Frank Pallone

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, if I could just say to the gentlewoman, she is getting to the point that I wanted to raise by our colleague from Texas. He talked about lip service, and what has been happening here with our Republican colleagues on the other side tonight is that they realize now that the Patients' Bill of Rights has the support overwhelmingly of the American people. As the gentlewoman said, the special interests have been out there, the HMOs, the insurance companies, fighting this thing tooth and nail. Even with all of that, look at all of the recognized groups that care about patients, and the AMA being probably the most prominent, but there are so many other supportive groups, the nurses and all the specialty care doctors, too. Our colleague, the gentleman from Connecticut, mentioned one specialty care, but I could rattle off every specialty care diplomate organization in the country that is supportive of the Dingell-Ganske- Norwood bill. What they are doing now is paying lip service to the issue because they know it is an issue that is strong and that people want because it affects real people, like the guy who lost his finger. What I wanted to say if I could, and then I will yield back, is that we have to be very careful what we do here. These people that oppose the Patients' Bill of Rights, the special interests, they are pretty sophisticated. What they are trying to do tonight with this Fletcher bill is suggest that somehow this is not that different from the Dingell-Norwood-Ganske bill. It is not true. It is simply not true, because we have to remember that that person who is in extremis, the person who lost their finger, they are very vulnerable individuals. If we are going to make sure that the decision about what type of care they get is made by the doctor, and that if that is denied that they have a real way to redress the grievances, we could make some very simple changes in the law and eliminate both of those things. That is what they have done with the Fletcher bill, because one of the things we have in the real Patients' Bill of Rights is to say that the standard of review about what kind of care is necessary, what the physician should be allowed to provide, is decided by the physicians, by the standard of care within the medical community, and particularly within those specialties, the pediatric standard, the cardiological standard for the specialty care, or the general standard for family practice care. They have basically said in their bill, in the Fletcher bill, that that review process is going to be different. It is going to be stacked against the patient. I will just give an example. The bill, basically what it says is the standard review used by the external review process requires the reviewer to make its decisions on only the patient's record and scientific evidence, and does not allow them to get to the standard of care that exists within the larger community or that exists for that specialty. I probably sound like a bureaucrat in relating all this, but the bottom line is, we make sure that the decision about what medical care is necessary is the standard that the AMA would use, that the cardiologists' Board of Diplomates would use. They are not using that standard. The guarantee that that decision is going to be based on what the physician thinks is necessary is denied by the Fletcher bill. The other thing is that we have a rapid ability to overturn a denial of care, in our bill. What the Fletcher bill does is to put all kinds of barriers in the way, so that guy who lost his finger, he cannot easily say, I have been denied care and I can go to somebody, and they right away turn around that decision, so he can get his finger reattached in a timely fashion. They put all kinds of barriers in his way. I will just give an example. In the Ganske-Dingell-Norwood bill, we require the decisions are made with regard to the medical exigencies of the patient's case. This means the plan has to act quickly when needed. There is no such requirement in the Fletcher bill. There is nothing that says, my finger is detached. If they are denying me care, I have to have somebody who is going to within minutes change that decision over the phone. That is not the case. They could say under the Fletcher bill that one would have to wait a few days, a couple of weeks. How does that work with a guy who loses his finger? I will give one more example, but there are ten that I could give here. The patient, under the Ganske-Dingell-Norwood bill, it requires that patients have a right to appeal to an external reviewer before the plan terminates care. That is not true in the Fletcher bill. So to use the example with the guy who lost his finger, they can continue to provide him all kinds of care, but maybe not what is necessary to reattach the finger. He cannot go to the board and have the decision turned around while they are continuing to treat him in some maybe not effective way. So there are all kinds of ways to get around the basic protections that we are providing in the Ganske-Norwood bill. The problem with the Fletcher bill, it is using all kinds of little ways to get around that. We do not have time to go into it all tonight, but I want there to be a basic understanding that there is a real difference here between these two bills. As the gentlewoman said, my colleague from Texas, they are giving lip service to the Patients' Bill of Rights, but they are not really for the real Patients' Bill of Rights. I yield back to the gentleman from Texas (Mr. Rodriguez.)

Mr. PALLONE. I appreciate the gentleman's comments. I yield to the gentlewoman from Texas (Ms. Jackson-Lee), Mr. Speaker.

Mr. PALLONE. Mr. Speaker, I thank the gentlewoman for bringing that up, because I think essentially what our bill does is empower people. It does not matter who one is, one's race, one's color. The bottom line is people who are sick are not easily empowered. They are victims, even though we do not want to use that term. What it does is it empowers people at a time when they really need help, regardless of their race, religion or whatever, and that is what we are all about. I thank the gentlewoman. Mr. Speaker, I yield to the gentleman from Texas (Mr. Rodriguez).

