John Shadegg

Mr. SHADEGG

Mr. SHADEGG. Mr. Speaker, as we stood outside of the building, witnessing the devastation, listening to the descriptions, the fact is that from the outside we can only see a part of what is going on. There is vastly more destruction inside the building as it is spread out and there are dead bodies there. I was struck by the comment of one worker. He had been there when the plane went in the building. He had seen the building moments after its first impact. He said to me his most difficult moment was not then and not when he was told perhaps there is a second plane en route and their lives were in danger. His toughest moment was when he went home last night and his 5-year old asked him who would do this and why would they perpetrate such an act, why would they bring down an airline, why would they seek to kill so many people. It is incomprehensible when you see the death, when you see the devastation, and when you understand it. But make no mistake, our opponents need to look no further than the roof of this building. The American flag, the symbol of freedom, Old Glory was there yesterday. It is there today. It will be there tomorrow. We will not surrender until we have found them and we have exacted retribution.

Mr. SHADEGG

Mr. SHADEGG. Mr. Chairman, I thank the gentleman for yielding me this time, and it has been a pleasure to work with him on this legislation. He has been tireless in his efforts to pass good legislation. These comments about a partisan divide and a deadlock are absolutely accurate. We have struggled to get legislation passed here. And, sadly, the extremes at each end have precluded us from doing so. The extremes who want the plans to have no liability under any circumstance, and the other extreme, which are the tort lawyers, who want to be able to sue over anything, any time, anywhere and get everything. The Norwood amendment pursues a goal that is absolutely fair, and it is the goal we ought to pursue. Patients get the right care at the earliest possible time. One of my colleagues on the other side said what is wrong with the current system is that HMO bureaucrats make health care decisions, and he is right. But the Norwood amendment, unlike the Ganske-Dingell bill, moves that decision-making authority over the quality of health care in America, what is the standard, what care should people really get, away from those HMO bureaucrats. It takes it away from the HMO bureaucrats and it gives it to a panel of at least three medical doctors who are practicing physicians with expertise in the field. That is where the decision should be. We should get it away from HMO bureaucrats, and we should give it to doctors so doctors can set the standard of care in America. But here is what is wrong with the underlying bill. They want to take it away from HMO bureaucrats, but they do not want to give it to doctors. What they want to do, and what their bill does, is give the ability to set the standard of care not to a panel of independent doctors but rather to trial lawyers. Under their bill an individual has to go through external review, but it means absolutely nothing. It is a chimera. It is of no value. Because whether someone wins or loses, they can go right ahead and sue, which means it will get us nowhere. It becomes a battle of experts. It does not advance health care in America. It does not empower doctors to set the standard. It empowers plaintiffs' lawyers. And that is a tragedy. I urge my colleagues to defeat the underlying bill and support the Norwood amendment.

Mr. SHADEGG. Mr. Chairman, I thank the gentleman for yielding me this time. And I rise in strong support of this legislation, and I rise in strong support of the gentleman from Georgia (Mr. Norwood). Make no mistake about it, there is no greater champion of patients' rights in this country than the gentleman from Georgia. And anybody who says that the agreement that the gentleman from Georgia negotiated with the President last night does not protect patients, does not know this issue and is just playing politics. Well, it is time for politics on this issue to end and for substance to emerge. Let us talk about what is in this bill. Number one, every single patient protection in the original Norwood- Dingell bill and in the original Ganske-Dingell bill is in this bill. The patient protections are there. So comes the criticism on liability. Well, let us talk about liability. For those who say this protects plans from being sued, they are not being honest, because whether the external review panel sides with a patient and says the plan was wrong, or whether the external review panel sides with the plan and says the plan was right, that individual can have a lawsuit. They have a right to recover damages. Let us talk about the current state of the law. The current state of the law in America is atrocious. It says if a health care plan injures someone through their negligence, through their conduct, they are immune. That is dead wrong. I know the Corcoran case inside out and backwards, and it is time to reverse that precedent. The reality is both sides agree that that policy of absolute immunity for HMOs that hurt people must end. This bill strikes a fair balance. It says that an external review panel, made up of expert doctors who are practicing physicians, will review the decision of the plan and will decide if the plan was right or if the plan was wrong. If they decide the plan was wrong, yes there is a lawsuit and that individual will recover damages. But let us look at the flip side of that issue. Let us say they decide the plan was right, and many would say that is a reasonable structure; that the panel second-guessed, reviewed through experts, the current status, where plans can simply deny care and walk away, but under that set of circumstance, even if this expert panel made up of doctors says the plan was right, that individual can still go to court. The AMA, when I argued this issue with them last year, said, well, what if the plan was wrong. It is a shocking lack of faith with doctors, but they won. The AMA is getting what they want. Even when the panel says the plan was right, the individual can go to court and sue. That is liability, that is fair, that is a very reasonable compromise. This is a good bill, and I urge my colleagues to support it.

Mr. SHADEGG

Mr. SHADEGG. I thank the gentleman for yielding me time. Mr. Chairman, let me begin by saying I respect greatly our colleague, the gentleman from Iowa (Mr. Ganske), who has worked very hard on this bill; but I think it is important to note he talked about the issue of affirmative defenses. In the negotiations between the gentleman from Georgia (Mr. Norwood) and the President, all of the affirmative defenses were stricken from the bill because the gentleman from Georgia (Mr. Norwood) wanted them stricken and they are gone. Let us talk about this, the other issue of preemption. I need to talk about preemption, because a great deal has been made here. Let us talk about the issue of preemption, because that seems to be of great concern here. It needs to be understood that, number one, ERISA today preempts a claim for benefits in all 50 States. If you try to bring a claim for benefits and bring that as a cause of action in State court, you cannot bring it in a single State, including Texas. Indeed, the corporate healthcare case, Corporate HealthCare v. Texas right here, says specifically that. If you seek to bring a claim for benefits case in State court, it is preempted by Federal law. There is a good reason for that. It is so that the management of claims in all 50 States can be uniform, because this law, ERISA, was intended to govern multi-State employers and multi-State unions. Now, let us talk about a second issue, that is the Ganske bill. They would have you believe that the Norwood amendment is the only thing that preempts anything. That is ridiculous. The Ganske-Dingell bill preempts issue after issue within the State cause of action. It says you can bring a State cause of action, but then it preempts pieces of that. It says you can only bring it against a designated decisionmaker, it says you can only bring it after exhausting external review. The preemption issue is in your bill as well as our bill, although it is 19 pages long in your bill. Let us talk about its effort at preemption in this bill. In this bill, we say what current law says, and that is if you are bringing a claim for benefits, that belongs in Federal court. But, do you know what? We give a remedy for damages. But we also go beyond and codify existing State law on the issue of the claims you can bring in States. If you bring a negligence claim against a plan or its doctor, you can bring that for the services they delivered, you can bring that under existing State law, and this bill specifically says you can continue to bring it. This is a red herring. I urge the adoption of the Norwood amendment.

Mr. SHADEGG. Mr. Chairman, my colleague from the other side said this was modeled, the Ganske-Dingell bill was modeled after the Texas law, and it was a wonderful bill. Mr. Chairman, I wonder if the gentleman has read page 167 of the bill which provides to certain health care plans sponsored by very large group providers absolute immunity for nonmedical injuries? The language of the gentleman's bill says if there is a self-funded, self-insured plan, it gets absolute immunity when someone is injured or killed by a nonmedical determination. So let us say they wrongfully decide coverage and a patient is injured, there is absolute immunity, there is no recovery whatsoever.

Mr. SHADEGG

Mr. SHADEGG. I thank the gentleman for yielding me this time. Mr. Speaker, I rise in strong support of H.R. 1088. I want to compliment the gentleman from Ohio (Mr. Oxley), the chairman of our committee, and the gentleman from New York (Mr. Fossella), the author of this bill, for bringing forward such a commonsense piece of legislation. The reality of this bill is very simple and very straightforward. American investors, and that is over half of all families in America, are being overcharged. It is simple, it is straightforward, it is that basic. They are being overcharged by $14 billion over the next 10 years. That is indeed an inequity and it is a maldistribution. This commonsense bill, brought to the floor after a thoughtful legislative process, with hearings, fixes that inequity. And so I rise in strong support of the bill but also in strong opposition to the amendment. The authors of the amendment are well intended. The substitute, they say they want to go not quite so far. What they would do is overcharge America's investors by $9.2 billion. I also want to compliment them on being very honest and straightforward. They are not doing this in a deceptive fashion. They say point blank, yes, we know it raises more money than we need, we know it raises $9 billion more than we need, but we ought to spend that money on, as they propose, elderly housing programs, CDBG blocks, Head Start, medical research, transportation and infrastructure. They admit it raises more than we need and we put that burden on investors, and they say spend it on general funds. I am glad there is bipartisan support for not doing that to America's investors. We have heard Democrats rise on this floor today and support the majority bill and oppose the substitute. I just want to make the point in opposition to the remarks that were just made. It was just pointed out by my colleague, an argument was made that what is being done wrong here is that, and the argument was made, that we are raising the cost and making more expensive multiple family housing by lowering this excessive fee which collects more than is needed for what the fee is supposed to do. Nothing could be further from the truth. The inequity in maldistribution is that we are imposing this fee on investors, not on others. If we want to subsidize housing, multiple housing, then let us do so honestly. Let us tell the American people we are doing it. I simply think it is fair to my colleagues and the American people to understand. If we want to subsidize multiple family housing, so be it, but do not hide it in this bill. We owe the American people honesty. This bill is honest. We owe American investors, more than half of all American families, to charge only what the fee is supposed to collect. I compliment the sponsors of the bill and I urge my colleagues to support H.R. 1088.

