RULES OF THE SENATE VERY WELL. AND THE PROPOSAL OF THE MAJORITY
           LEADER WAS PROPOUNDING IS VERY FAIR. THE SENATOR FROM
           CALIFORNIA WANTS A VOTE ON HER AMENDMENT, I'LL BE VERY FRANK,
           THE WAY SHE CAN GET A VOTE ON HER AMENDMENT IS TO MOVE FORWARD
           AND ACCEPT THE OFFER ALREADY MADE. SHE CAN OFFER HER AMENDMENT,
           FOR EXAMPLE, AS A SECOND-DEGREE AMENDMENT. YOU CAN GET A VOTE
           ON YOUR AMENDMENT. SO I AM TRYING TO TELL YOU THE WAY TO DO IT
           IS NOT ON AN APPROPRIATION BILL. THE SENATOR FROM IDAHO IS
           CORRECT. WE SHOULDN'T BE DOING THIS ON APPROPRIATION BILL AND

           EVERYBODY IN HERE KNOWS IT. EVERYBODY KNOWS IT. THIS IS NOT THE
           WAY TO LEGISLATE IT. AND WE OUGHT TO BE ABLE TO MANAGE THE
           NATION'S BUSINESS IN AN APPROPRIATE MANNER. AND COMING UP WITH
           PATIENTS' BILL OF RIGHTS SAYING WELL WE ARE GOING TO DO THIS
           PIECE BY PIECE WE HAVE 40 PIECES AND WE ARE GOING TO DO IT ON
           VARIOUS BILLS, BILLS THAT ARE GOING TO GO TO CONFEREES,
           CONFEREES THAT NO ABSOLUTELY NOTHING ABOUT THIS ISSUE, NEVER
           HAD A HEARING ON THIS ISSUE, NEVER DEALT WITH THIS ISSUE AND
           ASK THEM TO LEGISLATE ON IT IS WRONG. AND IT IS NOT GOING TO

           HAPPEN. IT IS NOT GOING TO PASS. IT IS NOT GOING BECOME LAUCH.
           WE ARE WASTING OUR TIME. I THINK THERE WAS A PROPOSAL OUT
           THERE, I WILL TELL MY FRIEND AND COLLEAGUE FROM CALIFORNIA
           THERE IS A PROPOSAL THAT FRANKLY IF YOU ARE GIVEN FOUR DAYS AND
           GIVEN SOME AMENDMENTS AND IT IS NOT ANYBODY INTENTION ON THIS
           SIDE TO FILIBUSTER, TO DENY YOU THAT OPPORTUNITY, AND YOU COULD
           HAVE THE OPPORTUNITY, YES, QUITE LIKELY THERE WILL BE
           AMENDMENTS THAT WILL BE OFFERED IN THE SECOND DEGREE, BUT A LOT
           OF AMENDMENTS WON'T BE OFFERED IN THE SECOND DEGREE AND
           LIKEWISE SECOND-DEGREE AMENDMENTS ARE AVAILABLE TO BOTH SIDES.
           I MEAN THAT SHOULD BE VERY APPARENT. AND SO THE POINT BEING, I

           AM A LITTLE FRUSTRATED AND PEOPLE SAYING WE ARE NOT BEING
           TREATED FAIRLY, YOU HAVE BEEN OFFERED A MOST GENEROUS PROPOSAL
           WHERE YOU COULD OFFER LOTS AND LOTS OF AMENDMENTS. LOTS AND
           LOTS OF AMENDMENTS. AND GET VOTES ON THOSE AMENDMENTS. AND IT
           DOESN'T TAKE A LEGISLATIVE GENIUS TO MAKE THAT HAPPEN. AND SO I
           WOULD ENCOURAGE OUR COLLEAGUES TO SAY LET'S SEE IF WE CAN'T
           WORK TOGETHER AND MAKE THIS HAPPEN INSTEAD OF SAYING WELL, WE
           ARE GOING TO INSIST AND I AM GOING TO START OFFERING THIS PIECE
           BY PIECE ON AG APPROPRIATION BILL, EVEN THOUGH WE KNOW IT IS