Mr. PALLONE. Mr. Speaker, I want to thank the gentlewoman from Texas for bringing out all of the really good points that she did in effectively refuting most of the points that the Republicans who support the Fletcher bill, the weaker bill, if you will, the points that they made this evening. But there were two areas that I would like to focus on before I yield to the gentleman from Texas (Mr. Rodriguez) that I think the gentlewoman really brought out and that I did not bring out, and one is that I focused a lot, and I think that the Republicans on the other side focus a lot, on the liability issue, the question of whether one can sue or not sue. I think to some extent, in refuting them, I kind of fall into the trap of discussing the liability issue. The fact of the matter is, and the gentlewoman pointed it out very effectively, that part of the problem or a major problem with the Republican alternative, with the Fletcher bill, is that it does not provide the patient protections that the real Patients' Bill of Rights that we advocate provides. The gentlewoman pointed out a number of them, but just to mention a few others: The Fletcher bill fails to protect the patient-doctor relationship. It leaves out two things with regard to the patient-doctor relationship that we have in the real Patients' Bill of Rights. First of all, we have the gag rule that says that the doctors can freely communicate with their patients and the HMO cannot tell the doctor that if it is their procedure or some type of care that is not covered that they cannot tell the patient that it is available. It is called the gag rule. Well, the Fletcher bill does not protect against the gag rule. The HMOs could still tell the physicians that they cannot talk about a type of care that is not covered, which is a horrendous thing. I mean, people would not believe that a doctor could be gagged in that way. Secondly, the Fletcher bill does not protect against using these improper incentive arrangements where the doctor gets paid more if he provides less care or does not provide as much care, depending on the procedure, he gets paid a little more. That is not protected in the Fletcher bill. The other thing, and the gentlewoman went into this, so I will not go into it too much, but basically the Fletcher bill has a lot of flaws in the area of access to specialty, clinical care and clinical trials. The other thing I will mention briefly before I yield to the gentleman from Texas is the poison pills. One of the ways that the Republican leadership succeeded in the last session in killing the real Patients' Bill of Rights, as the gentlewoman knows, and we all know that it passed here in the House, the Ganske-Dingell-Norwood bill passed and almost every Democrat and 68 Republicans, I believe, voted for it. But when it got to conference, what they did is, they kept arguing, if you will, over these poison pills. In other words, it passed in the House, but it had these poison pills with regard to the medical savings accounts and the malpractice suits. The Fletcher bill has two poison pills like this. It expands the medical savings accounts and also the association health plans. I do not want to spend time tonight getting into all of those, but the bottom line is they have absolutely nothing to do with the Patients' Bill of Rights or patient protection. They have to do with the way they save money and deal with your health insurance and what kind of health insurance pools we have. They do not belong in this bill. If we pass that bill, we will have the same thing again in conference where they try to argue those issues and they manage to kill the real Patients' Bill of Rights. Again, we need a clean bill. That is what we are asking for, the real Patients' Bill of Rights, the clean bill that only deals with HMO patient protection and does not mess things up with all of these poison pills. I am glad the gentlewoman brought that up, because it is another criticism of this Fletcher Republican alternative.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I come to the floor today to voice my support for both the Foreign Operations appropriations bill and the rule, and I want to thank the chairman and the ranking member for their efforts. I am pleased that this legislation addresses two areas of the world very important to me, Armenia and India. However, in both cases I am hopeful that more money can be found for both countries in conference. Earlier this year in testimony before the Subcommittee on Foreign Operations, Export Financing and Related Programs, I requested the subcommittee provide no less than $90 million in U.S. aid to Armenia. This was the amount that Armenia received in last year's bill. I was encouraged by the $82.5 million that was approved by the subcommittee because it was substantially higher than the $70 million President Bush requested in his budget earlier this year. However, I know that Armenia needs at least as much as it received last year. I am also pleased that no changes were made to section 907 of the Freedom Support Act. I have been concerned that negotiators involved in the Nagorno-Karabagh peace process would attempt to use section 907 as a bargaining tool prior to a peace agreement. I am also happy, Mr. Speaker, that the subcommittee included language encouraging the State Department send more of the money Congress has appropriated in the past for aid to Nagorno-Karabagh. In the past, I have been concerned that out of the $20 million allocated to the people of Nagorno-Karabagh, only $11.8 million has been sent to the region for aid programs. It is important that these remaining funds be appropriately sent to the region to ensure that the residents of Nagorno-Karabagh receive the assistance. Appropriators should also be commended for expressing the need to provide a peace dividend in the event a settlement is reached between the Caucasus nations over Nagorno-Karabagh. The bill also includes language directing assistance for confidence- building measures and other activities to further peace in the Caucasus region, especially those in the areas of Abkhazia and Nagorno-Karabagh. These measures include strengthening compliance with the cease-fire, studying post-conflict regional development such as water management and infrastructure, establishing a youth exchange program and other humanitarian initiatives. Finally, Mr. Speaker, in regards to India, a massive and devastating earthquake hit the Gujurat region in January. I am grateful for the more than $13 million that has already been sent to assist the region, but clearly $13 million is not enough to address the continued struggles India, particularly Gujurat, is facing during this earthquake's aftermath. We must continue to provide as much support as possible. An amendment may be brought up to provide more direct assistance for earthquake relief. Another may be proposed that would add $10 million to the Office of Foreign Disaster Assistance at USAID. There is also the possibility of providing more assistance in conference. I would ask that my colleagues support these efforts. But in any case, Mr. Speaker, this is a good bill and I would urge its adoption.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, this evening I want to spend the time with my colleague from North Carolina talking about the Patients' Bill of Rights. I have been to the well many times to talk about this legislation. I know that we do have a commitment from the House Republican leadership to bring up HMO reform, hopefully at some point over the next 2 weeks. But what I wanted to stress tonight is if we are going to deal with the issue of HMO reform, we have to pass real HMO reform, and that is the Patients' Bill of Rights. It is a bipartisan bill sponsored by the gentleman from Michigan (Mr. Dingell), who is a Democrat; the gentleman from Iowa (Mr. Ganske) and the gentleman from Georgia (Mr. Norwood), who are Republicans. This bill or a similar bill passed in the last session of Congress overwhelmingly, almost two-thirds of the Members, most Democrats, and 60-some-odd Republicans. However, once again the House Republican leadership does not support it and does not want to bring it up and is trying, even after a similar bill passed the other body, is trying to kill it effectively by coming up with what I consider a sham HMO bill and trying to get support for that sham Republican HMO bill. I would like to speak tonight to explain not only why the real Patients' Bill of Rights should be brought to the floor immediately and passed but also why it is such an improvement, as opposed to the sham bill that I fear the Republican leadership may try to slip by. But at this time I yield to the gentlewoman from North Carolina (Mrs. Clayton), who has worked long and hard, I think too many years that we have worked on this bill, and we hope it will come to the floor in the next few weeks.

Mr. PALLONE. If I could take my time back, I think that is real important, that people have to understand, even in Texas the majority of the people do not have the benefit of that Texas Patients' Bill of Rights.

Mr. PALLONE. Mr. Speaker, I want to thank the gentleman, first of all, for explaining how in his home State of Texas that this bill has been tremendously successful and has not brought the frivolous lawsuits that we keep hearing from the other side, and that really we have nothing to fear. It is just basically has been a success in every way. I know sometimes when we talk about the Patients' Bill of Rights, maybe we sound a little too lawyerly and technical about how one goes about appealing a denial of care. But the bottom line is, if there is no fair way to appeal a denial of care, if you have not been able to get the operation or procedure you need, if we do not set up a procedure to reverse that, then we might as well not pass the law. So it is necessary for us to go into how we go about letting people redress their grievances, and it is also important to point out that the Republican bill, the Fletcher bill, is not going to accomplish that, certainly not in any way that I think is meaningful. I did not want to dwell upon it too much, but I just wanted to mention a couple other examples. We have to keep in mind when we talk about these procedures to overturn a denial of care that the people that are seeking to do that are ill. Oftentimes they are very ill. They need action fast. They cannot sit around forever if the HMO denies them an operation or procedure. So it is very easy, as I think they do in the Fletcher bill, in the Republican bill, to tweak the bill in a way so that that procedure becomes meaningless. I do not want to dwell on it too much, but this is one of the things I thought was so important, was in the Ganske-Dingell proposal, the real Patients' Bill of Rights, there is a requirement that decisions are made in accordance with the medical exigencies of the patient's case, and there is a requirement that patients have a right to appeal to an external review before the plan terminates care. Those are not in the Fletcher bill. They do not take into account timeliness, the fact that you do not have a lot of time to appeal or to go to an external review board. There are little things like this, I am not going to get into them, but they make it very difficult. If you are in a situation where you are denied care and need the operation, that you can in a timely manner reverse that decision. So I just mention it, because I know a lot of times we talk about all these details, Federal versus State court, whatever, but these details are very important, because people do not have a lot of options when they are sick and ill and need to immediately have access to the kind of treatment that is necessary for them. I see my other colleague from Texas has stood up, and I would like to yield to him. I know, once again, he has been very much involved in this issue for a number of years both on our Health Care Task Force as well as on the Subcommittee on Health.

