would have hoped that the Senator from Texas at least would have urged the Republican leadership to permit us to debate this and let the Senate resolve these particular issues. That is where we would have the opportunity to make our respective presentations and call the roll on these matters, as to whether these requests amount to ``free lunches.'' Let him make his presentation, and those of us who are strong supporters of the Patients' Bill of Rights can respond and make a presentation to the Senate. Then let the Senate make a decision as to whether those individuals are trying to have a free lunch. I don't think a doctor who is penalized for telling patients about the best available treatment is asking for a free lunch. In too many HMOs, when doctors make that kind of judgment and tell that patient they ought to have a treatment that is not on the plan's list, is that they are effectively fired, or they are not rehired at the end of the year. The insurance companies and Republicans can say this isn't a gag rule. But the fact that they are not hired back when they are dismissed is effectively a gag rule. That is what is happening in too many circumstances. I don't think that the patient who is getting the best advice from that doctor, at the risk of that doctor's employment, is asking for a free lunch. I don't think an individual suffering from terrible mental illness, like schizophrenia or clinical depression, who wants effective pharmaceutical products to treat the illness rather than the older, ineffective, but cheaper medication that happened to be on the plan listing, is asking for a free lunch. That is happening in America today and will continue today and tomorrow, and it will continue day after day in the future unless we address that issue here. This isn't just my opinion or the opinion of our cosponsors. We have the strong support of the leaders of the medical organizations, doctors, psychiatrists, psychologists, social workers, nurses, and others who know firsthand that the various HMOs are doing these things. We have heard from countless patients who have been told, ``You can't get the good kind of medications that are necessary to meet your particular health care needs until you use these other ones and demonstrate to us, not just once, but twice, that they just don't work.'' This puts a patient's health at risk. That is happening today. Look right here on the chart, Mr. President--``access to the doctor prescribed drugs.'' But the Senator from Texas says, well, that particular patient is just looking for a free lunch. These Americans don't want something for nothing, and it is insulting of the Senator from Texas to suggest that they do. They have faithfully paid their premiums and they deserve quality care. These companies don't mind going out and representing that they have a whole range of different quality programs to get individuals into their HMO. But, too often, insurance companies then deny the individuals the kind of health quality protections they need when they get ill. That is what is happening. That is where there is bureaucracy; the bureaucracy is in that HMO that refuses to give the best in terms of health care to the patient. All we are requiring is that they just give the patient what they paid for, what HMO represented in terms of quality health care. They are not doing it. They are not doing it in the ways listed on this chart, Mr. President. These are not just made up categories of care; these have been recommended by the President's nonpartisan commission, and by Congress for the Medicare program. These are recommendations that have come from State insurance commissioners. These are recommendations that have been made by the health plans themselves. They are the ones who made these recommendations. We didn't just pull this out of the blue. These are protections that those who know the condition of what is happening in America have recommended to us. That is what this debate ought to be about. Mr. President, the American consumer has faithfully paid for their premiums. They deserve quality care. The characterization of it by the Senator from Texas is typical of the attitude that the Republican leadership has taken toward this issue. They want to allow insurance companies to continue to put the profits first and patients last--all driven by the bottom line. You can solve these issues and problems by having the decisions affecting the quality made by the doctors. There is not a great mystery about what the solution is. But no. We do not hear that from the opponents. They want to allow the insurance companies to continue to put the profits first. That is why they have offered a sham bill. That is why they won't allow the Senate to have a chance to debate and vote on this issue. That is why they are trying to change the subject to medical savings accounts. They don't want to debate this issue. They refuse to debate this issue. They want to debate another issue and divert attention away from the real issues in this discussion. They do not want to talk about clinical trials and their importance for women with breast cancer. They do not want to talk about the ability to have the pediatric specialist for children with dread diseases. They don't want to debate those issues. They don't want to debate the question about giving the family the right to be able to go to the nearest emergency room rather than across town. They don't want to debate that issue. Which of these do they not want to debate? We challenge the Republican leadership to tell us. But day after day we go on with the charade of trying to get cloture to prohibit any kind of amendments and any kind of debate on these issues--day after day, issue after issue. That is wrong. It is absolutely categorically wrong. We are committed to trying to have this kind of debate and discussion on, as Senator Daschle has said on many occasions, a reasonable way to proceed. But, quite frankly, we see day in and day out the Republican leadership attempting to do to the U.S. Senate what many of these HMOs are doing to their patients--gagging their doctors so they can't give them the right kind of health advice. The Republican leadership is gagging the Senate by saying: We will only permit you to bring this up if we have one vote--one vote--and do it now with no debate. Why aren t we debating this on Friday at 11 o'clock this morning, or this afternoon, or on Monday when millions of Americans are going back to work? Why aren't we debating these issues? Why aren't we, Mr. President? It is silence on the other side. It is silence on the other side. They are trying to gag us from debating these issues. They are trying to protect the profits of those HMOs that refuse to provide the right kind of treatment by refusing us the opportunity to address these issues. They are basically protecting those various special interests and denying to virtually every major consumer group, and every major medical professional group their voice here in the Senate on these points. They refuse to let us even debate these issues. And the American people understand it. The American people want Congress to pass strong and effective legislation to end the abuses of HMOs, managed care plans, and health insurance companies. They want us to pass the Patients' Bill of Rights, which was introduced by Senator Daschle and Senate Democrats, to provide the needed and long overdue antidote to these festering and growing abuses. Our goal is to protect the patients and to see that insurance plans provide the quality plan they promise but, too often, fail to deliver. Our bill has been on the Senate calendar since March. An earlier version of the legislation was introduced more than a year and a half ago, but the Senate has taken no action because the Republican leadership has been compounding the HMO abuses by abusing the rules of the Senate to block meaningful reform. This record of abuse should be unacceptable to the Senate. It is certainly unacceptable to the American people. We held a forum Wednesday in which a letter was released from 36 groups representing patients, families, psychiatrists, psychologists, social workers, and others concerned about quality health care for people with mental illness. As I discussed in a