           NOT GOING TO BECOME LAW. I JUST THINK THAT THERE IS A RIGHT WAY
           TO LEGISLATE, THIS IS NOT THE RIGHT WAY TO LEGISLATE, AND I
           WOULD HOPE THAT WE WOULD WORK TOGETHER TO COME UP WITH
           SOMETHING THAT'S ACCEPTABLE. I THINK THAT THERE HAS BEEN MORE
           THAN A GENEROUS PROPOSAL PUT OUT ON OUR SIDE, AND WE HAVE BEEN
           AMENDING IT FOR THE LAST TWO DAYS TRYING TO ACCOMMODATE
           LEGITIMATE CONCERNS. SOMEBODY SAID WELL, ORIGINALLY IT WAS
           THREE HOURS OFTEN EACH AMENDMENT. AND SOME PEOPLE SAY WE
           SHOULDN'T HAVE ANY LIMIT ON DEBATE ON AMENDMENTS. I HAPPEN TO

           THINK THAT THAT'S PROBABLY CLOSER TO CORRECT WHEN YOU CONSIDER
           THE MAGNITUDE AND SCOPE OF SOME OF THESE AMENDMENTS. SO I WOULD
           JUST URGE OUR COLLEAGUES TO STEP BACK AND MAYBE LOWER THE
           RHETORIC AND NOT QUITE GET SO EXERCISED AND SEE IF WE CAN'T
           COME UP WITH APPROPRIATE LEGISLATIVE WAY TO SOLVE THIS PROBLEM
           AND SEE IF QUESTION CAN'T COME UP WITH A LEGITIMATE, POSITIVE
           LEGISLATIVE APPROACH THAT WILL HELP SOLVE SOME OF THE PROBLEMS
           THAT HAVE BEEN ACKNOWLEDGED WITHOUT HAVING DRAMATIC INCREASES

           IN CONSUMER COST, AND INCREASES IN THE NUMBER OF PEOPLE WHO ARE
           UNINSURED. I WOULD LIKE TO SEE US DO THAT. FRANKLY, I THINK
           WHEN THE HOTTER THE RHETORIC GETS THE LESS LIKELY THAT IS TO
           HAPPEN. AND WE NEED TO WORK TOGETHER IN ORDER TO MAKE REAL
           POSITIVE LEGISLATION HAPPEN. IT IS NOT OWE TO DEMOCRATS ALONE
           ARE NOT GOING TO PASS LEGISLATION, REPUBLICANS ALONE WILL NOT
           PASS LEGISLATION, NOTHING IS GOING TO BECOME LAW IF IT IS
           STRICTLY PARTY AND SO PARTISAN. SO I MAKE THAT COMMENT. I WOULD
           URGE MY COLLEAGUES, LET MAYBE STEP BACK A LITTLE BIT AND LOOK

           AT SOME OF THESE UNANIMOUS CONSENT REQUESTS AND SEE IF WE CAN
           FIND AN APPROPRIATE VEHICLE AND MANNER TO LEGISLATE ON THIS

           IMPORTANT ISSUE. YIELD THE FLOOR. MRS. FEINSTEIN: MR. PRESIDENT?
           
           

           THE PRESIDING OFFICER: THE SENATOR FROM CALIFORNIA.
           

           MRS. FEINSTEIN: I THATCH THE CHAIR. I WOULD LIKE TO HAVE AN
           OPPORTUNITY TO RESPOND TO THE DISTINGUISHED SENATOR. I WAS
           GOING TO SAY THE DIFFICULT SENATOR, BUT I MEAN THE
           DISTINGUISHED SENATOR FROM OKLAHOMA. AND I FEEL CAUGHT ON THE
           HORNS OF A DILEMMA. ON ONE HAND, WHAT I AM SEEING IS THIS IS
           NEVER GOING TO HAPPEN ON AN AG APPROPRIATIONS BILL. ON THE
           OTHER HAND WHAT I AM HEARING IS, YOU HAVE GOT AN OFFER TO OFFER
           YOUR AMENDMENT, IT WILL BE SECOND DEGREED, IT WILL BE DEFEATED,
           THERE WON'T BE A REAL OPPORTUNITY TO HAVE AN UP-OR-DOWN VOTE ON