Mr. PALLONE. I want to thank the gentlewoman for all her participation and everything that she has done to try to put this patients' bill of rights together. There are a couple of things that she mentioned that I wanted to repeat, and I think are important and need to be repeated. One is that if you think about what we are really trying to do here, there really are basically two principles: one is that we want to make sure that decisions about what kind of medical care a patient gets or an American gets is a decision that is made by the physician and the patient, not by the insurance company, not by the HMO. Too often today I get complaints from my constituents in New Jersey who say that they were denied care, they were denied a particular operation, they were denied to stay in the hospital a certain number of days, they were denied a particular procedure because the insurance company did not want to pay for it. That should not be the way it is. Decisions about what kind of care you get, medical decisions, have to be made by the physicians. That is why we have physicians. That is why decisions are made collectively by physicians and their patients. The second thing is that if you have been denied care and you think unjustly so, you have to have some ability to redress your grievances, to appeal that. What we suggest in the patients' bill of rights, what we guarantee, is that you can go to an independent review board, outside the realm of the HMO, not appointed by the HMO, and that they will review the decision and if they feel that you were improperly denied care, then they can overturn the decision of the HMO or the insurance company. Failing that, you can go to court and ask that it be overturned or sue for damages if you have been injured and there is no real recovery from those injuries. These are just basic rights. Most people, until they get into a situation where they have been denied care, have no idea that what I am suggesting is not already the law. They think it is the law. They think it is fairness, which is essentially all we are asking for. The other thing that my colleague from North Carolina mentioned that I think is so important is that we as Democrats and a significant amount of Republicans as well in this Chamber, we are simply asking for an opportunity to vote on this bill. This bill was voted on in the other body. It is now over here. It should be taken up here in the House of Representatives; and we should be allowed a clean vote, not bogged down with all kinds of procedures so that we cannot vote on it, and certainly not have an alternative bill which the Republican leadership has put forward which is not protective in the same way of patients. To give us the opportunity to vote on that and say that is HMO reform and then not have the opportunity to vote on the real patients' bill of rights I think is a travesty. And I hope that that is not what the Republican leadership has in mind, although there is every reason to believe that, in fact, that is the case. I see I was joined also by my colleague from Texas. I was hoping, and I know that he will also get into the fact that in the State of Texas, our President Bush was the Governor of Texas and while he was there, the Texas legislature passed a patients' bill of rights, very similar to the patients' bill of rights that we now seek to have voted on here. It has been a tremendous success. It has not resulted in much litigation. People have been able to overturn denials of care on a regular basis without having to go to court. It works well, and there is absolutely no reason why the same type of legislation should not be passed on a Federal level so everyone in every State can have the same benefits that the citizens of Texas have. I yield to the gentleman. He has also been a very active member of our health care task force.

Mr. PALLONE. If I could follow up on that, Mr. Speaker, that is one of the things that is also a big difference with the Fletcher bill, with the Republican bill. The Republican bill, as the gentleman knows, that the leadership wants to bring out leaves out this basic right, if you will, or basic protection that we have in the real patient bill of rights that says doctors can communicate freely with their patients without fear of retaliation by the HMO. That guarantee, or the gag rule, is not in the Fletcher bill. The other thing that is not in the Republican bill, it also fails to protect against HMOs when they have these financial incentives where they say to the doctor, if you do not provide a certain amount of care, or if you do not have your patients use the hospital or certain procedures and save us money, then you'll get a financial incentive, sort of a rebate of some sort, there is nothing in the Fletcher bill that guarantees that those kinds of arrangements could not continue. We primarily tonight have been talking about the patients. Of course, this impacts the patients as well, but there are a lot of protections for physicians so they can practice freely that are in the Dingell- Ganske bill that are not in this Republican bill. Those are two important ones.

Mr. PALLONE. Is it not also true that in many areas, and it depends on what part of the country one is in, but there are certain parts of the country, and New Jersey is certainly one of them, where the physician is really forced to join the HMO. In other words, they have a difficult time staying independent and relying on traditional insurance, so they are in a situation where they have to sign up and take these contracts with gag rules and the financial incentives and all those things. They are not free necessarily to avoid all that.

Mr. PALLONE. I agree. And I know we are running out of time, so I guess we will finish off here; but I want to say two things. First of all, I really appreciate the gentleman's joining me tonight, because I think a lot of the emphasis that we have talked about, not only tonight but on other occasions, has been more from the patient's point of view. And what the gentleman is pointing out is that basically the patients' bill of rights frees up the doctors to practice medicine, and that if we do not do this, in the long run we are going to lose a lot of good doctors. We already have. And, of course, that is a patient issue as well. Whatever helps the doctors certainly in these circumstances also helps the patients. The other thing, of course, is my fear, and the reason we are here tonight is because we keep hearing that the Republican leadership, which does not want this bill and has done everything over the past 5 years to kill the bill, is trying to do that again. Basically, what they are doing is going to the 60-some odd Republicans who voted for the Patients' Bill of Rights in the last session and trying to get them to oppose that and support this Fletcher Republican bill, which does not accomplish the goal. My fear is that if they do not get enough votes to pass the Fletcher bill, the Republican leadership simply will not bring up the Patients' Bill of Rights. So we are just going to have to keep holding their feet to the fire, so to speak. And as the gentleman says, if they will not bring it up, I guess we will have to resort to a discharge petition. But these procedural efforts are difficult. It is not easy to accomplish these things. So as the gentleman says, if we can get the American people to wake up sort of and say, look, this is something that has to be voted on; if we can accomplish that, that is really the way to go. But we have to continue to speak out, as we did tonight and we will continue to, until we have a freestanding vote on this bill. It is that important.

Mr. PALLONE. I thank the gentleman again.

Mr. PALLONE. Mr. Speaker, if I could just interrupt a second, because we had a hearing a couple of years ago, I think it was one of our task force hearings, and I do not remember the details, but it directly referred to psychiatry. The problem was that the HMO was using a standard that was not really acceptable by those who certify psychiatrists and basically saying that, for a patient who had a mental illness, they would only be entitled to, say, three visits, where maybe the standard for the psychiatric society was 15 visits. They just made it up. I mean, they just made up the number of days that they would provide. The testimony showed that they were about to be acquired by another HMO, and so they were trying to show that they were making a lot of money. They just established that standard based on the cost, that they would save money. One of the things that is in the Dingell-Ganske bill, it says that, with regard to specialty care, that the standard has to be that which is typical for that specialty care. They use, I do not know what they call them, the diplomacy board or whatever as the standard. That is another major difference I think in terms of why the Patients' Bill of Rights is such a good bill. I do not remember all the details, but I remember specifically that.

Mr. PALLONE. Exactly. I would like to yield now to the gentleman from Washington (Mr. McDermott), who is one of very few physicians that we have in the House of Representatives. I know that he, because of his background as a physician, probably more than any of us knows about the problems that patients have with HMOs and with denial of care.