floor statement yesterday, these groups begged the Senate to act to pass a patients' bill of rights, because with every day that passes, patients and their families suffer needlessly because of abuses by managed care plans. The stories they told were tragic--they involved suicide, spousal abuse, anxiety attacks inflicted on a Vietnam veteran, successful courses of treatment cruelly interrupted--all because insurance companies are putting the bottom line first and their obligations to patients last. This forum was just the most recent one in which we have heard patients and doctors and nurses pleading with the Republican leadership to act on real managed care reform. In my statement yesterday, I reported on an earlier forum in which we heard from Dr. Charlotte Yeh, an emergency room doctor representing the American College of Emergency Physicians. Dr. Yeh described tragic cases in which patients had been denied the care they needed because of managed care penny-pinching. On behalf of the college, she endorsed our legislation, and she denounced the Republican leadership alternative as worse than inadequate. Only with a full and fair floor debate can we pass real protection for patients who need emergency care or who should be allowed to go to the nearest emergency room when the symptoms of serious illness strike. On July 24, we heard from cancer patients and their doctors who explained how critical the provision of the Patients' Bill of Rights was in assuring patients access to quality clinical trials. These trial are often the only hope for patients with incurable cancer or other diseases where conventional treatments are ineffective. They are the best hope for learning to cure these dread diseases. Insurance used to routinely pay the doctor and hospital costs associated with clinical trials--but managed care plans are refusing to allow their patients to participate or to pay these costs. We understand. When patients are in a clinical trial there isn't a significant increase in terms of the costs to the HMO. It is just the routine doctor costs and hospital costs that they would pay anyway. The trial itself pays for the kinds of additional attention and prescription drugs that are given to these patients. But the insurance companies won't even cover the minimal payments. Our bill requires them to respond to this need--but the Republican bill does not, and the Senate leadership does not want a debate on this issue. Fourteen leading organizations of cancer patients, representing the eight million Americans surviving with cancer and the 1.5 million Americans who will be newly diagnosed with cancer this year, have spoken out strongly on the need for this amendment. These are organizations that patients and physicians alike look to for guidance on cancer issues. They include the National Coalition for Cancer Survivorship, Cancer Care, Incorporated, the Candle- lighters Childhood Cancer Foundation, the Susan G. Komen Breast Cancer Foundation, the National Alliance of Breast Cancer Organizations, the North American Brain Tumor Coalition, US TOO International, the Y-ME National Breast Cancer Society, the American Society of Clinical Oncology, the Alliance for Lung Cancer Advocacy, Support and Education, the Friends of Cancer Research, the Leukemia Society of America, and the Oncology Nursing Society--all groups that speak out for patients who have cancer. They have made their recommendations. They support our legislation. But we are being refused and denied the opportunity to even debate it. Here is what the combined cancer groups say about this: Clinical trials represent the standard of care for cancer patients. Patient care in clinical trials is no more important than standard therapy. Cancer will strike roughly one in three Americans during their lifetimes. Even those who escape the diagnosis will have friends and family touched by the disease. Any patient rights or quality care legislation will be a shallow promise for people with cancer if it does not include provisions ensuring access to clinical trials. That is what we are talking about--clinical trials for individuals who have cancer. Why can't we debate that on the floor of the U.S. Senate on a Friday at noontime? Why can't we call the roll for those who believe, as the cancer organizations do, that clinical trials are a critical aspect of treatment, and that most Americans believe when they sign those HMO contracts that they are going to get the best in terms of American health care? And they do with a better HMO. But there are too many that are denying that care. Too many that are risking their lives because they are being denied the opportunity for clinical trials that may offer new hope and opportunity of survival for an individual member of a family. That is unbelievable. But that is happening-- denial. Too often the insurance companies offer a shallow promise. But our program ensures these protections. The Republican plan does not. Mr. President, we see that not one, not a single group that is concerned about the survival of cancer has supported the Republican program. But virtually every major cancer group supports our legislation and believes it is essential to protect American families. Why can't we debate that on the floor of the U.S. Senate? What is it about? Hard-working Americans--more than 160 million working Americans who are going to work today on Friday at noontime. Why aren't we debating that in the Senate? Why aren't we debating it at 2 o'clock or 5 o'clock or on this coming Monday morning or afternoon? We are prepared to debate these issues. But, no, the Republican leadership refuses to debate them. We are effectively seeing the manipulation of the Senate rules in such a way as to deny the opportunity for full consideration of something that is of core concern and importance to every American family, and that is the quality of their health care. So, Mr. President, I just want to again reiterate my strong support for our Democratic leader, Senator Daschle, who has indicated that we are going to still, even in the final days of this session, continue to pursue this. There are those who say, well, we haven't got enough time. But our Republican friends must think we do have enough time because they are continuing to resist our efforts. They must assume we do have enough time. It is amazing how quickly this body can act when we want to act on important pieces of legislation, and we do have time. So, Mr. President, we will continue to press these issues forward. I see other of my friends and colleagues in this Chamber. I will continue to address this issue at another time, but it is important to note that we have seen one more week go by and a denial of the request of our Democratic leader to at least have a reasonable period of time to debate these issues and resolve them in a way that would respond to the central concerns of every major medical professional group and society in our country. I am not aware of a single medical society or patient group that supports the Republican plan--not one. We have been waiting to hear one. They can't come up with one. In contrast, more than 180 groups support our particular proposal. Now, we may not have it all right, and we are interested in discussing adjustments that we may have to make. But 187 groups in our country, representing the cancer societies, the medical professionals, the nurses, the patient groups, working families, and others effectively support our proposal. Every major children's health organization in our society has endorsed this proposal because they know how important this is for children. Every major breast cancer group in our society that cares about women and understands the enormous possibilities of breakthroughs in terms of the new modern miracle drugs supports our proposal. Every major group that represents persons with disabilities in our country--individuals who are challenged mentally and physically every single day--supports our proposal. And still, because of the manipulation of the Senate rules, we are denied a full debate and discussion and ultimate resolution as to what this body would say to families of this country on such a matter. It is wrong, and we are going to continue to press our case. I yield the floor.