           THE AMENDMENT. OUR LEADER, I BELIEVE, IS WILLING TO COME TO A
           REASONABLE AGREEMENT WHEREBY THE MAIN POINTS OF THE PATIENTS'
           BILL OF RIGHTS CAN BE DEBATED ON THE FLOOR WITH AN AGREEMENT
           THAT AMENDMENTS BE VOTED UP OR DOWN WITHIN A CERTAIN PERIOD OF
           TIME, BUT HE IS VERY ASTUTE. I DON'T THINK HE WANTS US TO FIND
           OUT THAT SOMEONE COMES ON THE FLOOR, TAKES UP ALL THE TIME,
           THERE IS NO OPPORTUNITY FOR AN UP-OR-DOWN VOTE ON THE

           AMENDMENTS, THERE IS ONE VOTE EN BLOC, AND THEN THE MAJORITY
           LEADER CAN COME ON THE FLOOR AND UNDO IT ALL AFTER IT IS OVER.
           SO WHAT WE ARE ASKING FOR -- AND MAYBE NOW IS AS GOOD A TIME AS
           ANY -- YOU KNOW, I HAVE LEARNED IN THIS THERE ARE TIMES WHEN
           YOU GO TO THE WALL, AND THERE ARE TIMES WHEN YOU DON'T GO TO
           THE WALL. AND IT IS IMPORTANT TO KNOW THE DIFFERENCE IN THE
           TIMING. LET ME GIVE YOU ONE STORY THAT HAPPENED AT UCLA WHICH

           IS WHY I FEEL SO STRONGLY ABOUT THIS SENATE PASSING LEGISLATION
           THAT PREVENTS ARBITRARY INTERFERENCE WITH A PHYSICIAN'S
           TREATMENT AND THE SETTING OF THAT TREATMENT. IN OTHER WORDS,
           THE HOSPITAL LENGTH OF STAY. LET ME GIVE YOU ONE EXAMPLE, AND
           IF THE SENATOR WANTS I CAN GIVE YOU THE DOCTOR'S NAME AND YOU
           CAN VER NIGH IT. BUT THIS IS ABOUT A NEWER SURGEON WHO
           PERFORMED SURGERY TO REMOVE A BRAIN TUMOR AT UCLA MEDICAL
           CENTER. THE PATIENT'S MANAGED CARE PLAN COVERED ONE DAY IN THE

           INTENSIVE CARE UNIT. AFTER THAT DAY, THE PATIENT HAD UNEVEN
           BREATHING AND FLUX WAITING BLOOD PRESSURE AND HEART RATE. THE
           DOCTOR WANTED HER TO STAY IN THE HOSPITAL ANOTHER DAY FOR
           MONITORING. THE H.M.O. UTILIZATION REVIEW NURSE CONSULTED THE
           GUIDE BOOK THAT SAID ONLY ONE DAY WAS ALLOWED IN THE I.C.U. SO
           SHE DENIED THE EXTRA DAY. THE DOCTOR FELT IT WOULD BE MEDICALLY
           UNETHICAL TO MOVE THE PATIENT OUT OF THE I.C.U. SO HE KEPT HER

           THERE. THE NEXT DAY THE H.M.O. CALLED AGAIN AND SAID THAT THE
           COST OF THE SECOND DAY WOULD BE DEDUCTED FROM THE SURGEON'S
           FEE. THAT'S THE KIND OF THING THAT'S HAPPENING. WE'VE GOT TO
           PUT AN END TO IT, BECAUSE THE RESULT IS GOING TO BE TERRIBLE
           FOR THE PRACTICAL OF MEDICINE. YOU ARE NOW HAVING DOCTORS
           VOTING TO UNION EYES, TO COLLECTIVELY BARGAIN -- I KNOW SOME
           PEOPLE HAVE SAID WITH SOME KIND OF DISDAIN, OH, THAT'S JUST