Mr. PALLONE. I want to thank the gentleman from Texas. Again, he has been in the forefront on this issue, not only on putting together the Patients' Bill of Rights, but trying to get it passed. Frankly, I think we are just becoming a little impatient. This is a bill that passed in the last session, two years ago, overwhelmingly, almost every Democrat, about a third of the Republicans, and the only problem we have is that the Republican leadership refuses to bring it up. All we are asking for is a clean vote on the bill.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I would like to call the attention of Congress to an event on Thursday, August 16 in New Jersey. The Jewish Family and Children's Service of Greater Monmouth County is holding a dinner and tribute at Temple Beth El of Oakhurst to honor Ruth Hyman. Ruth will have the distinction of receiving an Ad Journal for her work as a philanthropist and her support of Jewish causes in the area, as well as in Israel. Ruth, close friend of mine, was born in my hometown of Long Branch, New Jersey into a family of four boys and four girls. She says that her parents' direction and teachings of tzedakah, menschlichkeit, and the Torah guided her to be the person that she is today. Ruth's teachings as a child can well be seen in her community involvement. She is a life member of Daughters of Miriam, charter and life member of the Central Jersey Jewish Home for the Aged, founder and past chairperson of the Federation Women's Business and Professional Division, benefactor and board member of the Jewish Community Center, and an active member of B'nai Brith, AMIT, and Congregation Brothers of Israel. For the past twenty-five years Ms. Hyman has been the Chairperson of the Women's Division of Israel Bonds, and for the past twenty-six years she has been the president of the Long Branch Hadassah. This is not the first time that Ruth will be honored for her service to the community. Ruth has received the Service Award from the Jewish Federation Women's Campaign, Woman of Valor of the Long Branch chapter of Hadassah, Israel Bonds Golda Meir Award and the Ben Gurion Award, Lay Leader of the Year by the Jewish Federation, and the Hadassah National Leadership Award. The community cannot express the debt that we owe to my friend Ruth who has shown us all that selflessness will never go unrecognized. I want to personally thank Ruth Hyman for being a leader of the Jewish community and an excellent role model for our youth.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I rise today in honor of Major General Robert L. Nabors, as he relinquishes his command of CECOM and Fort Monmouth in New Jersey. Major General Nabors 35 years of military accomplishments will be honored at the retirement and change of command ceremony on Friday July 20, 2001. This decorated officer has been a valuable member of the armed forces. He has helped spearhead the development of advanced command, control, communications and electronic welfare technologies essential for transforming the Army. His military awards include the Defense Superior Service Medal, Legion of Merit with four Oak Leaf Clusters, the Bronze Star medal and many more. Major General Nabors grew up in Lackawanna, N.Y. He received a Bachelor of Science in systems Engineering from the University of Arizona and is a graduate of the Senior officials in National Security Program at Harvard University. Major General Robert L. Nabors has done this country a great service. He has been a leader for this community and for those he has commanded over the past 35 years. I would like to personally thank Major General Nabors for his dedication and service to our nation and community. I ask my colleagues to join me in recognizing this great man.

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, I rise in support of the amendment offered by the gentleman from Ohio (Mr. Brown). Mr. Chairman, the problem right now is that brand-name drug companies have been attaching unrelated patents on to existing drug patents. They are required to list patents of drugs that directly relate to existing patents. However, one of the brand-name industry's tactics for extending patents is to stack a list of patents that simply relate to and do not directly affect existing patents. As the brand-name industry engages in this so-called ``patent stacking,'' unfortunately generic drug approvals are automatically basically tagged with a 30-month delay, and this delays consumer access to necessary prescription drugs and further delays the process from making prescription drugs more affordable. The FDA currently has the authority to ensure that only patents in compliance stay on the books, and this amendment helps the FDA Office of Generic Drugs use its $1 million in increased funding to exercise this authority and remove barriers to generic competition. Mr. Chairman, numerous pharmaceutical companies have listed patents for unapproved uses and inappropriate forms of the drug. I am not going to get into all the examples, but this adds up to billions of dollars lost in consumer savings. We need to pass this amendment.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, in May 1942 twenty-nine Navajos entered boot camp and later went to Camp Pendleton to develop a code that used the Navajo language as its basis. They worked at finding new words or meaning for military terms, which had no actual Navajo translation as well as an alphabetical way of spelling out other words. So began the career of the Navajo Code Talkers who were the secret weapon of the Marine Corps against Japan. Their unbreakable code would play a vital part in the United States ability to win World War II. The man credited for the idea of a code based on Navajo language goes to Philip Johnston, an engineer in Los Angeles. His father had been a Protestant missionary; therefore, as a child he moved to a Navajo reservation where he grew up and learned the culture and the language. Knowing that the Navajo language had been orally handed down through the centuries was Johnston's main argument for this code. He argued that it was a system that would not have to be changed on a regular basis, and because it had never been written down it could not result in falling into the hands of the enemy. Ironically, Navajos were subjected to alienation in their own homeland and discouraged from speaking their language yet they still came willingly forward and used their language to defend their country and help develop the most successful military code of the time. The code was such a success that the Department of Defense kept the Code secret for 23 years after World War II. It was finally declassified in 1968. The Code Talkers had been sworn to secrecy, an oath they kept and honored. Imagine these unsung heroes returned home with no special recognition for what they had accomplished and sadly over the years some have died never receiving the honor and accolades that they so deserved. The time has come for us to recognize the Navajo Code Talkers with a Congressional Gold Medal--the most distinguished honor a civilian can receive. It is for that reason I support House Concurrent Resolution 174, authorizing use of the rotunda to present Congressional Gold Medals to the original 29 Navajo Code Talkers. This honor has been a long time in coming.

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, I rise in support of the Brown amendment. There is a need for statutory or legislative initiatives that allow timely access and availability of generic drugs once the patent on a brand-name drug expires. Brand-name companies have become proficient in manipulating Hatch-Waxman law and aggressive campaigns to block or delay generic alternatives from reaching the market. One way of alleviating this problem is to provide more funding to the FDA's Office of Generic Drugs. Currently, the agricultural appropriation bill includes a $1.75 million increase in funding for this office, and I would like to see an additional $2.5 million for the Office of Generic Drugs. In addition, I would like to see an investment of an additional $250,000 on top of the $250,000 already in the bill for a national campaign to raise public awareness about the safety and cost effectiveness of generics. The tactics used by the brand-name industry to delay generic drugs from coming on the market are widespread and well known. By giving the FDA Office of Generic Drugs the appropriate levels of funding, it will have the resources to help move generic drugs to the market more quickly, to run an education campaign, and to overall significantly bring down the cost of prescription drugs. We need more money for this office so we can reduce the cost of prescription drugs, which is so important to our seniors and to so many Americans. I commend the gentleman from Ohio (Mr. Brown) for bringing this up, and I urge all my colleagues to support the amendment.