Mr. KENNEDY. I am glad to yield.

Mr. KENNEDY. I thank the Senator.

Mr. KENNEDY

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

Mr. KENNEDY

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

Mr. KENNEDY

Mr. KENNEDY. Mr. President, I want to point out once again to the Senate that we have been in a quorum call for about a half hour, and we are waiting to conclude the FAA legislation. As I understand, it has been tentatively agreed to be concluded later in the afternoon sometime--5 or 6 o'clock this evening--and we can anticipate perhaps one or two more votes. But I want to bring to the attention of the Senate again that we could be using this time to debate the Patients' Bill of Rights. We have by now seen the majority leader's priorities--the FAA bill, which is important to a number of communities, including my own State of Massachusetts is not a matter of insignificance--but we have had the salting legislation, we have had other pieces of legislation that have been advanced, and still the Republican leadership refuses to call up or permit our debate here on issues relating to the quality of health of some 140 million Americans, those Americans that are covered in various HMOs. In my own State of Massachusetts, we have some of the very best in terms of HMOs. The HMO program really took off, expanded, and we now find many high-quality HMOs. But in my State, and across the country, HMOs too often are making judgments and decisions based upon what insurance company accountants say, not what members of the medical profession recommend. I heard the President of the United States speak eloquently about his strong support for the Patients' Bill of Rights just a few days ago. And he made a point which I think is worth underlining here in the U.S. Senate this afternoon. He said that no one in these HMOs ever loses their job when they deny a procedure that a patient's doctor requests, because these HMOs are organized so that there are several different levels of approval required to receive medical care. The deep concern that many of us have is that these decisions be made at the ground level--by doctors and other trained medical professionals--so that American families receive the care that they need. And if decisions are going to be made that are in the interests of the profit of the HMO and not the health of the patient, and as a result of those decisions that that individual is killed or permanently disabled, there ought to be some form of remedy. That is a key part in our Patients' Bill of Rights. Why should we say that there is only going to be one industry in America that is going to be free from accountability to the American citizens? Why should they be the only one? They are, today, effectively the only one. Under existing law, the health insurance industry is the only industry in America where, if there is negligence resulting in the loss of life or serious bodily injury, they are essentially free of accountability. That is wrong. Most Americans believe that is wrong, and it is wrong. Accountability is an essential part of our Patients' Bill of Rights. Medical decisions should be made by medical professionals and not by accountants. And if a negligent decision was made, there should be accountability. Or what will happen to the family of the patient who died because an HMO refused to pay for a medical test? What will happen to the education of the children of the patient who is permanently disabled because she could not receive care at the closest emergency room? Our Republican friends say that is too bad, we don't want to change that provision. Why can't we debate that? Why are we taking time in a quorum, or the time used yesterday waiting for amendments to the FAA bill? We understand that there is no long list of speakers to come to the floor even this afternoon. Why aren't we debating managed care reform here on the floor this afternoon? Why aren't we able to make some decision that affects millions of families today, across this country, on the issues of accountability? It isn't just accountability. Another very important provision in our Patients' Bill of Rights would require HMOs to pay for routine medical costs associated with clinical trials for their patients. We know--I know from personal experience--the importance of clinical trials. These trials don't, in fact, add any substantial additional cost to the HMO, because most of the patient's expenses are covered by the trial protocol--the grant for that particular trial. There are very small additional expenses--very, very small additional expenses. And clinical trials are enormously important. They are enormously important for children who have cancer and other serious and dread diseases. My own son was involved in an NIH clinical trial when he had osteosarcoma. Only 22 children had been in that clinical trial prior to my son. He lost his leg to cancer. But his chances of surviving were 15-18 percent before he entered that clinical trial. And he survived, as about 85 percent of the children who got into that clinical trial did. Now the treatment used in that trial is a generally accepted procedure for children who have osteosarcoma, bone sarcoma. The idea of denying children the opportunity to enter clinical trials is outrageous. What are we supposed to say to a parent? ``Yes, we know your child has osteosarcoma. We know there is a clinical trial that could save his life. But we are not going to permit you to enlist your child in that clinical trial''? That is happening in the United States today in HMOs. These families say, ``My goodness, what will I do?'' They appeal the decision, they wait, they go to desperate lengths requiring tremendous courage, and finally they get in the clinical trial weeks or months later. But it is too late; that tumor that was a fraction of a centimeter has enlarged. There can be no treatment now. Denying our citizens an opportunity to participate in the greatest advances that are taking place in the medical profession is effectively a death sentence. We have made great advances in the war on cancer, especially in children's diseases. And I don't know what we would have done if we didn't have clinical trials for these children, and for patients with other diseases. We now have some very important opportunities for treatments of breast cancer, colon cancer, ovarian cancer, cancer of the stomach, and colorectal cancer. Diseases like breast cancer are becoming more and more of a challenge. Yet we are experiencing these breakthrough therapies that can make an enormous difference in saving the lives of our fellow citizens. I seriously believe that the next millennium will be the millennium of the life sciences, breakthroughs in terms of medicine. It will offer enormous opportunities. The opportunities of mapping the human genome alone--which our good friend, the Senator from Iowa, Senator Harkin, has been such a leader on here in the U.S. Senate--are just mind boggling. But we also have the opportunity now to make a difference in people's lives--to make sure that, when medical professionals recommend that patients enroll in clinical trials, these decisions are not overruled by insurance company accountants. That decision effectively denies them the opportunity to save their lives or to get the best in terms of medicine. Every single day we have examples of this type of situation. I will mention one, Diane Bergin. I have Diane Bergin's testimony from a forum that was held on the Patients' Bill of Rights. We talk about the Patients' Bill of Rights as a piece of legislation, but it is really an issue of lifesaving protections. That is what the legislation is really about, lifesaving protections, and we do it in a number of different ways. Mr. President, this is Diane Bergin's comment: My name is Diane Bergin and I was diagnosed with ovarian cancer two years ago. I had always been very healthy--so the news was particularly devastating. The only time I had been in the hospital was when I had my three children. My primary care physician referred me to a specialist at Georgetown, where I eventually had my surgery