           OVER THEIR WAGES. I AM HERE TO SAY IT ISN'T. MY OWN DOCTOR,
           GREAT MOUNT ZION MEDICAL CENTER NOW PART OF THE UNIVERSITY OF
           CALIFORNIA, AFTER 30 YEARS OF PRACTICE, SAYS HE HAS NEVER BEEN
           SO DISILLUSIONED, NEVER BEEN SO DISAPPOINTED, NEVER -- HE SAID
           THE MORALE IS SO LOW, OF DOCTORS BEING COUNTERMANDED ALL OF THE
           TIME BY MEDICAL PLANS, HAVING TO HASSLE TO GET A DRUG APPROVED,
           USING THIS KIND OF DISINCENTIVE THAT IF YOU BELIEVE A PATIENT

           BELONGS IN I.C.U. AFTER BRAIN SURGERY FOR AN ADDITIONAL DAY, WE
           ARE GOING TO DEDUCT IT FROM YOUR FEE. NOW WHAT KIND OF A
           PRACTICE OF MEDICINE IS THAT?
           SO THESE ARE BIG ISSUES, SENATOR, BECAUSE IN MY VIEW THEY ARE
           LIFE OR DEATH ISSUES. AND WE HAVE A CHANCE TO ADDRESS IT. I'M
           HAPPY -- I DON'T WANT TO LEGISLATE ON AN AGRICULTURE
           APPROPRIATIONS BILL. BUT ON THE OTHER HAND, I MEANEY BELIEVE TO

           THE DEPTH AND BREADTH AND HEIGHT OF ME IN THIS AMENDMENT AND
           OTHER COLLEAGUES HAVE OTHER AMENDMENTS. THE TIME HAS COME TO
           HAVE A DEBATE ON THE ISSUE. OUR LEADER WILL NEGOTIATE A FAIR
           AGREEMENT. AND SO I REALLY THINK THAT IT IS IN YOUR HANDS. WE
           WANT AN UP-OR-DOWN VOTE ON THESE AMENDMENTS. THIS ISN'T AN
           AMENDMENT THAT'S JUST BEEN QUICKLY BUDGET TOGETHER FOR WHAT
           SOMEONE MIGHT SAY IS POLITICAL PURPOSE. THIS AMENDMENT HAS BEEN

           WORKED ON, ET CETERA' BEEN VETTED, IT IS SUPPORTED BY 200
           ORGANIZATIONS, AND IT IS SUPPORTED BY EVERY SINGLE MEDICAL
           ORGANIZATION IN THIS COUNTRY. NURSES, AMERICAN CANCER SOCIETY,
           AMERICAN HEART ASSOCIATION, AMERICAN LUNG ASSOCIATION,
           ACROSS-THE-BOARD. NO ONE SHOULD HAVE TO BE AFRAID TO KEEP A
           PATIENT FOLLOWING BRAIN SURGERY IN INTENSIVE CARE FOR AN EXTRA
           DAY, AND THE GALL OF THE HEALTH INSURANCE PLAN TO SAY OKAY, WE

           ARE DEDUCTING IT FROM THE DOCTOR'S FEE. AND I WOULD HOPE THAT
           YOU WOULD HAVE SOME REACTION TO THIS, BECAUSE I KNOW THAT'S NOT
           THE WAY YOU WOULD WANT TO SEE MEDICINE PRACTICED IN THIS
           COUNTRY, AND I COULD GO ON AND ON AND ON, PERHAPS BECAUSE MY
           STATE IS SUCH A BIG MANAGED CARE STATE, THERE ARE SO MANY
           EXAMPLES, THEY NEED TO BE STOPPED. AND THERE IS NO BETTER TIME
           THAN RIGHT NOW. AND ALL WE NEED IS AN AGREEMENT THAT CAN ALLOW