Mr. SHADEGG

Mr. SHADEGG. I yield to the gentleman from New Jersey.

Mr. SHADEGG. Mr. Chairman, I rise to address the tragic issue of carbon monoxide deaths on lakes around the country and in any body of water. A little under a year ago, two young boys, Dillan and Logan Dixey, ages 8 and 11, died tragically swimming off the swim-step of their houseboat on Lake Powell. That triggered a study that revealed that there have been at least nine deaths on Lake Powell alone, and a total of over 111 injuries on that lake in my State. Following that, there had been a study by NIOSH which has documented at least an additional 30 deaths and 107 injuries. Mr. Chairman, these deaths are caused by the intake of carbon monoxide, both to people onboard boats and people swimming off the swim platforms of houseboats on various lakes. It was my intention to offer an amendment today to require the Coast Guard to perform a study of these carbon monoxide deaths and to study not only how they could be prevented by adding the correct venting mechanism to the boats but also how the carbon monoxide detecting devices, which are on many of these boats, could be improved so these tragic deaths do not occur. Over the past seven seasons, nine deaths and 111 injuries on Lake Powell alone, 30 more deaths and 107 injuries on other lakes besides Lake Powell. These are based solely on voluntary reports. Mr. Chairman, the gentleman from New Jersey (Mr. LoBiondo) conducted a hearing on this issue, and I commend the gentleman for doing so. At that hearing, the heart-wrenching testimony of the parents of Logan and Dillan Dixey brought this issue home; but there are many others. This is the NIOSH study discussing the 30 deaths that they know of on other lakes. I hold press reports of deaths on bodies of water around the country. This documents the death that the gentleman from Louisiana spoke about in that State. Mr. Chairman, it is extremely important that we study these deaths and find out the cause of them. The Coast Guard has been given a grant of money to study these deaths; but, unfortunately, I believe it is critically important that we put language in the law that the study be complete, that they study not only the cause of the deaths so we can end these tragedies, but also study the mechanism to improve the carbon monoxide-detecting equipment on these vessels. Mr. Chairman, my understanding is the gentleman from New Jersey will work with us hopefully through the passage of this legislation; and if not otherwise, to insert this language requiring such a study for the safety of all recreational boaters in the country.

Mr. SHADEGG

Mr. SHADEGG. Mr. Chairman, I thank the gentleman for yielding me this time. I want to first associate myself with the remarks of the gentleman from Colorado (Mr. Schaffer), who pointed out that it is regrettable that much of the reforms that were in this legislation that would have improved education across America are gone. But I really want to focus my remarks now on the Cox amendment and why I think it is such a good amendment. The gentlewoman from Hawaii (Mrs. Mink) who spoke before the last speaker on the other side, in her remarks, said that we should not begin this process by cutting; indeed, that that would be a serious mistake. Well, make no mistake about it: there is no cutting going on in this bill or in the Cox amendment, nor is there any cutting going on in education spending. Since the Republican Party became the majority in this Congress, we have more than doubled the funding for K-through-12 education. Indeed, we have increased it by 109 percent. That is not a cut of spending by any stretch. In the Cox amendment, we triple funding. As a matter of fact, as this chart shows, we triple the rate of funding increase from the original H.R. 1 for K-through-12 education. We go to the President's proposal of an 11.5 percent spending increase next year, the highest of any cabinet level agency in the country. So for someone to talk about cutting, they are simply not getting the facts straight. A tripling of the rate of spending is not cutting. This is a fiscally responsible amendment, which I urge my colleagues to adopt. Let us look at some of the other facts. The Cox amendment matches the President's Department of Education budget request. The Cox amendment authorizes more funding for K through 12 education programs than did H.R. 1, as introduced. The Cox amendment authorizes more funding for K through 12 programs than the President's budget. On top of that, the Cox amendment guarantees that the Department of Education will receive the single largest increase in spending of any cabinet agency. This is a reasonable amendment. It is a fiscally prudent amendment. To call it cutting is to misrepresent the facts. I urge my colleagues to join me in passing the Cox amendment.

Mr. SHADEGG

Mr. SHADEGG. Mr. Chairman, I rise in strong support of the Hoekstra- Frank amendment. I rise in support of it for at least three major reasons: Number one, we already test too much. Federal law mandates three tests already, and this bill doubles that requirement. I hope my colleagues understand that. The Hoekstra-Frank amendment simply says we will continue with the tests that are currently mandated but do not double the number of tests that are required. Now, how do I come to that conclusion? Well, my wife is a teacher, both of my sisters are teachers, and my niece is a teacher, and I have talked to them about this bill extensively, over and over again, and not a single one of them says that either they or their peers believe that teaching will be benefitted by more testing. As the gentleman from Virginia just pointed out, you do not fatten the pig by weighing it; you do not improve education by mandating more tests. Federal law mandates three tests already, and yet only 11 out of 50 States comply with this current demand. The reality is more mandated Federal tests will take up more time. The courts have already reported on this. There is too much testing at this point. The President is right, we should have accountability; he was wrong, we should mandate a doubling of the number of tests.

Mr. SHADEGG

Mr. SHADEGG. Mr. Speaker, I rise to commend and pay tribute to the University of Arizona Wildcats on their outstanding basketball season. This is truly a special team which should be lauded for their courage and for their effort in the face of very, very difficult circumstances, both on and off the court. As a U of A alum, I closely followed their amazing story. The Wildcats' victory in entering the Final Four perfectly captured their great season. In a rough and tumble fight, in a contest that the Wall Street Journal described as ``equal parts rugby and hoops, with a little WWF thrown in,'' the Wildcats triumphed over a physically gifted University of Illinois squad. After the game, Illinois point guard Frank Williams said, ``We gave them our best punch and they survived it.'' Indeed, the University of Arizona Wildcat basketball team this year suffered a lot of punches, many thrown in their direction. Toughest of all, head coach Lute Olson suffered a blow on New Year's Day, losing his beloved wife Bobbi to ovarian cancer. Known affectionately by players and coaches and students at the U of A alike as Mrs. O, Bobbi Olson was a special person. In fact, many considered her to be the Wildcats' sixth player. Famous for her efforts on behalf of the team and the university, her efforts in recruiting and her famous apple pancakes, Bobbi Olson provided encouragement to the players and perspective to her husband. She will be dearly missed by the Olson family and by all fans of U of A basketball. I would like to express my personal condolences to Coach Olson. Cancer is a terrible disease that affects thousands of families each year. In fact, Mr. Speaker, cancer has reared its ugly head in my family. It took the life of my mother, and my oldest sister is today thankfully a breast cancer survivor. I share Coach Olson's grief and greatly admire his strength to overcome this tragedy as he did this year and lead his team to such a wonderful and stunning season. The individual members of the Wildcats basketball team also deserve mention. Arizona arrived in Minneapolis this past weekend with a star- studded line-up that boasted five preseason nominees for the John Wooden Award which goes to the sport's top individual collegian. Led by junior forwards Richard Jefferson and Michael Wright, center Loren Woods and a back court of Jason Gardner and Gilbert Arenas, the Cats overcame a disappointing 8-5 start to finish the season with a 20-2 run into the final game this past Monday night. Individually, these men are exceptional athletes but, more importantly, under the coaching of Lute Olson, when they played together, they formed an exceptional team. It was this unselfish teamwork that led this talented squad to the Final Four and indeed to the final game. In an era where the best prospects see college basketball as a 1- or 2-year stopover on their way to the next level, the NBA, I would be remiss if I did not mention a rare exception, an athlete that recognizes that an education and a contribution to society are noble pursuits. The University of Arizona had such an individual in the person of Eugene Edgerson. As a freshman reserve, he played on Arizona's 1997 national championship team. However, he was also a member of this year's gifted Wildcat team because he took a break last year to complete the student teaching requirement in a kindergarten for his degree in elementary education. Then he stayed to take graduate courses when he finished his fourth year of eligibility. Eugene says he came to school both for the books and for the hoops and could not see leaving without getting the most out of both of them. Mr. Edgerson serves as a model on and off the court. Unfortunately on Monday night, the Wildcats came up short in their quest for a second national championship. But even in defeat, they displayed the talent and grace of a championship team. I want to congratulate Lute Olson. I want to congratulate all of the assistant coaches. I want to congratulate the team for its great season, for its unselfish play. You have made University of Arizona alumni like me, the student body of the U of A, the State of Arizona and fans of basketball, particularly college basketball, all across the country extremely proud. Thank you very much for a great year. I commend you all. Our hearts and sympathies go with you, Lute. And to the team, bear down. arizona wildcats 2000 basketball roster No--Name, Position, Ht., Wt., Class, Hometown: 0--Gilbert Arenas, G, 6-3, 188, So, North Hollywood, CA. 2--Michael Wright, F, 6-7, 238, Jr, Chicago, IL. 3--Loren Woods, C, 7-1, 244, Sr, St. Louis, MO. 4--Luke Walton, F, 6-8, 233, So, San Diego, CA. 5--Travis Hanour, G, 6-6, 189, Fr, Laguna Beach, CA. 11--Jason Ranne, G, 6-4, 200, Fr, Tulsa, OK. 13--Andrew Zahn, F, 6-9, 254, Fr, Redondo Beach, CA. 14--Mike Schwertley, F, 6-5, 224, Fr, Phoenix, AZ. 15--John Ash, G, 5-11, 179, Sr, Tucson, AZ. 22--Jason Gardner, G, 5-10, 181, So, Indianapolis, IN. 23--Lamont Frazier, G, 6-3, 182, Sr, Los Angeles, CA. 24--Russell Harris, G, 5-11, 165, So, Mundelein, IL. 30--Justin Wessel, F, 6-8, 240, Sr, Cedar Rapids, IA. 33--Eugene Edgerson, F, 6-6, 237, Sr, New Orleans, LA. 35--Rich Anderson, F, 6-9, 213, Jr, Long Beach, CA. 44--Richard Jefferson, F, 6-7, 222, Jr, Phoneix, AZ. Head Coach: Lute Olson.