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, I move to strike the requisite number of words. Mr. Chairman, I want to speak strongly against this amendment for several reasons. First of all, I want to address my comments to some of the comments that the gentleman from Colorado (Mr. Tancredo) made. I need to stress, first of all, Mr. Chairman, that if this amendment were to pass, I assure everyone that the shore protection beach replenishment projects in New Jersey and probably throughout the country would simply not take place. It is erroneous to assume that the towns that are being asked to foot the bill, and in this case under this amendment the additional costs to pay for these beach replenishment projects, would be able to pay for them. They simply would not. I live in a municipality that has about 30,000 people. I represent some towns that have less than 2,000 people. They barely are able to get the money together now to pay for the percentage that they have to pay with the Federal Government paying most of the cost. If they had to double or triple that under the funding formula that the gentleman from Colorado (Mr. Tancredo) is proposing, the beach replenishment projects would simply not take place. Let me say that in my district where one of these projects basically extends about 50 miles along the shoreline, that with a very small exception, probably of that 50 miles maybe no more than one or two, we are talking about public municipally owned beaches. We are not talking about mansions and big homes and wealthy Gold Coast municipalities here. The town that I live in has 5 miles of that 50-mile coastline that is affected by a beach replenishment project. We are what we call an urban-aid project in New Jersey, which means we are one of the poorer towns in the State. We have the second poorest town in the State. I will not mention the name. I do not need to. That is also part of this project. We are not talking about rich areas. This will not happen. These projects will not take place if this amendment were to pass. Now let me talk about two other things that I think are misleading here with regard to this amendment. First of all, I think it should be understood that the current beach replenishment program is done in a way to save the Federal Government money. Not cost the Federal Government more money, but save the Federal Government money. I will say why. The Army Corps of Engineers goes through a very strict cost benefit analysis in deciding which of these beach replenishment projects to fund, and they weigh the costs and the benefit to the Federal Government. In every case, the cost to the Federal Government has to be significantly less than the benefit. What is the cost to the Federal Government if they do not do the projects? Well, we know about FEMA. We know about emergency disaster declarations after a hurricane or a tidal wave or whatever it happens to be. We have a lot of hurricanes along the New Jersey coast. Every time there is a hurricane, there is an emergency disaster declaration. The Federal Government, under FEMA, has to come in and spend millions and millions of dollars to replace and rectify the situation and the damage that occurs. The Army Corps of Engineers does these beach replenishment projects not because they want to give somebody a nice beach to sit on but because they know that they do not have to come in with a disaster declaration because the storm does not affect the upland area, the infrastructure, the utilities, the roads, that the Federal Government would have to come in and bail out. This is done to save the Federal Government money that they would have to spend through a disaster declaration. It makes no sense not to do these projects from the Federal Government's point of view. It is cost effective. Lastly, I want to make one other point, Mr. Chairman. It has not been said yet but I am sure I am going to hear from some that somehow these projects are not good for the environment. That is simply not true. There is strong indication that when beach replenishment is done it is a good thing for the environment. We have been able to do the beach replenishment so that the surfers and the bathers and the fisherman are not negatively impacted. It can be done and it has been done, and it has to be done under the current law so there is access to the beaches for the public and so that the beaches are done or sculpted in a way that the people that use the ocean, whether they be fisherman or surfers or whatever, can continue to do so. So do not let anybody tell me that a vote on this amendment is a good environmental vote. That is simply not true. I am one of the staunchest defenders for the environment in the House of Representatives. A vote against this is a good environmental vote. I am going to tell everybody I know who thinks that somehow this is something that relates to the environment, it is not. Beach replenishment is good. It helps the Federal Government cut costs. It is good for the communities and it is good for the environment.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I would like to ask my colleagues to join me in congratulating Hugo Neu Schitzer East, one of the largest scrap metal recyclers in New Jersey, for their proactive efforts to improve industrial recycling. The Hugo Neu Schitzer East Company has been operating in Port Liberte, New Jersey for the last 40 years. They have invested several million dollars in research and development, attempting to find new and better ways to mine and recycle waste metal. They have done so with the goal of reducing the amount of scrap metal that needs to be disposed of in landfills. For example, almost a quarter of the metal produced by the shredding of an automobile cannot be recycled and needs to be disposed of in a landfill. Hugo Neu is working to dispose these waste materials in a more environmentally sound manner, as well as find ways to recycle and reuse a larger portion of scrap material. I ask to submit an article from the Business News New Jersey that better outlines Hugo Neu's efforts on behalf of the environment. [From the Business News New Jersey, Jersey City, NJ, June 5, 2001] Scrapping Old Ways and Look for New Ones (By Geeta Sundaramoorthy) John Neu and Robert Kelman like to say jokingly that they are still trying to figure out how to make money after being in the scrap metal recycling business for 40 years. As part owner and general manager, respectively, of Hugo Neu Schnitzer East, one of the biggest recyclers in the region, they may only be half joking. Jersey City-based Hugo Neu buys scrap metal from auto dealers and construction companies, then shreds, processes and ships it to customers for use as raw material in making steel. With international prices of scrap funding to historic lows and costs going up, scrap metal recyclers, including Hugo Neu, are finding it hard to keep the revenue flowing in from their core business. The company has annual revenues of about $170 million, 225 employees, and handles 1.3 million tons of scrap annually in the New York metro region. It says it is the region's largest exporter of processed scrap. According to Kelman, in the last 18 months scrap prices have dropped from about $130 per gross ton to less than $80, a 38% falloff. International demand for scrap has also fallen as Asian economies hit hard times, competition increased from Russia and domestic demand decreased as cheap imports of steel pushed many U.S. steel makers near bankruptcy. Strict environmental standards for the disposal of waste and higher wage and energy costs are also pushing the costs up, he points out. ``We are squeezed into a box,'' says the 62-year- old Neu. Their neighbors, which in Hugo Neu's case include the residents of the Port Liberte condominium complex, on the Jersey City waterfront also don't much appreciate the noise and grit associated with recycling operations. So Neu and Kelman, as well as other recyclers, are now busy looking for ways to diversify their revenue stream. Hugo Neu is looking for ways to recycle new materials, especially the waste left behind after the current processing is done, and for new lines of business to enter. Hugo Neu is spending $20 million to dredge the channel leading to its Claremont terminal pier facility in Jersey City to a depth of 34 feet so it can use its port and crane facilities to off load freighters carrying break bulk metal cargoes such as rods, rails and other steel products. The company is splitting the cost of the dredging project with the state and work is slated to be finished in 18 months. Hugo Neu is not the only scrap recycler looking to diversify into break bulk cargo. Newark-based Naporano Iron and Metal, a unit of Chicago's Metal Management which is close to emerging out of Chapter 11 bankruptcy, also plans to boost its stevedoring business and handle break bulk cargo at its Port Newark facility. Last month, the company won a battle against the International Longshoremen's Association to use its own labor for loading and unloading some break bulk cargo. John Neu's father, Hugo Neu, who is considered a pioneer in the scrap recycling industry, started the family business in the early 1960s. It split in 1994, after Hugo Neu's death, with John Neu getting the scrap metal operations and half the real estate business. John Neu, now CEO of Manhattan-based Hugo Neu Corporation, formed Hugo Neu Schnitzer East in 1998--as