           SOME AMENDMENTS UP TO OUR LEADERS, UP-OR-DOWN VOTE, AND PREVENT
           THE OPPORTUNITY FROM SIDE TRACKING THAT UP-OR-DOWN VOTE. AT THE
           END OF IT I THINK WE WILL HAVE SOMETHING. I THINK SENATOR
           KENNEDY IS ABSOLUTELY RIGHT. I REMEMBER THE WRANGLING OVER
           KENNEDY-KASSEBAUM, AND THEN FINE HI, BINGE GO, IT JUST GOT
           DONE. I THINK THAT'S WHAT WE ARE ASKING FOR NOW. I THINK THAT'S
           WHAT THE PEOPLE OF AMERICA ARE ASKING FOR NOW AS WELL. I YIELD

           THE FLOOR. MR. NICKLES: MR. PRESIDENT?
           
           

           THE PRESIDING OFFICER: THE SENATOR FROM OKLAHOMA.
           

           MR. NICKLES: I APPRECIATE MY COLLEAGUE FROM CALIFORNIA'S
           COMMENTS. YOU MENTIONED TIME BEING. I DON'T THINK THE TIME IS
           NOW. I DON'T THINK IT IS ON THE APPROPRIATION BILL. I THINK WE
           HAVE BEEN PRETTY STRAIGHTFORWARD IN SAYING WE WILL GIVE YOU A
           FEW DAYS AFTER THE FOURTH OF JULY BREAK. BASICALLY THAT MEANS
           WE WILL BE WORKING ON OTHER APPROPRIATION BILLS, IT MEANS THE
           FOLLOWING WEEK WE WILL WORK ON PATIENTS' BILL OF RIGHTS. I WILL
           JUST TELL MY COLLEAGUE, I CAN EASILY TELL YOU AND ANYBODY ELSE,
           YOU CAN ORCHESTRATE A WAY TO GET A VOTE ON YOUR AMENDMENT. IT

           CAN BE DONE. YOUR AMENDMENT CAN BE A SECOND DEGREE AMENDMENT. I
           WILL TELL MY COLLEAGUE THAT. AND I HAVE ALREADY STATED WE CAN
           LIMIT THE AGREEMENT TO ONE SECOND-DEGREE AMENDMENT, INSTEAD OF
           TWO. SO THERE ARE MANY OF US WILLING TO DO IT. THE WAY NOT TO
           DO IT IN MY OPINION IS PIECEMEAL ON 20 DIFFERENT LEGISLATIVE
           ITEMS. SOME ON THIS APPROPRIATION BILL, SOME ON THIS
           APPROPRIATION BILL, KNOWING THOSE APPROPRIATORS ARE GOING TO GO
           INTO CONFERENCE AND SAY WHAT ARE WE GOING TO DO WITH MEDICAL
           NECESSITY. WE DON'T KNOW WHAT THAT IS. I APPRECIATE THE FACT

           YOU MENTION A BRAIN SURGEON SAYS THE PATIENT SHOULD STAY IN A
           DAY LONGER AND SOME MANAGED CARRIED YACHT SAID OR BUREAUCRAT
           SAID NO. I DON'T HAPPEN TO THINK THE LEGISLATIVE SOLUTION
           PROPOSED IN YOUR LEGISLATION IS THE RIGHT FIX. I HAPPEN TO
           THINK A BETTER IDEA WOULD BE TO GIVE AN INTERNAL APPEAL THAT
           WOULD BE DONE IMMEDIATELY. IT CAN BE APPEALED. AND IF IT IS NOT
           OVERTURNED, THE EXAMPLE YOU CITED I THINK IT WOULD BE
           OVERTURNED IMMEDIATELY, AND IF NOT DONE IMMEDIATELY IT CAN BE
           DONE BY EXTERNAL APPEAL. EXTERNAL APPEAL DONE BY OUTSIDE PEER