Mr. SHADEGG

Mr. SHADEGG. Mr. Speaker, on March 7, 2001, I missed rollcall votes 31 and 32. I was chairing a hearing with Vice President Cheney. Had I been present I would have voted ``yea'' for H.R. 624, the Organ Donation Improvement Act of 2001, and ``yea'' for H. Con. Res. 47, which honored the 21 members of the National Guard who were killed in the tragic crash of a National Guard Aircraft on March 3, 2001.

Mr. SHADEGG

Mr. SHADEGG. Mr. Speaker, today we celebrate President Reagan's birthday. Although he left office more than 12 years ago, after eight years of distinguished service as our Commander in Chief, Americans today continue to benefit from the fruits of his hard work. It is for that reason; I rise to honor Ronald Reagan on his 90th birthday. During the 20th Century America witnessed the rise of a handful of great leaders. From Theodore Roosevelt to Franklin Roosevelt to John Kennedy, America rose to prominence--she expanded internationally, built the Panama Canal, overcame a Great Depression and fought two world wars. However, it was under Ronald Reagan that America achieved her true greatness. President Reagan was a common man who, unlike many who came before him, entered politics at a later stage in life. He did so because of a belief that the country was headed in the wrong direction. A common man who touched every American, Ronald Reagan used his charm and steadfast beliefs to right the direction and shape the United States into the great country she is today. President Reagan turned around the public perception of government, sparked economic growth, restored the military, won the Cold War and restored our faith in America. My first memory of Ronald Reagan dates back to 1964 when Ronald Reagan spoke to the country on behalf of the Republican candidate for President that year--Senator Barry Goldwater of Arizona. On a personal note, my father, Stephen Shadegg, worked for Senator Goldwater during the 1964 presidential campaign. This afforded me the opportunity to experience, first-hand, what a true visionary and leader Mr. Reagan was. Ronald Reagan gave a speech on behalf of Senator Goldwater that year. It later became known as ``A Time for Choosing.'' Many of the points he raised in that speech I hold dear and use to guide my judgment while serving the citizens of my District and the state of Arizona. In that speech President Reagan spoke of several principles Republicans, indeed all Americans, continue to hold dear. The first principle is personal freedom. Ronald Reagan quoted James Madison when he stated that the Framers of the Constitution, ``base[d] all our experiments on the capacity of mankind for self-government.'' He was correct: Each person should be able to live with the freedom that the Constitution guarantees. Ronald Reagan spent every day in office seeing to it that this principle was advanced and defended. The second principle that President Reagan advocated was that the government is beholden to the people. Not the reverse. He stated: ``This idea that the government was beholden to the people, that it had no other source of power is still the newest, most unique idea in all the long history of man's relation to man. ``This is the issue of this nation: whether we believe in our capacity for self-government or whether we abandon the American During the speech, he also asked: ``Are you willing to spend time studying the issues, making yourself aware, and then conveying that information to family and friends?'' He continued: ``Will you resist the temptation to get a government handout for your community? Realize that the doctor's fight against socialized medicine is your fight. We can't socialize the doctors without socializing the patients. Recognize that government invasion of public power is essentially an assault upon your business. If some of you fear taking a stand because you are afraid of reprisals from customers, clients or even government, recognize that you are just feeding the crocodile hoping he'll eat you last.'' Truer words have never been spoken, Mr. Speaker. In fact, these words ring true today. Mr. Reagan extended his vision to a third principle--the economy and the tax code. His belief in lower taxes and private enterprise was based upon the idea that each individual best knows how to spend their money and manage their store. Like the Founding Fathers, President Reagan believed that government control of any enterprise leads to control of the people who run them. How correct he was when he stated: ``The Founding Fathers knew a government can't control the economy without controlling the people. And they knew when a government sets out to do that, it must use force and coercion to achieve that purpose. So we have come to a time for choosing. Public servants say, always with the best of intentions, ``What greater service we could render if only we had a little more money and a little more power.'' But the truth is that outside of its legitimate function, government does nothing as well or as economically as the private sector.'' President Reagan led by those principles. His faith in the individual, belief in free enterprise, and unending conviction in providing freedom of choice in everyday decisions helped to restore the ``great, confident roar of American progress, growth and optimism.'' The ``choice'' was right then. It is right today. Yet, we must continue to fight for these principles today. In his farewell address in January of 1989, President Reagan modestly summed up his eight years in office, ``All in all, not bad, not bad at all.'' Well, Mr. Speaker, I believe this is more fitting of his overall contribution to the American public: ``All in all, not bad, not bad at all.'' Happy Birthday Mr. President. We salute you.