and received standard chemotherapy treatment. For three months, everything looked good. At my next checkup, however, the cancer had come back. My physician recommended that I consider getting a bone marrow transplant. Before I could get treated, however, I had to go through a round of medical testing to see if I was a good candidate for a transplant. All through the testing I kept hoping that I would qualify. I worked hard to keep my spirits up and be optimistic. But in addition to worrying about whether I would qualify for a transplant, I also had to worry over whether my insurance would cover the procedure. It felt like the insurance company held the balance of my life in their hands. I had no guarantee that if I qualified, I would be covered. My husband and family couldn't have been any more supportive. They told me to count on getting the transplant and that they would somehow find a way to pay for it. In my heart I couldn't accept that I would impoverish my family to have a chance at prolonging my life. Fortunately we weren't asked to make that decision. My insurer finally sent me a letter approving my treatment. Again I improved immediately after the transplant, but six weeks later I was not so lucky. I was sent to another specialist in Philadelphia who put me on tamoxifen. This was the only drug I could tolerate because my condition was so fragile after the transplant and there was some hope it would help me. Unfortunately I didn't improve. It was then that my physician suggested that I enroll in a clinical trial for a new treatment at the Lombardi Cancer Center. Even though I had been on an emotional roller coaster waiting for my insurer to approve other treatments, I never thought my insurer wouldn't pay now. But on the Friday before I was to start my treatment, I was called and told that my request had been rejected. I was devastated and didn't know how I could get through the weekend with my husband and son out of town. It struck me how arbitrary the insurance system was. They were acting as judge and jury on what medical care I could receive even though my doctors recommended this care. The denial felt like a death sentence--that I wouldn't have any more chances to fight for my very survival. I refused to accept that I couldn't get this treatment that I so desperately needed. I objected and started my appeal. When my family returned, they joined in the fight. Fortunately, my son works at the Cancer Center and is very involved in the clinical trial program there. With all our efforts, and the aggressive appeal by my clinical team at Lombardi, my insurer finally agreed to pay the routine costs of my care. I'm in the midst of that trial right now. I don't know if this trial will help me. And I don't know what will happen if I should need to seek treatment through another clinical trial. I anticipate another fight, only next time I may not be so lucky. I wanted to come today to tell my story because I believe that no one facing a serous illness should be denied access to care because that treatment is being provided through a clinical trial. Sometimes, it is the only hope we have. And the benefit to me, whether short or long term, will surely help those women who come after me, seeking a cure--a chance to prolong their life for just a little while, just so that they can attend a graduation, or a wedding, or the birth of a grandchild. I strongly support, and my family is right there with me, requiring insurers to pay for the routine costs of care that are part of an approved clinical trial. I think the cures of the future depend on it. Mr. President, letters signed by scores of groups supporting the right to get into clinical trials, and we have letters signed by scores of groups regarding access to specialists, such as pediatric oncologists. In our legislation, we also have provisions for guaranteeing that a child can see a specialist if that child has a serious illness. That is not in the Republican program. We in the Senate ought to be able to debate the merits of this provision. But the bottom line, at the end of the day, is what the additional costs are going to be. We ought to be able to debate these, as well. You will find out that the cost of our protections is approximately $2 per worker per month. I think most workers would be glad to pay that additional $2 a month for the kind of protections we are talking about here in terms of clinical trials and specialists for members of their family. Why not give us an opportunity to debate that? Why not call the roll on those particular provisions? We need to have a debate on the situation we see taking place around this country, where if you are a member of an HMO, your ambulance will drive by the nearest hospital and go to another hospital on the other side of town just because they are a member of that HMO. They will drive right by it. If a family goes to the closer hospital, the HMO will charge the family for the emergency care, which perhaps saved their child's life. We ought to be able to debate that. Why are we being shut out and denied? Why are we continuing in these quorum calls that last the course of the afternoon? Why didn't we take time yesterday and why aren't we taking time this afternoon to move ahead on this kind of legislation? Mr. President, many of the guarantees that have been included in the Patients' Bill of Rights are guarantees that were unanimously recommended by the bipartisan President's Commission on Quality Care. In fairness, I will say that the Commission didn't recommend that these recommendations necessarily be put in legislation. But if all of the HMOs had just accepted those requirements, then we would not be needing this legislation. The problem is that the good ones have it, but the others don't. So we are saying that we want to make sure that the protections are going to be across the board. If all of the HMOs complied with the legislation, we would not need it. But these are very sensible and responsible recommendations. Half of them have been recommended by the President's Commission, half of them by the American Association of Health Plans. We have more than half of them that are already in existence included in form of Medicare, and 32 million Americans get those protections. So they are working in the Medicare, but they are not available for other Americans. Other protections in our bill were recommended by the National Association of Insurance Commissions--again, a bipartisan group of insurance commissioners representing the States who have a pretty good understanding and awareness of what is needed. There is not one of our recommendations--not one of them--that has not been recommended by one of those four organizations or groups. Not one. Mr. President, what I am saying is that these protections have been well thought out. They are reasonable, they are sensible, they are responsible, and they will make a significant difference in terms of protecting the health care of the American people. Now, Mr. President, it is time to give us an opportunity to debate those and act on them. I will wind up with these final comments. We have every professional medical organization, every nursing organization, every consumer group in the country supporting our Patients' Bill of Rights. Not one is supporting the Republican proposal. Not one. No matter how many staffers go out and search, they can't find one. The doctors and the medical profession understand the importance of this, as well as the parents. Every children's group, every disability group, every women's group, every one of those groups support this because this is the way to protect children, the disabled, women, and families. With all respect to the importance of the legislation that we are currently considering, we have few days left to debate the Patients' Bill of Rights. We continue to implore the Republican leadership to bring up this legislation and permit the Senate to work its will so that we can do something to protect the American consumer in health care. Mr. President, I see my friend and colleague from Arizona on the floor. I yield the floor.