           REVIEW EXPERTS, POSITIVE. DON'T HAVE TO GO TO COURT. DON'T HAVE
           TO SUE. YOU HAVE IMMEDIATE CHANGE. I THINK THAT WOULD BE A
           BETTER PROCESS. BUT MY POINT; AS FAR AS PROCESS IS CONCERNED
           NOW, WE SHOULDN'T BE DEBATING THIS NOW ON AN LEGISLATIVE
           APPROPRIATIONS BILL. I THINK WE HAVE OFFERED BY SAYING A FEW
           DAYS BEGINNING ON JULY 12, IS MORE THAN GENEROUS. I WILL BE
           HAPPY TO TRY TO BE FLEXIBLE IN FURTHER NEGOTIATIONS, BUT I
           THINK THE GIVE IS JUST ABOUT GIVEN WHEN YOU LOOK AT WE ONLY

           HAVE ABOUT EIGHT WEEKS TO LEGISLATE BEFORE THE END OF THE
           FISCAL YEAR. I THINK THE MAJORITY LEADER HAS BEEN VERY, VERY
           GENEROUS. I WOULD WORK WITH MY COLLEAGUE TO SEE IF WE CAN'T
           COME TO A CONSTRUCTIVE CONCLUSION. I APPRECIATE HER WILLINGNESS
           TO DO SO. MR. PRESIDENT, I YIELD THE FLOOR.
           

           A SENATOR: WILL THE SENATOR YIELD FOR A QUESTION?
           
           

           MR. NICKLES: YES.
           

           MR. SCHUMER: I THANK THE SENATOR AND APPRECIATE EVERYTHING HE
           SAID AND THE GRACIOUSNESS WITH WHICH HE SAID IT. I GUESS I
           WOULD JUST MAKE TWO POINTS IN TERMS OF MY QUESTION. AS I -- AND
           I AM A FRESHMAN HERE, I AM WELL-FAMILIAR WITH THE PROCESS OF
           THE HOUSE, THAT'S SOMETHING I WISH TO ESCAPE. THAT'S ONE OF THE
           REASONS I RAN FOR THE SENATE. AND THE REASON WAS THAT WE COULD
           NOT DEBATE, AT ANY TIME, APPROPRIATIONS BILLS, AUTHORIZATION
           BILLS, WITHOUT REALLY THE CONSENT OF THE RULES COMMITTEE WHICH

           WAS CONTROLLED BY THE SPEAKER 11-5, WE COULDN'T GET ANYTHING
           DONE. BUT FROM WHAT I UNDERSTAND JUST LISTENING TO MY
           COLLEAGUES AND BEING HERE MYSELF, THIS IS SORT OF BEEN LIKE A
           PRESSURE COOKER. AND ON BILL AFTER BILL, THE BILLS THAT WE HAD
           DONE, INSTEAD OF BEING OFFERED THE CHANCE TO OFFER AMENDMENTS,
           WE DID SOME AUTHORIZING BILLS, BUT THAT ON A GOOD NUMBER OF
           THEM, Y2K, FOR INSTANCE, THE TREE WAS FILLED. IN OTHER WORDS,
           THAT THE MAJORITY LEADER WOULD INTRODUCE AN AMENDMENT, AND THEN

           PUT ON A SECOND-DEGREE AMENDMENT. AND THEN ANOTHER AMENDMENT
           AND PUT ON A SECOND-DEGREE AMENDMENT. AND SO WE WERE NOT
           PERMITTED TO SAY ADD A FEINSTEIN AMENDMENT. OR AN AMENDMENT
           THAT I HOPED TO OFFER ABOUT SCOPE. OR OTHER AMENDMENTS AS WELL.
           AND THAT THE FRUSTRATION ON OUR SIDE MOST OF I BEGAN TO HEAR MY
           COLLEAGUES WHO HAVE BEEN HERE MANY MORE YEARS LONGER THAN I
           HAVE BEEN, START SAYING THAT THIS IS JUST LIKE
{END: 1999/06/24 TIME: 17-30 , Thu.  106TH SENATE, FIRST SESSION}