Mr. SHADEGG

Mr. SHADEGG. Mr. Speaker, I appreciate this opportunity to address my colleagues and to talk about, in fact, the exact same subject that my colleague from the other side of the aisle, from the Democrat side of the aisle, just addressed. He talked about a wide range of medical issues. I am going to do that in this hour as well, but I am going to begin by focusing on the issue of patients' rights legislation, the issue of HMO reform, the issue of managed care reform. After I have spent some time on that and focused on why that issue is so critical and why I so strongly disagree with much of what was just said and how sad I think it is that this debate has boiled down to this struggle where one side is saying the other side is just carrying the water for a special interest, then I would like to turn perhaps in the latter half of the hour to the issue of the Medicare drug benefit and perhaps other topics that are worth talking about and that were raised in the remarks in that regard. Again, I want to focus tonight on the issue of patients' rights legislation, the issue of a Patients' Bill of Rights, the critical question facing our country of managed care reform, HMO reform. We are in the midst as everyone knows of a political campaign. There are ads running across the country saying that it is sad that my party, so these ads say, has blocked, the Republican Party, has blocked the passage of patients' rights legislation. I simply want to start by saying that is not true. Indeed, the opposite is true. We have worked very hard to pass patients' rights legislation that will help patients. That is the key difference. Sometimes it is said that the devil is in the details and the devil is in the details. In this case there are two competing ideas on patients' rights legislation: one is the idea advanced by Democrats, the idea which they are pushing, the idea which their ads talk about, the idea which the President is saying he supports; and that proposal sadly does not help patients. That proposal helps trial lawyers. Rather than just talk about that, I am tonight going to explain exactly, precisely, how their legislation would advance the cause of trial lawyers but do literally nothing to help and in fact hurt patients and weaken the position of doctors to control health care in America. I think that is the debate that needs to occur. I think we need to understand why, yes, patients' rights legislation is vitally important for this country. There are serious problems in managed care. But how you enact that legislation, what it does, is so critically important and why, sadly, the bill that the Democrats are advancing, and they call it a patients' rights piece of legislation, in fact is fatally flawed in its structure, because instead of giving patients more power, instead of giving doctors the ability to set the standard of care and to decide how patients are treated in America, that legislation takes power away from HMOs, and that is good, but instead of giving that power and that authority to set the standard of care in America to doctors where it belongs and to patients where it belongs, their legislation gives that ability to trial lawyers to take the issue directly to court. We have heard just a few minutes ago in the rather partisan remarks by my colleague from the Democrat side that the Republicans are for the special interest of HMOs and that Democrats are for the people. Sadly, that charge is just flat false. Let me start with my position. I have been passionately fighting for patients' rights legislation, the right patients' rights legislation, for the last 2 years. I have met with countless doctors from all over the country, many in my State, I cannot tell you how many, my own medical association in Arizona; and I have talked with them for hours and hours about how do we go about fixing the problem with managed care in America, how do we deal with the problems that have been created by managed care in America. In every one of those conversations, I have never once heard, well, Congressman, the way to fix it is to let lawyers step into the middle of the process, take a claim by an injured patient, take my request as a doctor to get my patient care and have a lawyer step in and rush to court and file a lawsuit. Never has a doctor in America in my home State or anywhere else that I have met with said the answer to this problem is to let the trial lawyers address the issue. The reality is we do need patients' rights legislation to change managed care and to make it more pro-patient and more pro-doctor. But we need legislation that will accomplish that goal, that will take power away from the managed care industry, to tell doctors how to treat their patients and move that power over to patients and doctors to determine what the standard of care ought to be in America. I am adamantly for managed care reform, and I am a Republican and I have fought for that legislation since I have gotten here. One of the offhand remarks of my colleague just a moment ago was that the conference only met a few times. Well, my colleague was not on the conference. I was on the conference. We spent countless hours trying to reconcile the differences between a pure trial lawyer piece of legislation that will not help patients and a piece of legislation that would advance the cause of doctors and patients. I am going to explain that in my remarks. I tell you that every other Republican with whom I served on that conference committee and the Speaker himself who was asking in the last several weeks to try to bridge this gap and try to pass legislation, they are all adamantly for the passage of meaningful legislation that will empower patients and doctors and solve this problem. As to my own bona fides on this issue with the gentleman from Oklahoma (Mr. Coburn), who is going to join me later in this Special Order, we wrote the Coburn-Shadegg managed care reform bill, the Coburn-Shadegg patients' rights legislation. That bill would have put the emphasis precisely where it should be. It would have empowered doctors and patients to resolve medical questions, doctors in consultation with their patients to set the standard of care; and it would not have given that power over to trial lawyers. It is sad that it has gotten tied up in this kind of a debate, but it has. Everyone who understands managed care reform understands that we need to reform the system in a way that will be pro-patient. Let us start with why we need managed care reform. It is important to understand how managed care works in America. It was a reform idea itself to try to hold down the costs of medical care in America. In that sense, it has worked to some degree; but sadly it has been abused, and it is susceptible of abuse and we need to fix that. Let me talk about why we need to fix it. Right now in America, in our managed care system, a given doctor meets with his or her patient, does an examination and decides the patient needs a particular type of care. And so that doctor makes the recommendation for the care and goes to their managed care plan and says, ``My patient needs this care.'' There is an initial review of that claim, sadly often by an HMO bureaucrat, not a medical personnel, but a nurse or someone else; and let us assume it is turned down by the plan. There then is in some instances an internal appeal, an appeal to doctors at the managed care plan. If you follow that structure, if there is no appeal beyond that, you have a doctor, a treating physician, saying that his or her patient needs care. And then you have a managed care bureaucrat, an HMO bureaucrat, saying, no, you do not get the care. That is where the first point of abuse is. In America today under that system, a managed care bureaucrat can turn down the request for care by the treating physician, and they can turn it down perhaps for the wrong reason. They can turn it down to protect the profits of the managed care company, rather than to protect the care of the individual. I have been working on this issue, and I have been in my district when hundreds of people have talked to me over time about how they or a member of their family, their mother, their father, their daughter, their sister, their brother was abused by a managed care company when the treating physician said my patient needs this care and the HMO denied the care for a specious reason. So what is wrong with that structure? The thing that is wrong with that structure is that under that structure, the managed care plan, the HMO, is telling the treating physician how he should care for the patient. In medical jargon, that really means the managed care plan is setting the standard of care for any individual patient under a set of circumstances. That is crazy. Managed care plans are essentially insurance companies. They ought to try to hold down excessive costs, but managed care plans should not set the standard of care. HMO bureaucrats should not tell doctors how to treat patients. That ought to be a decision made by doctors. They were trained to practice medicine. HMO bureaucrats were not trained to practice medicine. So the current system is backward. It lets doctors be told how to practice and how to treat their patient and what the standard of care in America is for a given set of circumstances by an HMO bureaucrat. So that is why I fought for managed care reform. They can deny that care for monetary reasons, not reasons of care. The second reason that we need managed care reform is actually a tragedy, and it falls into my own area of expertise. And, that is, that as a result of, I believe, an unintended consequence of a Federal law called ERISA, a managed care company in America today can deny care; and if they negligently deny care, in that example I just gave, they make a mistake when they said the treating physician may not provide this care, if when they do that the patient is injured or dies, there are no damages. There is no recovery. That managed care plan can simply walk away and say, ``Wow. Our mistake injured or killed somebody, but since we're a managed care plan and we are operating under this Federal law called ERISA, we can't be held accountable.'' I think that is an outrageous structure for the law. Every one of us knows that if we make a mistake, if we, let us say, run a red light at an intersection and our negligence injures or kills somebody, we are responsible for that injury and hopefully our insurance policy will make the injured person whole, will pay damages for them. Sadly, even though every business in America, every homeowner in America, every car driver in America, every one of us in America is legally accountable when we injure or kill somebody, that is not the case for federally governed ERISA managed care plans. They have as a result of this Federal law an interpretation of it by the United States Supreme Court, immunity. They cannot be held liable when they injure or kill someone. That is a tragedy, and it should be fixed. That is why I have fought for patients' rights legislation and fought to hold plans accountable. The best story on that is the story of Mrs. Corcoran. Mrs. Corcoran became pregnant. She was an employee of Southern Bell in Louisiana. It was her second pregnancy. She applied for benefits. Her treating physician was treating her through the course of the pregnancy. At one point he told her she needed to go to the hospital, to be in the hospital for the balance of her pregnancy so that if there was a problem with the baby, and it was her second pregnancy and she had had a difficulty the first time, he said, If you're not in the hospital, there is a danger you will die or a danger your baby will die. Tragically, her HMO denied her that benefit and said, No, we won't pay to put you in the hospital. We'll pay for a little bit of home nursing, somebody to come by and visit you. Even more tragically, the worst possible circumstance happened. While Mrs. Corcoran was home, her baby went into distress, still in the womb; and notwithstanding that they did everything they could, her baby died as a result of the fact that she was not in the hospital. Mr. and Mrs. Corcoran, tragically hurt by this event, filed a lawsuit to recover damages; but of course, they did not sue their doctor. Their doctor had done the right thing. He had said you should be in the hospital but their HMO had said, No, I'm sorry, we won't put you in the hospital and we won't pay for it. Under the current Federal law, the law provides that the Corcorans cannot recover, could not recover, did not recover any damages for the death of their child. That is an outrage, and it has to be fixed. The next question is, why then, Congressman, have you not embraced and why have Republicans not embraced the Democrat Patients' Bill of Rights? There is a simple answer to that, and I am going to explain it here today. It is because the Democrats' Patients' Bill of Rights will not help Mrs. Corcoran. The Democrats' Patients' Bill of Rights would, in fact, hurt patients. It would, in fact, hurt doctors. It would, in fact, hurt businesses across America; and it would, in fact, cause more uninsured Americans. There is one group that the Democrats' Patients' Bill of Rights would help and there, is one group that is supporting the Democrats' Patients' Bill of Rights, and that group is tied to them through contributions, and that is the trial lawyers. The Democrats' Patients' Bill of Rights, the bill that has been debated on this floor, the bill that the President says he wants to pass, moves power away from HMOs and moves it directly to not doctors, not patients, it moves it directly to lawyers. That is a problem, and let me explain how that Democrat Patients' Bill of Rights, it is known as Dingell-Norwood, works. The Vice President referred to it in the debate the other day. I do not know that the average American out there listening knows the word Dingell-Norwood, so I am just going to refer to it as the Democrat Patients' Bill of Rights, but it is the bill that Vice President Gore wants us to enact. It is the bill the President has asked for us to enact. If you live in a congressional district where there is a commercial running right now, it is the bill when they say pass a Patients' Bill of Rights, they want you to pass the Democrat Patients' Bill of Rights, the Dingell-Norwood Patients' Bill of Rights, which will not help patients, will not help doctors. It will cause a flood of lawsuits. Now, let us start kind of with a fundamental issue in this debate, and to do that I want to refer to a chart. This chart asks the basic question that anybody concerned about health care ought to ask, and that is health care in America, who should make medical decisions? Right now one issue is, well, should HMOs make medical decisions? We just talked about how under the current structure HMOs, managed care companies, indeed maybe even managed care bureaucrats, get to make medical decisions. Should HMOs make decisions? I do not think so. Another alternative is the one I favor, and that is the one here at the bottom; and we have put a red check to show that is where I believe the power ought to be. Should patients and doctors, or doctors in consultation with their patients, make medical decisions? I think the answer to that question is obviously that as between HMO bureaucrats making medical decisions, what should be the standard of care, what course of treatment is right for a particular patient, should that be decided by a treating physician talking to his or her patient or should it be decided by some HMO bureaucrat? That is a no brainer. I hope everyone in America agrees it should not be an HMO bureaucrat. It ought to be the doctor, the treating physician, who has touched you, who knows you, who has known you perhaps for years, who has looked you in the eye and assessed your medical condition and says, this is what we ought to do for your care. It should not be a bureaucrat at the HMO who has never seen you and has just read kind of a cold chart. That is where this debate ought to be. It ought to be between HMOs making those decisions and doctors and patients making those decisions, and that ought to be the fight that is going on right now and on that one I think we win. It ought to go to doctors in consultation with their patients. My friends who are doctors tell me that the practice of medicine is more art than science, and