Mr. KENNEDY

Mr. KENNEDY. Mr. President, I was over in my office earlier in the afternoon. I heard the quorum calls. Now again we are wasting time in the middle of the afternoon. We are talking about a Wednesday afternoon at about quarter of 5. The Senate is in a quorum call when we could be debating the issue of the Patients' Bill of Rights. I have taken the opportunity at other times to remind the Senate about the importance of that debate. Last week, we had the Republican leadership effectively close down the Senate for 5 hours, by essentially prohibiting Members of the U.S. Senate to speak at that time on the issue of the Patients' Bill of Rights. And, as has been pointed out by our Democratic leader, Senator Daschle, the Republican leadership shows an unwillingness to debate this issue during the evening times, which would allow us to do the country's business and do the people's business. I rise again today to talk a bit about this issue, and the importance of it, because it is of such compelling importance to millions of Americans--more than 160 million Americans. Every time I go back to Massachusetts--and I think it is generally true with others as they travel across the country to their States--I run into the people who have faced the kinds of situations that I will mention in just a moment or two. These are situations that cry out for action. Still we don't take the action. We have considered other pieces of legislation that have some importance. But I daresay that none of the recent pieces of legislation that we have considered, I believe, rise to the importance of the debate and discussion on the Patients' Bill of Rights. Mr. President, I want to include in the Record today the testimony and the comments of some leading American citizens who are very concerned about ensuring adequate protections for consumers of mental health services--protections that are included in the Patients' Bill of Rights, which has been introduced by Senator Daschle, and are not included in the Republican proposal. In the forum that was held this afternoon, 36 groups--representing patients, families, psychiatrists, psychologists, social workers, and others who are concerned about quality of health care for people with mental illness--begged the Senate to act to pass the Patients' Bill of Rights. With every day that passes, these patients and their families are suffering because of abuses by the managed care systems. In too many instances, the stories they told were tragic. They involved suicide, spousal abuse, anxiety attacks inflicted on a Vietnam veteran, and successful courses of treatment cruelly interrupted because insurance companies are putting their bottom line first and their obligations to patients last. One of our speakers, the president of the National Alliance for the Mentally Ill, NAMI, focused on an important provision of our legislation that has not received as much attention as some of the other issues--access to needed prescription drugs that are not on a health plan's approved list. For mental patients, the last few decades have seen a significant growth in the number of new medicines that can treat their diseases. For many patients, these new drugs represent genuine medical miracles and opportunities to resume lives that have been devastated by these cruel diseases. But too often managed care plans have said ``no'' to these patients and their doctors. They say: ``The new drugs are too expensive. You will have to make do with older, cheaper drugs that are on our approved list. If they don't work for you, that is just too bad.'' That should be unacceptable to every American. Our legislation will guarantee that no family with a mentally ill member will ever be subjected to this kind of abuse again. Mr. President, I ask unanimous consent to have printed in the Record the statement of the Mental Health Liaison Group.