a 50% joint venture with Schnitzer Steel Industries of Portland, Oregon. It is now Hugo Neu's largest operation, and is run by Kelman, 38, who is Neu's brother-in-law. Kelman concedes the scrap business is dusty and noisy and some neighbors have a legitimate grouse about noise. Port Liberty is about 1,000 feet from Hugo Neu's Claremont terminal, and is separated by a channel, where the recent dredging work has only increased residents ire. Our business involves processing and transportation. It is an environmental issue. ``People say why do we need to have a scrap processing business in a residential area?'' says Neu, adding that most scrap is generated in the New York metro area. ``It has to get out of the city and come to the docks in the New York harbor.'' Kelman says his company's port has been operating for more than 40 years, whereas the Port Liberty residents came only 12 years ago. ``There is only so much we can do to minimize the impact,'' he says, adding the company has even built a container wall to keep the operations out of the sight of residents. The question is whose impact will be greater for the economy, ours or the residential units, he asks. Jersey City has, in a way, answered that question by choosing to keep that part of waterfront reserved for industrial use. AnneMarie Uebbing, director of the city's department of housing, economic development and commerce, says it has supported Hugo Neu's dredging project, recognizing the importance of Claremont as an international port, especially when Hugo Neu starts bringing in more ships carrying break bulk cargo. Uebbing says the city supports industrial development that can arise around the port, including warehousing and manufacturing. ``We see port activity in the New York harbor increasing. It is imperative that we maintain our competitive edge.'' Hugo Neu has also invested several million dollars in research and development to find new ways to ``mine'' the waste metal it produces. About 25% of every automobile that is shredded can't be recycled and has to be disposed of at an environmentally approved landfill, an expensive proposition for many recyclers. A year ago, Hugo Neu entered into a joint-venture project with Daimler Chrysler and set up a facility in Utah to do research on recycling plastics. Kelman hopes to announce the results of that research in the next two months. In addition, the company is converting waste from the auto shredding process into landfill cover that reduces its tipping fee-- money charged by landfill companies for dumping waste. Kelman hopes in the next few years the company will be able to reduce its waste by 50%, with the ultimate goal of producing zero waste.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I do not know whether I will use all of that time, but I do want to discuss tonight another health care issue. I appreciate my colleague, the gentleman from Vermont (Mr. Sanders), talking about the prescription drug issue and the reimportation issue; and that is certainly one of the major health care issues that needs to be addressed in this Congress. I talk all the time about three health care issues that I know that President Bush said during the course of his campaign he would address and that have not been addressed. Unfortunately, what we have here in the House, with the Republicans in control, the Republican leadership so far has been unwilling to address the three major areas that I hear about most in health care. One is prescription drugs, which my colleague from Vermont just mentioned; the other is the Patient's Bill of Rights, or HMO reform; and the third is the need to try to cover those 40 to 45 million Americans who have no health insurance. Mr. Speaker, fortunately, the other body is now discussing HMO reform, the Patients' Bill of Rights. I would say that the reason that has happened is because of the switch in the majority from Republican to Democrat in the other body. The first order of business that the new Democratic majority took up was HMO reform, the Patients' Bill of Rights. Tonight I would like to discuss briefly why I think it is important to pass the Patients' Bill of Rights, and not just any Patients' Bill of Rights, but the Patients' Bill of Rights, or HMO reform, that was introduced in the other body by Senator McCain, Senator Kennedy, and Senator Edwards, and that has been introduced in the House by the gentleman from Iowa (Mr. Ganske) and the gentleman from Michigan (Mr. Dingell). These are bipartisan bills, but I need to point out that the thrust of the bills is from the Democratic side, because the Republican leadership, even though there are some Republicans that are playing a key role on these bills, the Republican leadership has refused to bring them up in either House, or to support the Ganske-Dingell bill, the real Patients' Bill of Rights here in the House, or the McCain-Kennedy- Edwards, the real Patients' Bill of Rights in the other body. I will not refer to them necessarily as the Democratic bills because we do have some Republican support, but they are Democratic bills in that the Democratic leadership supports them in both Houses and the Republican leadership does not support them in either House. Why are we talk talking about the Patients' Bill of Rights and HMO reform. Two reasons. This comes from my constituents and from Americans from all walks of life. Increasingly, if a person is in a managed care situation, if you are in an HMO, the decision about what type of care you get, and that means whether you get a particular medical procedure, whether you can go to a particular hospital, whether you can stay in the particular hospital for a particular length of time, these types of decisions about your care unfortunately are made almost exclusively now by insurance companies, by the HMOs. What the Democrats have been saying and what the real Patients' Bill of Rights says is that that needs to change. That needs to go back to medical decisions, what is medically necessary for you as a patient, that decision is made by your physician, your health care professional and you as a patient, not by the insurance company. That is the one major change, and the one need for reform with regard to HMOs that the Patients' Bill of Rights seeks to accomplish. The other major issue and the other major change is the fact that today in HMOs, if a decision is made about what type of care you get, and you do not agree with that, in other words you have been denied the care that your doctor and you feel is medically necessary, you do not have any place to go. You can file a grievance with the HMO; and they will review it and say sorry, we made a decision, and we are not going to change it. What the Democrats would like to see, what the Dingell-Ganske bill would do is turn that around and say if you want to seek a redress of grievances because you feel you have been improperly denied care, you can go to an external review board, an independent review board outside of the HMO, and they will review that decision by the HMO. They have the power to overrule it if they think that care was improperly denied and you need the care that your physician says is necessary. Failing that, in certain circumstances you would be able to go to court and bring suit so you could have the decision of the HMO turned around, or you could even be granted damages if you were seriously injured and it was too late to correct your situation; or God forbid, you died, your estate could sue for damages. Now, those two things, those two basic theories, the decision about what kind of care you get is made by a health care professional, not by the insurance company, and that you have some place to go to right that wrong and to turn that decision around are really at the heart of the Patients' Bill of Rights. Mr. Speaker, I want to talk about some of the specific things that the Patients' Bill of Rights will do which I think are important. I will mention a few that apply to patients, and then I want to mention a few that apply to doctors, because I think as you know, the doctors now under HMOs feel that they cannot even practice medicine. There are a lot of restrictions on what they can do, so the decision is important for the doctors as well as for the patients. One area is access to emergency room care. The Patients' Bill of Rights allows patients to go to any emergency room during a medical emergency without having to call a health plan first for permission. Emergency room physicians can stabilize patients and begin to plan for post-stabilization care without fear that health plans will later deny coverage. This is a big concern that patients have. I get chest pains, I think I am having a heart attack. I cannot go to the hospital that is down the street. I have to go to one 150 miles away. I may suffer damage because I have to go to an emergency room so far away. That makes no sense. We reverse that and say if you feel, if the average person feels by having severe chest pains they need to go to the closest hospital, they have the right to go there and the insurance company has to pay for that emergency room care. Access to needed specialists. Part of the problem now is many patients, many Americans in HMOs do not have access to a specialist. They may have access to a family physician, but if they want to go to a specialist in that particular area where they need help, they cannot obtain that through the HMO. The