what they mean by that is that the doctor that is treating you, the doctor that knows you, your own treating physician, can sense what really ought to be done about your condition. The problem with giving this power to HMOs is that that is a cold bureaucratic decision often made by somebody who is not even trained as a doctor, perhaps made ultimately by someone that is a doctor but has not practiced medicine for many years because they could not hack it in the practice of medicine. It should not be made by that person who has never touched you or felt you or looked in your eye or tried to assess in conversation what is really wrong with you. It ought to be made by your treating physician. So what is this middle line doing here? Why are lawyers in the discussion? Well, the answer is, they should not be. Lawyers should not be a part of this discussion. We need to write a patients' rights piece of legislation that drives care, a patients' rights legislation or patients' rights bill that incentivizes or encourages the system and the managed care company to deliver the best possible care at the earliest possible moment, and that is the goal. The goal is the best care at the earliest moment. I think that happens when a doctor, after consulting with his or her patient, says this is the care that is right. But how are lawyers in this discussion? Well, the answer is, some people who want to reform managed care really do not really care about patients and doctors. What they care about is litigation. Sadly, what they want to do is create a structure where you do not get care very quickly because your HMO decided to approve the care recommended by your doctor. You do not get care very quickly because an independent external review panel said your HMO, when it denied you was wrong and darn well better deliver that care, what they say is, we really need to turn this whole thing over to lawyers. We need to turn it over to trial lawyers. We need to let the trial lawyers get to court quick so that those trial lawyers can drag this out in a nice long lawsuit. Do not mess with the doctors. Just get in front of a judge, drag the lawsuit out and if nothing else perhaps if we do not have a meritorious case, we can exact some kind of a settlement. I said earlier that the Democrats' bill, the Dingell-Norwood bill, is tragically flawed; and it is. This issue has been little discussed on the floor, almost not discussed anywhere across America, but if you hear the President or the Vice President call for patients' rights legislation, you need to know the bill they are asking for is Dingell- Norwood; and you need to know that bill will not let your doctor make the decision. It will take down a restriction that exists in the law right now and let your lawyer, if you get one, quickly rush off to court and perhaps win himself a large settlement of which he gets a third, or 40 percent. Now, I believe in the tort system. I think if somebody hurts you, you ought to be able to recover your damages; but I sure do not think our first goal in patients' rights ought to be to empower lawyers. I think it ought to be to incentivize the best possible care at the earliest moment. I want to move to one more chart. It is a chart that is a schematic of the Democrat Dingell-Norwood bill, and I apologize for having to do a schematic, but it is how we can illustrate what is wrong with the Democrat legislation and why if you hear a commercial that says, by gosh, we need patients' rights legislation, you are right, we do need a patients' bill of rights; but we do not need the flawed Democrat bill. We need a bill that will get you the best care at the earliest possible moment; not a lawsuit. Let me explain this bill, and we will walk through it. We talked about your doctor consulting with you and then making an initial claim. Often unfortunately that is currently done through some bureaucrat at the HMO, and they may turn you down. The next step under the Democrat's bill is a good one, and that is you ought to have a right to get to a doctor at the HMO. That is called internal review. You ought to force the HMO not to let a bureaucrat turn you down. The HMO ought to have to hire a doctor to make a review of your case. Hopefully, that doctor will say you get the care, rather than deny you. So that is a good step. That is a step in the right direction. Everyone in America ought to have an internal review by the plan and let the plan make the right decision. But if they do not, the critical question in managed care reform, the critical question for patients' rights legislation, is what do we do next? I argue the answer is that in every case, what we ought to do after internal review, if this managed care company, this HMO denies your treating physician and you the care you need, the next step ought to be an external review, what we call an external review. That is not complicated. What it is is that if the plan will not give you the care you need after their doctor has looked at it, you ought to have a right to get to three totally independent doctors and to have those three totally independent doctors review your claim. Now when I say totally independent, what do I mean? Well, the law that we talk about would say that these doctors have to be selected independently. They cannot be controlled by the HMO. They cannot be hired by the HMO. They cannot have a conflict of interest because of their connection with or their income from the HMO. They have to be totally independent of the HMO so they can make an unbiased decision. Obviously, they also need to be independent of your own doctor. So they are truly experts. In our bill, we call for them to be practicing physicians, with expertise in the field, who are independent of the HMO and independent of you and your treating physician. Our goal is to have that external review panel of three doctors make a quick decision; yes, the patient deserves the care, the plan was wrong and, by the way, HMO, if you do not give them the care and they get injured or they are injured, then you not only are going to be liable for the care you should have given but you are going to be liable for all of their economic damages, you are going to be liable for all of their pain and suffering; and if the plan acts in an arbitrary and capricious fashion, then you are going to be liable for punitive damages. The bottom line here is that there ought to be a review by three doctors very quickly, and we have an expedited time frame to do that. Here is the flaw with the Democrat bill, and here is why you see this little red circle with a bar through it. It is probably hard to see on the TV, but you see under the Democrat Dingell-Norwood bill you do not go to external review. As a matter of fact, that will never happen under that bill. It will literally never happen, and the three doctors over here will not get to set the standard of care by telling plans how they should treat patients. They will not get a chance to say was your treating physician right or was the plan right. They will not define the standard of care in America because under their bill there is this gigantic loophole, and it is the lawyers' loophole. Here you see the arrow going down. It says, well, guess what? The minute you finish internal review you can go straight to court. We do not really want an independent panel of doctors to make a decision. We want some aggressive trial lawyer to go hire his own expert witnesses who will interestingly always side with the trial lawyer, and file a lawsuit. Now, I said earlier in all of my conversations with doctors across America, and I have talked with literally, I think, hundreds, not a single one of them, not in Arizona, not anywhere else that I have met with them, have they said, you know, Congressman, we really think the way to solve the problem with managed care in America is to get people to lawsuits, because lawsuits will deliver care. Indeed, none of them have said the problem with managed care is that we do not get to court quick enough. What they have said is, the plan can turn us down and we could get an independent group of doctors to review our request. So this is the loophole in their bill; and it is why, and I said earlier, that the Democrat's bill is fatally flawed. They talked about how Republicans favor the special interests of HMOs. The legislation I favor lets HMOs be sued, lets them be held accountable, says if they kill Mrs. Corcoran's baby they must pay damages. But it does not carve a loophole to prevent people from getting quick care and the proper care by letting the case go to court. It rather is legislation that says get them care. If you talk about special interests, the Democrats have a special interest that my colleague on the other side did not talk about a few minutes ago, and that special interest is trial lawyers. That is why they created this loophole. This, by the way, is a structure that takes power away from HMOs and hands that power to trial lawyers. That is crazy. What we do need to do is take power away from HMOs to decide how you should be treated, or your wife or your daughter or your son. You need to take that power away from HMOs and put it in the hands of your treating physician and in the hands of an expert panel of independent doctors. That kind of takes me to the structure that we have proposed; and you see here it says, the compromise patients' bill of rights, and it is a simple structure. It is a structure that incentivizes or encourages the best possible care at the earliest possible moment, because that is what managed care reform ought to be about. Tragically, my friends on the other side of the aisle, Democrats, adamantly to the death oppose this structure. They say absolutely not. We need the trial lawyer plan. We do not need the plan that empowers doctors and patients. Let us talk about how this structure for the bill is different; and again I apologize, but a flowchart really does kind of let you understand the legislation. Here in the legislation we are proposing, the legislation we have begged the American Medical Association to endorse, there is first an initial claim just like the Democrats' bill. Then there is internal review, just like the Democrats' bill in Dingell-Norwood; but you will notice there is no loophole here. We do not let the lawyers cut off external review. What we say is that if the plan turns you down at external review and says to your treating physician, no, we are not going to give you the care, you would have an immediate right, indeed we have three different time procedures, one for extremely urgent situations where it is within a matter of hours you would have a right to get to external review. If it is less urgent, there are two more time frames for less urgent circumstances. But if you were denied that internal, you would get to go within hours in an emergency situation to the external review that I talked about, and that external review is conducted by three independent doctors who will get to judge the recommendation of your treating physician that my patient needs an MRI, and judge the decision of the managed care company that, no, your patient does not need an MRI. Those three independent doctors would have to be practicing physicians, as opposed to physicians who quit years ago because they could not make it. They would have to be experts in the field, and they would get to make a decision. Now, here is the key: that can happen within hours under certain circumstances and once that happens, and it may be hard for you to read but right here it says, the HMO is bound by the decision of this medical panel and the patient receives the care. You can see that this is a quick process. It happens very quickly. By the way, there is no lawyer yet. The lawyer did not get in here. The lawyer did not get to take the case off to trial court or get into discovery and try to extort a settlement. This went straight through. It went through internal review, and it went to the external review; and if the external review panel says the treating physician is right, you get the care. Sadly, the Democrats do not like this bill because it cuts trial lawyers out to that point in time. Now, what do we do about the people who are truly injured? Well, we say in our legislation, if as you have been going through this process you were injured, not only do you get the care here but now you have the right to go to court after the plan has been told to deliver the care, you have the right to go to court and you have the right to recover your damages. So it is not that we are against giving people access to trial lawyers. I have many friends who are trial lawyers, and they do a great service for people who are truly injured. It is not that we are against the tort system. Indeed, I am outraged by the fact that Mrs. Corcoran, under the current structure of the Federal law, her baby was killed by a managed care company, and they did not have to pay a dime. They just got to walk away. But the issue is where do you put in legal accountability? The Democrats, the Dingell-Norwood bill, lets lawyers jump in right up front, boom, here we just get to go straight to court. Our bill says, no. Let us let a panel of three independent doctors make the decision, and then, if the plan is wrong and someone has been injured, then let us go to court. Let us let someone recover their economic damages; if they lost time from work, they ought to be able to recover that. If they have suffered pain and suffering as a result of this wrongful decision by the HMO, perhaps motivated by their desire to keep their profit line looking good rather than the patient's need for health care, then they get to recover their economic damages, they get to recover what we call their noneconomic damages, which means their pain and suffering, and if the plan did not follow the instructions of the external panel, then there are punitive damages on top of that. But we can see that this structure is designed to empower doctors, not lawyers, and that is the huge difference. That is the debate that has been going on. Sometimes in the last few days when I have been thinking about this issue, I thought, how could it have been so complicated for 2 years for us not to get across the issue and explain to the American people, patients' rights legislation is vitally needed, but the bill they want, the bill the Democrats are pushing on us, the bill they talked about in their ads and the bill the President will probably speak about many times between now and election day, the bill that the Vice President will talk about many times between now and the election does not help doctors; most importantly, it does not help patients. What it helps is trial lawyers. We want a bill that empowers doctors to decide what care should be, what the standard of care should be. I have to tell my colleagues, and in a moment I want to discuss these issues with the gentleman from Oklahoma, I have to say that I am amazed. If the Trial Lawyers Association were actively advocating this structure, the structure where one gets to court, but they do not get to a panel of independent doctors, I could understand that. But what puzzles me and what I do not understand is that the American Medical Association is supporting that structure, the trial lawyer structure, and I do not understand, and I hope some day they will explain to me, why the American Medical Association is not supporting a structure that will empower doctors rather than lawyers. We do need to diminish the ability of managed care companies to hurt people. We do need to take away from HMOs the ability to set the standard of care. The standard of care in America ought to be set by doctors who are trained in medicine. But, when we take that power away from a managed care company and move that power somewhere, I suggest it would be a tragic mistake to, as the Democrats propose, move that power, to decide how one should be treated as a patient who needs medical care, to move that power to a trial lawyer, rather than moving it to a trained physician; in our structure, to a panel of trained physicians who will tell the HMOs exactly what the standard of care ought to be. For perhaps any doctors listening across America, in my own city of Phoenix, and the reason I care about this issue, the managed care penetration is so deep, they have such power. Announcement by the Speaker Pro Tempore