Mr. KENNEDY. Seeing Senators are here and ready to move ahead, I will just make some few concluding remarks on this issue and then get back to it at another time. I think we could have been debating this, rather than just filling in the time with the quorum calls, which we have been doing frequently. So I indicate to colleagues, I will make some concluding remarks for just a few more minutes and then yield the floor. Again, from Dr. Yeh's testimony: What's the difference between the real ``prudent layperson'' standard included in the Balanced Budget Act and the Democratic Patients Bill of Rights and the imposter that has been included in the GOP Patient Protection Act? The GOP Patient Protection Act would establish a weaker coverage standard for privately insured patients than what exists for Medicare and Medicaid patients. This is not Senator Daschle or myself making this statement, this is a leading member of the American College of Emergency Physicians-- doctors who deal with this problem every single day--talking about how the GOP Patient Protection Act is a fraud. She continues along. I ask unanimous consent to have her full statement printed in the Record.

Mr. KENNEDY. Mr. President, we heard today from Jackie Shannon. She is the president of the National Alliance for the Mentally Ill, NAMI, and the mother of a son with schizophrenia. I would like to read from her very, very moving testimony. This passage refers to a woman named Pam Childs from Miami, Florida and her problems with manic-depressive illness: Pam was a Ph.D. psychologist who specialized in treating children and adolescents . . . Repeatedly, Pam's HMO told her that the treatment being recommended by her doctors were ``not part of the plan.'' On several occasions, doctors who made progress in treating Pam were later told that they were ``being taken off the plan.'' Pam Childs never got the treatment she needed, and this story did not have a happy ending. On July 2 of this year, at 34 years of age, Pam took her own life by leaping from the window of her father's 15- story apartment. Mr. President, Jackie Shannon also told us about the problems the mental health community faces in terms of access to various prescription drugs. The prescription drug formularies used by insurance companies limit access to the newest and most effective medications. I would like to read from her testimony: Over the past decade, the most far-reaching advances in the treatment of brain disorders such as schizophrenia and manic- depressive illness have all been in the area of prescription drugs. These new medications are highly effective in treating severe symptoms, without many of the disturbing side effects associated with older medications. While some of these medications may cost more at the front end, they deliver significant long-term savings through fewer and shorter hospitalizations, and, more importantly, a higher quality of life for consumers. Unfortunately, managed care plans too often use formularies--restrictive lists and bureaucratic rules--to limit access to the newer, more effective medications. What kind of rules? A 1997 survey of managed behavioral health plans by NAMI revealed widespread use of policies such as prior authorization, and what they call ``twice-fail'' requirements as parts of the formulary. These ``twice fail'' rules are especially offensive to the NAMI members. Our survey found that some managed care plans actually require patients to fail on older, cheaper medications multiple times before being able to access the newer medication. NAMI believes that psychiatrists and their patients should be able to select the medication that is right for them based on clinical effectiveness, not on a managed care plan's financial bottom line. The best treatment available should be the treatment of first choice. Do we understand that, Mr. President? The best treatment available ought to be the treatment of first choice. The Democratic version of the Patients' Bill of Rights guarantees that. It would allow the doctors to overrule a plan's restrictive drug formulary when it is in the patient's interests. The Republican bill would not. Now, Mr. President, this is an issue of particular importance to persons with mental illness who need these newer drugs. We hear case after case of patients who would be helped if they had access to the newest and most effective medications. We heard of one young person whose plan required him to use the cheaper drugs and demonstrate their failure not just once, but twice, before they would even be eligible for the right drugs. This is one of the reasons that we provide this kind of protection in our Patients' Bill of Rights. We believe it is important to ensure that the doctor can to say, This is the kind of prescription drug that is necessary to deal with your particular health need and that the plan will cover it, if the plan offers drug coverage. That is a very important protection. We would like to debate that issue. If the Republican leadership does not believe that we ought to provide that kind of protection, they should come to the floor of the Senate and let's call the roll. This is not a complicated issue. It is not a very complicated issue. But it is one of the very important protections that exist in our bill and which does not exist in the Republican bill. The American people have been effectively denied--with the various proposals that have been offered by the majority leader in terms of the debate of the Patients' Bill of Rights--from seeing where the Senate stands on these important issues. The leadership has said, in reference to their proposal, You can either take it or leave it. They are attempting to gag not only the doctors in this country from giving the best advice on health care needs, but they are also attempting to gag the Senate from having any kind of debate or discussion on these issues, let alone a vote on them. That is very, very important, Mr. President. The National Association of Mentally Ill feel that access to prescription drugs is of enormous importance to their membership. Their view is shared by all of the leading mental health organizations. That is why the 36 different groups have indicated strong support for the Democratic Patients Bill of Rights. Mr. President, I refer right here to this chart that compares our Patients' Bill of Rights, which puts patients before profits, and the Republican legislation. Right here, No. 11--access to doctor prescribed drugs--the question is whether you will be able to get the kind of prescription drug--new or old, perhaps somewhat more expensive--that your doctor recommends, or be forced to take only those medications that are listed on the HMO plan and just do not work for you. Mr. President, this forum that we had was just the most recent one in which we heard patients and doctors and nurses pleading with the Republican leadership to act on real managed care reform before the end of the year. At today s forum, I spoke about a particularly tragic set of circumstances surrounding the case of a man who died because his plan denied necessary treatment. In this case, however, like too many others, the plan was not