Patients' Bill of Rights ensures that patients who suffer from a chronic condition or require care by a specialist will have access to a qualified specialist. If the HMO network does not include specialists qualified to treat a condition, such as a pediatric cardiologist, for example, to treat a child's heart defect, it would have to allow the patient to see a qualified doctor outside the network at no extra cost. The Patients' Bill of Rights also allows patients with serious ongoing conditions to choose a specialist to coordinate care or to see their doctor without having to ask their HMO for permission before every visit. This is common sense. The Patients' Bill of Rights also allows direct access to an OB-GYN. It allows the woman to have direct access to OB-GYN care without having to get a referral from her HMO. Women would also have the option to designate their OB-GYN as their primary care physician. This is very important to women. Finally, and there are so many other patient protections, and I just want to mention a few because I want everyone to understand how important these patient protections are, the Patients' Bill of Rights says that needed prescription drugs would be available to patients. Currently, many HMOs refuse to pay for prescription drugs that are not on their preapproved list of medications. As a result, patients may not get the most effective medication needed to treat their condition. The Patients' Bill of Rights ensures that patients with drug coverage will be able to obtain needed medications even if they are not on the HMO's approved list. If your plan does not include drugs, we are not saying that you are going to get it. But if your plan includes drugs, they cannot limit you to the preapproved list of medications. Let me talk about some of the ways in which the Patients' Bill of Rights, the Dingell-Ganske bill and the McCain-Kennedy-Edwards bill, frees up doctors to practice medicine, because many times they feel that their hands are tied. My point is what I originally said, is that accountants and insurance company executives and staff should not be making medical decisions. It is the doctor who should be able to make medical decisions. What the Patients' Bill of Rights says is that it prohibits insurers from gagging doctors. Patients have a right to learn from their doctor all of their treatment options, not just the cheapest. The Patients' Bill of Rights prevents HMOs from interfering with doctors' communications with patients. Doctors cannot be penalized for referring patients to specialists or discussing costly medical procedures. People do not understand that a lot of Americans are in HMOs where they say that the doctor cannot talk to you about a preferred method of treatment. If the insurance plan does not cover a particular procedure, then they can tell the doctor that he cannot talk to you about it even if he thinks that you need it. That is the gag rule. We have eliminated it. The Patients' Bill of Rights allows doctors to make the medical decisions. It says that doctors rather than insurance company bureaucrats will basically decide what kind of medical care you get. HMOs are prevented from inappropriately interfering with doctors' judgments and cannot mandate drive-through procedures or set arbitrary limits on hospital lengths of stay. In addition, doctors and nurses who advocate on behalf of their patients will be protected from retaliation by HMOs. There are many patient protections in the Patients' Bill of Rights. I am not going to go into all of them tonight, Mr. Speaker. Suffice it to say the main thing is the idea that doctors will make decisions, not the insurance company; and there is some way to appeal that decision outside of the HMO. Mr. Speaker, I wanted to go into some other areas that relate to the Patients' Bill of Rights because we know that the other body is considering it. They have done so for about 10 days, and we are hoping that it will come here to the House of Representatives eventually. Some of the arguments that are being used now against the real Patients' Bill of Rights, the Democratic bill, are that a lot of States have already enacted legislation that would protect patients, and so it is not really necessary for the Federal Government to act. I hear this from time to time. My State of New Jersey has actually passed a fairly strong patient protection act. Some people say we have it in New Jersey, or maybe we have some form of it in other States. Why do we need to do something on the Federal level? I think that is a very important point that needs to be responded to. I just want to talk a little bit about that tonight if I can, Mr. Speaker. First of all, the real reason we need Federal legislation is that these protections that do exist today are sort of like a patchwork quilt, and there are a lot of holes in it and a lot of differences from State to State. There are a lot of differences in the protections that are afforded to people. There are enormous differences in the way that a person can redress their grievances, what kind of external review they would have, what kind of ability to sue that they would have. Also, let me just get into basically three areas, if I could, where we see the State laws different and I can explain why we need a Federal bill. Of the 10 areas of consumer protections that are primarily the focus of the Patients' Bill of Rights, only one State has adopted most of those protections. In a lot of States maybe half of the protections are provided and half of them are not. But even in States that have adopted specific patient protections, those laws are not applicable to many of the States' residents. So you might have in a State with no patient protections, or in a State that has some; but you might not be in a group that is covered by those patient protections. The State laws differ in terms of who is covered. For example, some States have the prudent-layperson standard for emergency room care. If I feel as an average person because I have chest pains I should go to the local emergency room, I can go there and it will be paid for. That varies. Some States have it, and some States do not. About 43 percent of all employees who get their health care coverage through their employer are not covered by protections even in the States that have something like a Patients' Bill of Rights. Mr. Speaker, I do not want to dwell on this forever, but the point I am making is that it is a very hollow argument for somebody to say that we do not need the Federal law because some States have enacted this because some States have, and others have not. Some people are covered in those States, and others are not; and they may have some protections, but they may not necessarily have all of the protections. In New Jersey, which has a pretty strong Patients' Bill of Rights, there was an article just a couple of months ago in one of my local papers, the Home News Tribune, an editorial, that advocated for a Federal Patients' Bill of Rights because it said that it is very difficult in New Jersey to sue if you have been denied care. That is just another example, even in a State as strong as New Jersey, where we need some Federal action. I wanted to talk about two other things tonight, Mr. Speaker, two other areas related to the Patients' Bill of Rights, before I yield back the balance of my time. One is that I know that in the other body, efforts are being made to weaken the Democratic proposal, the McCain-Kennedy-Edwards bill, through amendment. Fortunately, those efforts have failed. I think it is significant because it shows that even though this is primarily a Democratic bill, that we clearly have enough Republicans now that are coming over with us on these key amendments that we are forging a bipartisan coalition to support the real Patients' Bill of Rights regardless of the fact that the Republican leadership opposes the bill. The two amendments that came up within the last week, I think, are significant. One of the amendments which was rejected by a vote of 56 to 43 proposed to exempt employers from health care lawsuits in every situation. Now, this has been a major point of contention, because some people say, well, the problem with the Patients' Bill of Rights is that employers may be sued. What we have said is there is a very limited situation where employers can be sued and that is only if they have taken direct responsibility and have been directly involved in the decision of what type of care you should get. But the Republican leadership wanted to just say that they could not be sued under any circumstances. I think that is wrong. I was glad to see that that amendment was struck down. I think actually that took place today in the other body. The other amendment which I believe was defeated last week related basically to tax breaks. This was a Republican proposal to add a provision speeding up tax breaks to cover costs of health insurance for the self-employed. I mention that one, although it may not be as obvious why that is a bad thing, because what we have seen in the past, and this is what happened in the House of Representatives last year when we took up the real Patients' Bill of Rights, is that there was an effort to try to add all kind of things to the bill, what I call poison pills, to load it up with all kinds of unrelated ideas, if you will, or proposals so that it would never pass. What really happened last year is