Mr. SHADEGG. Mr. Speaker, I used the term HMOs to refer to a broad array. Some would argue that PPOs are a little bit different, that one gets a little better care under a PPO. But fundamentally, we are talking about managed care companies and HMOs, which are health care management organizations, whose job it is to manage the care, and it is these managed care companies or HMOs, and now as they are kind of morphing themselves into the latest version which is a PPO, we are talking about all of these structures under which someone other than the treating physician gets to make the decision. In our discussions of this in the past, the gentleman has pointed out that if you have a fee-for-service plan, your doctor gets to make these decisions. There is not someone second-guessing him. Of course, it does not matter to me whether we are talking about the doctor being second- guessed by an HMO or being second-guessed by a managed care company, or being second-guessed by a PPO. The fundamental issue is, if the plan one is in gives some insurance company bureaucrat or some insurance company employee the power to deny the treating physician the ability to deliver the care they think is appropriate, there ought to be a quick appeal and they ought to get a quick answer so that the patient can get the care he or she needs.

Mr. SHADEGG. Mr. Speaker, if the gentleman would yield just on that point, it occurred to me as I listened to the gentleman precisely the point the gentleman is making with regard to improving care. I think it is very important to understand that. Under the structure we have talked about, if immediately following internal review by the plan, one wants to appeal and one gets to appeal immediately to an external panel of doctors, one has a chance for that panel, the gentleman said, to educate the plan on the care they ought to be delivering, and once the plan has been told a couple of times by that external panel, no, you should not be denying care under this set of circumstances, you can bet the plan will quit denying care under that set of circumstances. The other scenario, the trial lawyer scenario, I used to be a practicing lawyer and I have tried my share of lawsuits, I can tell one thing that never happens once you get into litigation, you almost never settle. You polarize physicians at the extremes. So under the structure we are talking about where you go to internal review and you quickly go to external review and the panel tells the HMO the plan they should be delivering, there is a chance for education and reconciliation and for everybody to learn what the standard of care ought to be and for the care to be given as quickly as possible. Mr. Speaker, I just want to make the point that under the alternative structure where we go from internal review straight to lawsuits, what we have is two polarized, extreme positions, with the lawyer for the plan doing battle and going to war with the lawyer for the patient, and it is not a reconciliation, and there is no education. I just have to make one other comment. George W. Bush, the Republican candidate for President, in some ways almost characterizes this perfectly. He says, for too long the partisan fights back here between Republicans and Democrats have kept us from getting anything done. He says, I am going to come to Washington and bridge that partisan fight and try to bring Republicans and Democrats together to get something done. It occurred to me that the partisan structure where we have been fighting each other for the last several years in this Congress and doing more for the lawsuit structure. The plaintiff's lawyer says, the defense lawyer is wrong and the defense lawyer says the plaintiff's lawyer is wrong. We have this war going on. Instead, we could have a reconciliation. It just occurred to me that is exactly what George W. Bush is saying to America. Let us not have that polarized, pitched fight. Let us try to talk to each other.

Mr. SHADEGG. Mr. Speaker, I very much appreciate the gentleman bringing up the fact of cost. I was here on the floor during the previous Special Order by our Democrat colleague. I heard a lot of railing against the Republicans backing special interests and they do not care about people and they are just for the HMOs. They hate little people and do not care about it. That kind of rhetoric I do not think is very productive, and I do not think it helps bridge the gap and solve problems in America. But I thought it was interesting that in the close of his remarks, he said he had had a conversation with an employee at a restaurant he frequents. And I have actually been to his district a number of times, and I have a friend who has family in that district. It is on the beach in New Jersey. The gentleman talked about a friend that worked for a restaurant, and she would very much liked to have had health insurance, but her employer, with whom she had a good relationship, could not afford to provide that insurance. It is important to understand that if we do this wrong, if we drive our system to lawsuits rather than care, if we encourage many, many lawsuits to be filed, and the latest structure is that they want to be able to bring these lawsuits in State court and in Federal court, if we encourage too many lawsuits, if we turn the system over to the trial lawyers, then costs are going to go up. The structure we have tried to encourage goes at this issue of cost. It says, if Americans are injured, they ought to have the right to go to court. I have many, many good friends in Arizona who are trial lawyers who I respect immensely. I talked to one just a few hours ago back in Arizona, and he has helped me immensely to learn about this issue. He wants to be able to go to court when he has a genuinely injured patient that an HMO has injured. But I do not think he wants to be able to run off to court and have lawsuits filed under frivolous circumstances. That is a point we have not talked about. The structure that we have asked for where every case would go from the initial denial by the HMO to this panel of expert doctors who would decide, is a treating physician right and the patient ought to get the care or is the plan right and they should not get that care, that mechanism will screen out frivolous lawsuits. It is the frivolous lawsuits that will be turned down by that mechanism. The meritorious lawsuits where this panel of three expert physicians says, no, this plan was dead wrong; the injured party goes to court and they get to recover damages and get to be made whole. But, Mr. Speaker, if we encourage too many frivolous lawsuits, if we encourage lawyers who are not conscientious to be able to file a lawsuit in Federal court any time they want and muck up the system with an excessive number of lawsuits, costs will go up. One of the things that we have not talked about here is that issue of cost and its implications for the uninsured. We cannot get into a long discussion about the uninsured, but that is one of the tragic problems here. We have too many people in America, 44 million, who are uninsured. If we drive costs up further, then we are going to have even more uninsured. As the gentleman from Oklahoma knows, I believe we need to make it possible for every American to have insurance. I favor a tax credit so that they can go buy insurance. And for those who can't afford to go buy insurance, I favor a refundable tax credit. But it is important to understand that the Democratic bill, the Dingell-Norwood bill, perhaps supported by many of our colleagues on the other side, not understanding what it will do, that bill will drive costs through the roof and will hurt health care in America. Indeed, I fear it will lead to a single-payer, government-run, one- size-fits-all type of health care where we do not get to consult with our doctor and decide the care; some Federal bureaucrat decides the care.