held accountable for its abusive actions. Let me just tell you, Mr. President, about this very tragic case. Richard Clarke of Haverhill, MA, was struggling to deal with a serious problem of substance abuse. His health plan clearly covered 30 days of inpatient rehabilitation. But when Mr. Clarke's doctor admitted him to a detoxification program, the plan provided only 5 days of treatment. His treatment was cut short, and his pattern of abuse and inadequate treatment continued. Shortly after the first hospitalization, his doctor again tried to admit him. But his HMO approved just 8 days of inpatient rehabilitation. And 24 hours after this discharge, Mr. Clarke attempted suicide. Again, he was referred for additional inpatient treatment, but this time the HMO refused to pay for any additional services--even though his policy clearly should have covered 17 additional days. At this point, a judge committed Mr. Clarke to a State correctional center. Mr. Clarke was abused in that center and received only minimal treatment. Tragically, just a few weeks after being discharged from the correctional center, Mr. Clarke committed suicide at age 41. He left a widow and four children and 17 days of inpatient rehabilitation coverage on his insurance policy--17 days that were not used, 17 days that were repeatedly denied by the HMO. And he took his life. His widow took the insurance plan to Federal court. But Judge William Young had no choice but to reluctantly dismiss the case because the Federal law protected the HMO from accountability for its actions. Judge Young was frank in his opinion: Federal law has evolved in a shield of immunity that protects health insurers. . . and other managed care entities from potential liability for the consequences of their wrongful denial of health benefits. The Federal law thwarts the legitimate claims of the very people it was designed to protect. There it is, Mr. President, an example of an individual who needed help, consolation, rehabilitation, and attention, but was denied it by the HMO. A tragic, tragic ending, with the HMO responsible--I believe, just from a reading of these facts--or certainly contributing to the anxiety and ultimately to the untimely death, and the loss of this father of four children. And, under current law, the HMO is able to stand back and say, no, we can't be sued. And they cannot be, Mr. President. That particular issue is addressed in our legislation. Right here on the chart where we say ``ability to hold plans accountable.'' But it is not in the Republican legislation. We looked through their bill. It is not there, but it is in ours. Another issue to debate. Another issue to discuss. Another issue to vote on. It is not very complicated. Are you going to hold a plan accountable when its decisions result in the death or serious injury of an individual who may be the breadwinner for a family? Are you going to deny a family the opportunity to hold insurance companies responsible if a loved one has been the recipient of negligent treatment? We ought to be able to vote on that. It is not very complicated. But no, no, we cannot even bring that up. We cannot even debate it. It is a crucial matter, certainly, to the Clarke's or any other family in this situation. It is a crucial matter to millions of other families. Mr. President, there are millions of Americans who have that kind of protection today, but it is not guaranteed to over 120 million Americans who receive their insurance through employers in the private sector. It is not guaranteed. It is effectively excluded. Mr. President, more than 40 million Americans can hold their HMOs accountable, but more than 120 million others cannot. The others cannot. Why not, we might ask? Because the power of the special interests will not permit us to get to this legislation, to consider it, debate it, and call the roll on it. Mr. President, this forum was just the most recent one in which we have heard the patients and doctors and nurses pleading with the Republican leadership to act on real managed care reform. Several weeks ago, we heard from Dr. Charlotte Yeh, an emergency doctor from Boston who also is a leader in the American College of Emergency Physicians. In fact, we have had the leaders of many of these professional groups appear in these forums--representatives of from many of the more than 180 different groups of patients and doctors, nurses, health professionals that support our legislation. Dr. Yeh described cases where HMOs denied treatment that patients needed because of managed care penny-pinching. She indicated she was appearing at the forum ``representing the concerns of 20,000 emergency physicians, on behalf of 90 million patients we see every year.'' She went on to say, ``For emergency physicians protecting patients is not just a job, it is our lives.'' They are strongly in support of our legislation. They strongly believe that we ought to have an opportunity to debate this legislation. They are strongly opposed to Republican leadership, and are concerned about the leadership s refusal to let us have an opportunity to debate the legislation. This is what Dr. Yeh commented on: For the last several years, the tactics of the managed care industry with respect to coverage of emergency care has become a national issue. * * * * * We've all heard the stories. In Detroit, a 46-year old woman collapsed in her husband's arms and was rushed to the hospital by ambulance. She died of cardiac arrest after a failed resuscitation attempt. Unbelievably, her managed care plan later denied payment for her treatment because she did not call for prior approval. In Boston, a boy's leg was seriously injured in an auto accident. At a nearby hospital, emergency doctors told the parents he would need vascular surgery to save his leg and a surgeon was ready and available in the hospital. Unfortunately, for this young man, his insurer insisted he be transferred to an ``in-network'' hospital for the surgery. His parents were told if they allowed the operation to be done anywhere else, they would be responsible for the bill. They agreed to the move. Surgery was performed three hours after the accident. But by then, it was too late to save his leg. These are not episodes from the TV program, ``ER''. These are not anecdotes. They are real people with real lives. A bipartisan majority in the Congress has called for enactment of standards that will put an end to episodes like the ones I just described. Last year, the Congress adopted the prudent layperson standard and other protections for Medicare and Medicaid patients seeking emergency care. Millions of Medicare and Medicaid beneficiaries have these protections, but not the 160 million people outside of those programs. They do not have these protections. She continues: We thought there was consensus on this issue. . . . But we are very disturbed about the way in which the emergency service protections were drafted in the Republican ``Patient Protection Act.'' As a physician, it seems that a little unnecessary surgery was performed on the ``prudent layperson'' standard to the point where barely recognizable as the consumer protection we envisioned.