that the Republican leadership was fairly successful, in that even though we passed a good Patients' Bill of Rights in the House of Representatives, they put in all these poison pills or extraneous provisions related to tax breaks, related to malpractice, related to medical savings accounts, and so that when the bill went to conference between the two Houses, it was virtually impossible to get a bill out of conference and to the President because of all these poison pills, added provisions, loading down the Patients' Bill of Rights so that it could not pass and was not a clean bill. We do not want that to happen again. I have been very happy with what is happening in the other body because it is clear that we have a majority, albeit a slight one, between most of the Democrats and a few Republicans to try to have a bill that clearly will shift the burden so that decisions are made by doctors and there is a real way of redressing your grievances and, on the other hand, not loading this bill down with all kind of extraneous material so we can never get it out of conference and to the President's desk. But the other development that occurred today that was disturbing, and I think I need to speak out on it because I need to expose again what the Republican leadership this time in the House is trying to do, is that the Republican leadership in the House, which so far has refused to bring up the real Patients' Bill of Rights, will not have it go through committee, will not bring it to the Committee on Rules, will not bring it to the floor, as the Republican leadership has unveiled their own HMO reform bill which, of course, you know, they are going to call the Patients' Bill of Rights, but it is not the real Patients' Bill of Rights. It is not the bill that has already passed the House, that is now being considered in the other body, that has the support of almost every Democrat and about a third of the Republicans. I want to talk a little bit, if I can this evening, Mr. Speaker, about why this latest House Republican leadership proposal for HMO reform does not cut the mustard and is just a subterfuge to try to kill the real Patients' Bill of Rights, because what I think is going to happen is that the Republican leadership when we come back from the July 4th recess is going to try to bring up their version of HMO reform and ignore the real Patients' Bill of Rights and try to make it so that the real Patients' Bill of Rights never gets considered on the House floor. Let me tell you a little bit about what this Republican plan that was introduced today, or they had a press conference today, is all about. I would characterize it as an HMO, an insurance company bill of rights rather than a Patients' Bill of Rights. Once again the Republican leadership is protecting managed care plans from simply being held accountable for their actions. Unlike the real Patients' Bill of rights, the Republican plan leaves the review of patient grievances in the hands of the insurance companies and still allows insurance companies the ability to dictate the services patients receive. Now, I have said before why this is unacceptable. It is unacceptable because the core of the real Patients' Bill of Rights is the idea that the insurance companies do not make medical decisions; the doctors and the patients do. We want to see a real Patients' Bill of Rights, that is what our constituents tell us, not a phony one. The legislation that the Republican leadership introduced today does not provide many of the assurances that I talked about tonight that the real Patients' Bill of Rights provides. It allows HMOs to choose the external appeals panel and then allows the panel to determine whether the patient can go to court without allowing the patient the right to appeal. In addition, the Republican bill provides only a narrow venue for State lawsuits which then forces all suits over improperly denied care to go to Federal court. Now, some people may say, Well, what's the difference whether I sue in State court or Federal court? Let me tell you, it makes a big difference. What the Democratic bill says is that you can sue in State court. If the Republican bill forces you into Federal court, there are not that many Federal courts and their dockets are overcrowded and people have a much harder time suing in Federal court, and it costs you a lot more money to sue in Federal court. So there is a difference. I do not want to play it up in a major way, but I want to explain why there is a difference. I think that what the Republican leadership did today in the House is that basically what they are trying to do is sort of outbest what the other body is doing. They know that the other body is likely to pass a real Patients' Bill of Rights, and they want to bring up a fake one here in the House that the majority of the Members, almost all the Democrats and even about a third of the Republicans are opposed to. We will see what happens, but I think that we need to expose what is happening here and how this latest bill which was much heralded today by the Republican leadership really does not accomplish the major goal of the real Patients' Bill of Rights, which is to switch the decision about what kind of care you get to your doctor and you rather than the insurance company and that allows you to basically appeal a denial of care to an independent body outside of the HMO and ultimately to court if you do not have a fair shake. Mr. Speaker, I just wanted to say, I know that every night this week the Democrats are using our time during Special Orders to draw attention to the Patients' Bill of Rights and why we need to pass the real bill here in the House and also in the other body. Last night we had Members of the Texas delegation get up, and I thought that was very significant because, as you know, President Bush said during the course of the campaign that he would sign a bill that was like the Texas law. Frankly, the Dingell-Ganske bill, the McCain-Kennedy-Edwards bill, the real Patients' Bill of Rights, is exactly like the Texas law. Yet now President Bush says he will veto that bill and he does not find that bill acceptable and is asking for something else. I think that is not the commitment he made during the campaign. It was not the commitment he made when he was Governor. And it certainly is a commitment that he should keep and hopefully if we send him the real bill, he will sign it even though he is now threatening to veto it. The second thing I wanted to say is that tomorrow night, the Democrats will have some of our Members who are health care professionals, who are nurses and who are other types of health care professionals, taking to the floor. The reason we are doing that is because I think that oftentimes it is the people that are in the health care profession, the doctors, the nurses, the technicians, these are the people that understand, I think, oftentimes even more than the patients, why it is important to have a real Patients' Bill of Rights, because they want to take care of their patients. They want to make sure they get the proper care and the care they deserve. They do not want monetary or other considerations, the bottom line, to dictate the quality of care for the average American. We will be here as Democrats every night this week and also when we return after the July 4th recess to bring up the point that the real Patients' Bill of Rights must pass. It is the highest priority of the Democrats in both Houses, and we are determined to see it through.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, we need to shift our educational focus to the proud Native Americans who have endured a long history of struggles and hardships and at the same time contributed so richly to the United States. In our schools, we can begin to educate children in the elementary and secondary grades about the history, culture, traditions, language and government of America's own indigenous people. Recently setting the pace on the State level is Penobscot Representative Donna Loring from Maine. She celebrated the signing of her bill last week requiring Maine Native American history and culture to be taught in all elementary and secondary schools. Mr. Speaker, Native Americans have given much to their country. They developed well-tuned techniques for sustainable management of ecosystems. They basically pioneered, Mr. Speaker, star and constellation knowledge through their tribal religions. Their arts and crafts, basketry, pottery, and carving are world renowned. They have made significant contributions and knowledge with regard to fishing, hunting, and agricultural techniques. Their medicinal knowledge is outstanding and is more frequently used today to complement traditional medical treatment. Mr. Speaker, Native Americans are a proud people who are still here today despite over 500 years of struggle. It is time that we begin to honor and respect Native Americans for their rich history and contributions to the United States, which is what this resolution seeks to accomplish. The best place to begin this is in the elementary and secondary schools of America. Mr. Speaker, finally I want to say that while we are recognizing the importance of Native American contributions and history and culture, we should also give serious consideration to creating a day of honor for America's indigenous people. Now is the time to create a legal public Native American holiday.