Mr. SHADEGG. Mr. Speaker, I thank the gentleman for yielding. It is probably worth it, in the minutes we have left, to focus on really the crux of this issue, what we care about, what this discussion is about, why I believe the issue is so critical, why the gentleman from Oklahoma (Mr. Coburn) believes it is so critical. In the immediate preceding hour there was a lot of rather harsh rhetoric saying that Republicans do not care about a Patients' Bill of Rights, Republicans do not care about patients, Republicans are just for HMOs. That kind of talk makes me angry. It is divisive. It divides the country. It is polarizing, and it is just flat wrong. I have worked, as the gentleman from Oklahoma has, now for 2 years nonstop on patients' rights legislation. I consider it a privilege that the gentleman and I were able to write a patients' rights piece of legislation, a bill that moves the ability for medical decisions to be made, not by HMOs, but moves that ability away from managed care companies and PPOs and HMOs and gives that decision-making authority to doctors to make the decisions about the standard of care. But on this partisan attack, I just have to say that it upsets me. Because after writing the bill with the gentleman, I had the privilege of being appointed to the conference committee. I served on that conference committee. I did not miss a single one of those meetings, and I spent countless hours with my House colleagues, Republicans and Democrats, countless hours with my colleagues in the other body in the Senate. Mr. Speaker, not a single Republican that I dealt with in that process, not one did not want to pass a Patients' Bill of Rights that would do the right thing; a Patients' Bill of Rights that would empower doctors, not lawyers; a Patients' Bill of Rights that would deliver care at the quickest point in time. They understood these issues. They discussed these issues at great length. And the reality is we could not get there because of the opposition of Democrats. So this kind of ``Republicans do not care about patients; they only care about special interests,'' that rhetoric is not productive. What we need is to pass legislation and quit pointing fingers of blame. We do need to analyze the issue, and we need to understand what should happen in the legislation. Again, I want to conclude by referring to this chart, because it really sums up this whole debate. Health care in America, who should make medical decisions? The Republican position is very, very clear, contrary to what has been said here on the floor. Contrary to what the President might say. Contrary to what the Vice President may say. Contrary to what that commercial that our constituents are watching in their congressional campaigns back home may say. The Republican position is that doctors, in consultation with their patients, should make health care decisions. So on this chart where it says, ``Who should make those decisions?'' HMOs? Our answer is no. Managed care companies can do their job, but they should not ultimately have the decision authority. That decision authority should be the treating physician's to decide care. Lawyers? Absolutely not. And that is the central feature, as we have talked about for the last hour, of this fight. The Democrats' bill, the Dingell-Norwood bill, and I brought it to the floor to hold up, this is Dingell-Norwood One, the first bill they wrote. It had the same structures. It empowered lawyers, not doctors and patients. After a lengthy debate, they produced Dingell-Norwood Two. I have read every word of every one of these bills. I have pored over them and highlighted the pages. The fundamental flaw in the legislation that they want is that it does take power away from HMOs, but it does not give that power to doctors or patients. It gives that power to lawyers. It encouraged lawyers to go to court, and it makes possible for them to go to court. It makes it possible for them to go to court before there is an independent review by three doctors to say, was the plan right or was the plan wrong? We have to ask ourselves why. Why do they oppose giving the ability to decide what the standard of care in America should be? Why do they oppose that? Why are they opposed to giving it to doctors and rather want to give it to lawyers? I do not know the answer to that question. I am puzzled by the answer to that question. I know that many of my Democrat colleagues are very sincere about their concern about patients and very sincere in their opposition to HMOs and managed care. But for the life of me, I think it is because they have not carefully studied the bill that they have been advocating, but that bill which the President would say is vitally important will not help health care in America. Indeed, that bill, if we encourage excessive, frivolous lawsuits by not letting a panel of expert doctors review the case, if we facilitate and make possible frivolous lawsuits in State courts and Federal courts and we allow that to happen before there is an independent review by doctors of whether the care was right or wrong, there is a very, very, very real danger. And that very real danger is that by turning the system over to lawyers and lawsuits and not having an independent external review by doctors but rather letting a lawyer get ahold of the client and rush off to court with a lawsuit and demand a settlement will polarize the parties. The HMO has been sued. They hire their defense attorney. The plaintiff has her lawsuit going forward. Now we have a polarized position. Not only will that drive costs through the roof and perhaps result in thousands more uninsured; but as the gentleman from Oklahoma has pointed out, it will not incentivize the best care at the earliest point in time, and it will not create an atmosphere in which there is education, in which this panel of doctors teaches the HMO what it really ought to be approving and what it maybe can turn down. We will not have that educational process. We will not have incentives to deliver the best care at the right time. What we will have instead is a quick lawsuit process whereby power to decide care is taken away from doctors and awarded to lawyers. We simply cannot make that mistake. There is no margin of safety financially to allow costs to escalate like that. We can pass legislation. Indeed, I would argue we can pass legislation this Congress which does what we have asked for it to do which empowers doctors in consultation with their patients to make the right care decisions, which encourages the best care at the earliest time, and which teaches HMOs what care they ought to be approving and not approving, rather than throwing the whole thing over to the lawyers.

Mr. SHADEGG. Mr. Speaker, I thank the gentleman and would echo those remarks. I think the reality is clear. I know the gentleman from Georgia (Mr. Norwood) and the gentleman from Michigan (Mr. Dingell), and both of them are honorable men and both have the best interests of patients at heart. But, sadly, what happens in Washington, D.C. is that these debates get pulled down into political wars and the Democrat party has a constituency and that constituency happens to be trial lawyers. So I think this bill got drafted with the input of trial lawyers and, sadly, we have a war going on. I do not defend the insurance companies either. We have a polarization here with the insurance companies and the HMOs on one side saying: do not pass any legislation. We have the trial lawyers on the other side saying: no, turn it all over to us. Sadly, nobody is fighting for the doctors and the patients. Look how thick this bill is. I think many of our colleagues, indeed, I would guess the vast majority of our colleagues have not had the chance, because these issues are too complicated, to study Dingell- Norwood and understand its public policy flaw and recognize that it does have the danger of driving costs up, and try to understand that the legislation that we are asking for which would empower doctors and patients and would enable doctors to teach plans what care they ought to approve and not approve, that legislation has not been studied carefully. I think we can still pass it this Congress. The gentleman and I have been in consultation with our Senate colleagues, and we may even have a meeting yet with them tonight on this. I am encouraged. I think we can, if we cut the partisan bickering, pass legislation that will protect patients across America. I appreciate the gentleman from Oklahoma for his brilliance and instruction and all of his help in this debate. It has been a great privilege.

Mr. SHADEGG. Mr. Speaker, let me point out that in my State of Arizona, there are so many managed care companies that a doctor that does not sign up with an HMO, indeed with several HMOs literally can barely survive economically, and yet we look at the structure that currently exists where HMOs tell practicing physicians what care they can and cannot deliver, one can imagine that the doctors in my State are enraged at that structure. Mr. Speaker, the doctors in Arizona, and I have talked with hundreds of them over the last 2 years, they want a structure where doctors set the standard of care and where doctors tell HMOs how patients should be treated; where doctors tell the managed care company, this is the right kind of treatment to give to a patient. The doctors in Arizona, at least, and the other doctors I have talked to, do not want to turn that ability to set the standard of care over to lawyers or even to encourage more lawsuits. You bet: If somebody is injured, then, in fact, a trial lawyer should come in and recover for their injury, and indeed, I wish that Mrs. Corcoran, I wish we could have passed this law in a way to allow Mrs. Corcoran and her husband to be made whole for the managed care company's decision that killed their baby. We cannot do that for them, but we can do that for future people, for someone tomorrow. That is why I have worked so hard here at the end of this session, desperately around the clock, with everyone involved in this debate, to try to pass a patients' bill of rights that would correct these problems in a way that will help patients and will help doctors.

Mr. SHADEGG

Mr. SHADEGG. Mr. Speaker, I will start here and then come down there and use some of those charts. I would like to pick up on some of the remarks that the gentleman has made. Most importantly, the key factor here is choice. In the gentleman's remarks, he pointed out that most of us, at least most of us in the workforce, those who have a job, if we are lucky enough to have health care at this point in time, if we have health care coverage, we likely get that health care coverage through our employer. That is good, because it means we have health care coverage; and that is an advantage. But there are some tragedies involved in that structure. First of all it means that thousands of Americans, tens of thousands of Americans, indeed 44 million Americans who are uninsured, they do not get the chance to get their insurance through their employer, so many of them do not have any insurance at all. That is not right, and we need to deal with the problem of the uninsured. I think the right way to deal with it is to give them a refundable tax credit and let them go buy an insurance policy that is theirs, that is a portable insurance policy that belongs to them and lets them go buy the health care plan they want. But the other problem with the other half of this structure is those people that get their insurance from their employer. The problem with that structure is we lose all choice. If we work for any employer in America large enough to buy health care insurance, we are offered either one choice or a fairly small list of choices, unless we work for a very, very large employer. I like to talk about Joe Jordan's Mexican food restaurant, which is where my wife, Shirley, and I went on our second date. Joe Jordan and his family did not go into the Mexican food business because they thought they were good at buying health insurance. They went into the Mexican food business because they were good at making and cooking Mexican food. And yet under our structure today, Joe Jordan has to select the health insurance for his employees and they get no choice. Mr. Speaker, we can change that. We could go back to a system where we gave individual people choice in health insurance and let them buy the health insurance that meets their needs. And the key to that would be if the plan they bought did not satisfy their needs, if they went out and bought an HMO because they thought it was the most cost- effective type of care they wanted and that HMO did not service their needs or do a good job by them or their family, they could fire that HMO and go hire another one. The gentleman from Oklahoma said we would not need a patients' bill of rights if health care were a matter of choice, but it is not. We get it through our employers. Earlier this year, I introduced legislation to give people choice, to let them buy a health care plan of their own, or to let their employer give them essentially the right to go buy with his funds their own health care plan. With that kind of choice, we would, as the gentleman said, we would not need a patients' bill of rights. Because if their HMO did not treat them right, they would fire that HMO and they would go buy an HMO that serviced them well and did a good job by them. Just like they do with their auto insurance company or homeowners insurance company or any of the decisions they make in there lives. But we are at the point where we are debating on the floor of this House, we have all year and indeed last year as well, the issue of a so-called Patients' Bill of Rights. I think it is important to talk about the differences and the choices in that legislation and why the bill that passed this floor is so bad and indeed would do damage to health care in America. I would like to do that with the charts down there, so the gentleman and I will trade places. This chart right here kind of shows the fundamental question that faces America on the issues of health care for the working people of America who get a health care plan from their employer. It is a simple, straightforward question, ``Health care in America, who should make the decision?'' You get three choices: HMOs, lawyers, or doctors and patients. I think the answer to that question is very obvious. I think doctors, together with their patients, ought to make medical decisions in America. But it is important to understand how the system works today. The system works today to say doctors and patients do not get to make the choice. No. The system today provides that HMOs make medical decisions; indeed, HMO bureaucrats often make medical decisions. But somebody out there watching might say, well, why are lawyers on this chart? That does not make any sense. I thought it was a battle between HMOs on the one hand and doctors and patients on the other hand. Well, that is what one thinks it should be, but that is not what it is. Because some of the legislation that has gone through this House and the legislation that the President talks about, the legislation that is discussed by our Democrat colleagues, would not leave power in the hands of HMOs. Indeed, it would take power away from HMOs. But, sadly, it would not move that power over to patients and doctors. It would instead move that power to trial lawyers. And that will set health care back rather tragically. Since the gentleman is a doctor, perhaps he would like to comment on that.