Mr. KENNEDY. We heard from cancer patients, and their doctors, who explained that the Patients' Bill of Rights is critical to ensuring patients access to quality clinical trials. These trials are often the only hope for patients with incurable cancer or other diseases where conventional treatments are ineffective. They are the best hope for learning to cure these dread diseases. Insurance used to routinely pay the doctor and hospital costs associated with clinical trials, but managed care plans are refusing to allow patients to participate. Our bill forces the insurance companies to respond to these needs, but the Republican bill does not. And they refuse to debate this issue. Here it is on the chart, ``Access to Clinical Trials.'' We provide this protection, and they do not. Yet, this is very important for women who are battling breast cancer. It is important for children--like my own son, Teddy, who was able to get into a clinical trial when he had osteosarcoma at age 12, and survive that dread disease. He is alive today because he was in a clinical trial. Mr. President, as I have pointed out before, these are the guarantees that are in our legislation. Under our proposal, the doctor, the medical professional, will make the decisions on medical treatment for the patient--be that you or your spouse or your child or your grandchild. Medical decisions will not be made by an insurance company accountant. That is what is at the heart of the differences between the two pieces of legislation. We welcome an opportunity to just say we will take 10 of the issues on this list, and vote on those measures and vote on the legislation, while permitting our Republican friends to have a similar number of amendments. But let us at least get about it in these final days. It is not too late. It must not be too late, or we would not see the kinds of activity to deny or delay action on this legislation by our Republican friends each day. Just in conclusion, earlier in the day--although this was not advanced, it was circulated by the majority--there was a unanimous consent that was going to be proposed on the Internet tax legislation. I will include the whole provision in the Record. This was circulated to see whether there would be any objection on the Democratic side. It basically allowed all types of amendments-- unlimited first and second degree amendments or amendments that are not relevant to the Internet tax issues in the underlying bill--but, and this is important, no health care amendments. Here is the text that would have been spoken by the Majority leader, ``I further ask that during the Senate's consideration of S. 442 or the House companion, no amendments relative to health care be in order.'' There you have it: One piece of legislation, with possibilities for all other legislation, except one--health care, the Patients' Bill of Rights, guaranteed protections for more than 160 million people. Under this proposal from the Republican leadership, we are permitting other kinds of amendments, but we are going to say no amendments relative to health care be in order. Thankfully, our Democratic leader rejected this, so it was not offered. But these are the tactics we are facing. We are as committed as ever to ensuring that we will have an opportunity to debate this issue--even if not on this particular measure. So we are going to continue to pursue it. I thank the Chair and I yield the floor.

Mr. KENNEDY. Yes.

Mr. KENNEDY

Mr. KENNEDY. I thank the Senator from Arizona. I just wanted to join in expressing support for our leader's position in raising this extremely important issue, the Patients' Bill of Rights. Our leader, Senator Daschle, has indicated a willingness to enter into agreements that would be reasonable and which would permit debate and discussion of these important matters that are at the heart of concerns of millions of American families, and to do it in a way we would not interrupt the important legislation that the Senator from Arizona has identified. We have been frustrated in having that opportunity. We had similar difficulty earlier in terms of the minimum wage. We were able to address that, not with the outcome that some of us might have hoped but nonetheless we were able to at least get a judgment on that. And we wanted to try to also get a judgment on this matter which is of central concern to families all across this country. I want to just add my support to the objections of Senator Daschle and also to express appreciation to the Senator from Arizona. We know that this is not his decision at this time to be making, but it is a leadership decision. I thank him for his courtesy and recognize it.

Mr. KENNEDY

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

Mr. KENNEDY

Mr. KENNEDY. Mr. President, I understand that there is a time allocation, 1 hour for those who support this amendment, and 1 hour in opposition. Am I correct?

Mr. KENNEDY. I yield 7 minutes to the Senator from Illinois.

Mr. KENNEDY. Mr. President, I yield 10 minutes to the Senator.

Mr. KENNEDY. I yield 3 minutes.

Mr. KENNEDY. Mr. President, I ask unanimous consent that reading of the amendment be dispensed with.

Mr. KENNEDY

Mr. KENNEDY. I move to lay that motion on the table. The motion to lay on the table was agreed to. Amendment No. 3602