Mr. SHADEGG. Mr. Speaker, I simply want to reiterate what you said. The reality is that many people want this very complicated scheme. They want a Norwood-Dingell bill to pass, not because they think that will take care of patients. They understand turning this whole system over to the trial lawyers, taking it away from HMOs, but not giving it to doctors, but rather giving it to trial lawyers, they understand that that will drive costs dramatically through the roof. But that is not against their goal, because their goal is to have the current HMO system, to have the current health care system fail, and then to force America to turn to a single payer, Hillary-Care, one- system-fits-all, the Federal Government runs the health care system- type program. I believe that will be a tragic flaw for this Nation. If we go to a flawed system that lets trial lawyers circumvent independent doctors making the decision, if we do not give patients the right to choose their own doctor, the net result is that costs will go through the roof and we will get to a single-payer system. I want to thank the gentleman for allowing me to participate in this Special Order. It is important that our colleagues saw the flaw in this current patients rights legislation. I hope they will join us in passing legislation that would give people choice. Let them hire and fire their health care plan, the way they hire and fire their auto insurance plan or their homeowner's insurance plan, or, for that matter, the way they decide where they live or what brand of shoes or coats to buy. Give people choice, and they will take care of themselves.

Mr. SHADEGG. I take it instead what we are proposing is yet another Government program to pay for prescription drugs and to subsidize the cost of those drugs. I wholeheartedly agree with the gentleman that the answer to the problem is choice. Let patients have choice. Unfortunately, as is often the case, that is not in the debate in Washington right now. The debate as we enter the last 10 days of this political campaign is a debate over the failure of the United States Congress to deliver patient rights legislation and to pass what has now, I guess, become famous, since it was referred to by the Vice President in one of the debates, as the Dingell-Norwood or Norwood-Dingell bill, and that is the debate here. Often we debate issues, and we are way behind the marketplace. The American people are ahead of us. That has become a political issue. Why has the Congress not passed Norwood-Dingell? The answer that we hear is, well, you cannot get through the Senate; there is a terrible problem with it. It is a vitally important piece of legislation for the American people. As we kind of close out this discussion tonight, I think it is important to be sure that people understand that it is not a lack of resolve to take care of patients and doctors. The gentleman and I wrote a bill over a year ago, a patients' rights bill, because of this debate that has occurred in America, because of the abuses caused by HMOs; but that bill empowered doctors and patients to make health care decisions. That bill said, as this flowchart I just showed illustrated, that every single case, every single case, where an HMO turned down somebody's doctor and said, no, you are wrong, the patient does not need that care, 100 percent of those cases would go quickly through initial claim, internal review and straight to an external review panel of three doctors. Those three doctors had to be practicing physicians, a provision the gentleman insisted on. We did not want physicians who had not practiced in 20 years telling physicians currently practicing what they should be doing. We wanted physicians practicing right then. They had to have expertise in the area. Those three doctors would say, Plan, you are dead wrong. When you denied that care that the treating physician said was necessary and you said you would not pay for it, you were wrong. That care should occur and occur now. Under our legislation, people would be able to not only get the care, but sue for the damages. One of the things that made me angry in this debate is the current system in America says if an HMO governed by this Federal law called ERISA we are trying to amend, by their negligence, if they injure or kill someone, there is no recovery. I have talked on the floor of this House about the tragic case of Florence Corcoran, whose baby was killed by a negligent decision by an HMO, and the Federal courts interpreting the current law said, we are terribly sorry, Mr. and Mrs. Corcoran, your baby was killed by the negligent decision of United Health Care; but under our law, you recover nothing. The legislation we want to past will address this problem. If we cannot get to choice and freedom, we will say 100 percent of those cases go to a panel of three doctors. Mr. and Mrs. Corcoran would have gotten in front of three doctors, had a speedy decision. We would have set the standard of care, the baby would probably not have died, and the lawsuit would not be necessary. The Dingell-Norwood bill, the bill that Vice President Al Gore said that America deeply needs, does not do that. It does not take the case to a panel of doctors; it takes the case straight into a courtroom, so that a trial lawyer can get rich. I am not against trial lawyers. I believe in the tort system. I think when there has been an injury, they ought to recover. I wish the lawyer representing the Corcorans had won. They deserved to win. They deserved to recover. That is not the answer that gets people care. The answer that gets them care gets them first to a review by an independent panel of doctors to say what care should be delivered. Then, if there has been a bad decision, there has been injury, then let it go to court. But do not destroy the system by letting it go straight to court and letting trial lawyers decide what the standard of care is.

Mr. SHADEGG. We have talked about the flaw in the Norwood-Dingell bill which would allow a trial lawyer to step in, circumvent external review, take the power to set the standard of care away from doctors and take that decision to a courtroom, and why we think that is a bad idea here. Maybe we ought to talk about some of the other trade-offs that are going on here. It is absolutely true that there are about 13 individual patient protections in the legislation, and I support those patient protections. They include things like the right of a woman to have an OBGYN as her primary care physician; the right of patients like my wife, Shirley, and I to have a pediatrician as our child's primary care physician; the right of all of us to go to an emergency room even if it is not an emergency room signed up with our HMO and get care. And each of those are important rights, but only important rights as long as we are trapped in a system where we cannot fire our HMO and hire one we want. The reality be known, we would not need, as the gentleman has said, a patients' bill of rights. We would not need this complicated flow chart. We would not need to bring trial lawyers into the whole discussion. We would not need to be talking about cutting out the ability of doctors to set the standard of care if, as a matter of right, we could go as individuals, as employees of a company, and say, you know what, I do not want the HMO you picked for me. I want to go buy a plan that I can hire, a plan that I can fire, a plan that has already in it, and I get to pick it and I get to sign up for it, the right of my wife to see an OBGYN of her own choice; the right of she and I to pick a pediatrician as a primary care physician for our children; our right to go to an emergency room of our choice. If we had that kind of freedom, then we clearly would not need not only the liability scheme in this flawed Dingell-Norwood legislation, we would not need the patient protections. Sadly, that is not where we are. We are debating yet one more massive government scheme to try to regulate the marketplace.

Mr. SHADEGG. They are talking about a bureaucratic Government program that tries to mandate something from Washington, D.C., and I could not agree more with the gentleman. As the gentleman knows, I have introduced legislation that would let people choose their own health care. Indeed, the legislation we introduced would say to an employee, whether they worked for Joe Jordan's Mexican Food, the one I talked about, the Mexican food restaurant in Phoenix, Arizona, or whether they worked for a large employer, Caterpillar Tractor, General Motors, whoever it was, would let that individual employee exercise choice so that they could hire or fire their health insurance plan based on their own decision, not their employer's decision. I think, in discussing this issue, it is important to note that the current Federal Tax Code allows employers to give employees health insurance, and they are not taxed on that benefit. That is the reason that most people get their health care from their employer. If their employer gives them an extra thousand dollars, they pay taxes on that thousand dollars and they give somewhere around a third of it to 50 percent of it to the Federal or the State or the local government in income taxes. On the other hand, if their employer simply hands them a health care benefit worth a thousand dollars, they get that full thousand dollars in value. The plan we are talking about, giving people choice to go buy the plan they want, actually is allowed under the current Tax Code. Under the current Tax Code, your employer can say to you, I am going to give you the $1,000 dollars or the $500 or the $1,500 or the $2,000 that I spend on your health care and as long as you go spend that on health care and confirm that fact back to your employer, it is not income to you and it is still a deduction to your employer. So we can move to a choice system. We can give people freedom if American employers will simply do it.