OPINION GIVEN TO US THAT EXONERATES --
           

           MR. EDWARDS: WHAT HARM WOULD IT BE TO DO IT?
           
           

           MR. JEFFORDS: WE BELIEVE WHAT WE HAVE IS ABSOLUTELY PROTECTION
           FOR THE PATIENT. AND NOT ONLY THAT, ESTABLISHES A NEW NATIONAL
           STANDARD WHICH YOURS DOES NOT. YOU ARE USING "GENERALLY
           ACCEPTABLE PRACTICES," WHICH IS A MUCH LOWER STANDARD. WE
           ESTABLISH A HIGHER STANDARD THAT EVERY PATIENT IS ENTITLED TO
           THE BEST MEDICAL CARE WHICH IS NECESSARY AND APPROPRIATE.
           THAT'S A NEW STANDARD. THAT'S WHY DOCTORS ARE CONCERNED. THEY
           HAVE TO REACH A NEW STANDARD.
           

           MR. EDWARDS: AND WANT CONTROL OF MY TIME. IF THAT'S TRUE, WHY
           DO YOU HAVE ANY OBJECTION TO A SIMPLE SENTENCE IN THIS
           AMENDMENT THAT SAYS DENIAL OF SERVICES UNDER ANY OF THOSE AREAS
           IS DIRECTLY APPEALABLE TO AN INDEPENDENT BODY, DO YOU OBJECT TO THAT?
           
           

           THE PRESIDING OFFICER: WHO IS YIELDING TIME.
           

           MR. JEFFORDS: ITSELF IT'S NOT IN THE BILL WHY SHOULD I PUT IT
           IN?
           
           

           THE PRESIDING OFFICER: THE SENATOR FROM NEVADA.
           

           MR. REID: SENATOR KEN AT THIS MADE THE SAME OFFER, WE HAVE BEEN
           THROUGH THIS BEFORE. OUR LEGISLATION SAYS THAT ANYTHING AS SET
           FORTH BY THE SENATOR FROM NORTH CAROLINA IS APPEALABLE. SIMPLE
           AS THAT. IT IS APPEALABLE. THEY ARE DEPENDING UPON A LEGAL
           OPINION FROM SOME INSURANCE LAWYER. WE ARE NOT WILLING TO DO
           THAT. WE WANT APPEALABLE AS PART OF THE LEGISLATION. THEY ARE
           UNWILLING TO DO THAT FOR OBVIOUS REASONS BECAUSE THEIR
           LEGISLATION IS DICTATED BY THE INSURANCE COMPANIES. I WOULD
           ALSO SAY, MR. PRESIDENT, THAT THERE WAS -- THE MAJORITY LEADER

           TODAY BRAGGED ABOUT ONE OF HIS MEMBERS, I WOULD LIKE TO BRAG
           ABOUT ONE OF OUR MEMBERS. WE HAVE JOHN EDWARDS, A NEW SENATOR
           FROM THE STATE OF NORTH CAROLINA, WHO HAS RELATED THE INJURED
           THE MAIMED AND WRONGFULLY KILLED FOR MANY YEARS. HE IS ONE OF
           THE PROMINENT ATTORNEYS IN THE UNITED STATES. ONE OF THE FINEST
           REPRESENTATIVES OF PROTECTED THE RIGHTS OF THE OPPRESSED AND --
           OPPRESSED AND INJURED. THAT SHOULD BE SPREAD ACROSS THE RECORDS
           OF THIS SENATE. WE HAVE HEARD SOME PEOPLE BOASTING ABOUT
           MEMBERS ON THE OTHER SIDE. WE HAVE ONE. FINEST LAWYERS IN

           AMERICA NOW A MEMBER OF THE UNITED STATES SENATE. WE ARE VERY
           PROUD OF THAT. I THINK HE HAS MADE A VERY CLEAR CASE THAT THE
           REASON THAT THEY ARE UNWILLING TO AGREE TO HIS SIMPLE WORDS, IT
           IS APPEALABLE, IS BECAUSE THEY DON'T WANT IT APPEALABLE. THEY
           KNOW IT IS NOT APPEALABLE. MR. PRESIDENT, WOULD THE CHAIR
           INDICATE TO THE SENATOR HOW MUCH TIME THE MINORITY HAS LEFT ON
           THIS AMENDMENT?
           
           

           THE PRESIDING OFFICER: THE MINORITY HAS 26 MINUTES, 11 SECONDS
           REMAINING.
           

           MR. REID: I YIELD FIVE MINUTES TO THE SENATOR FROM RHODE
           ISLAND, SENATOR REED.
           

           THE PRESIDING OFFICER: THE SENATOR FROM RHODE ISLAND.
           
           MR. REED:, THANK YOU, MR. PRESIDENT. I RISE IN STRONG SUPPORT
           OF THE BINGAMAN AMENDMENT AND HARKIN AMENDMENT AND ALL OF MY
           COLLEAGUES WHO ARE SUPPORTING THIS. THIS AMENDMENT IS
           PARTICULARLY RESPONSIVE TO THE NEEDS OF CHILDREN IN THE HEALTH
           CARE SYSTEM. THAT'S WHY IT HAS BEEN ENDORSED BY THE CHILDREN
           DEFENSE FUND. WE FIND WHEN WE LOOK AT ACCESS TO PEDIATRIC
           SPECIALISTS, CHILDREN DON'T HAVE THAT KIND OF ACCESS. AS A
           RESULT, THEY ARE THE ONES WHO WILL SUFFER THE MOST, I BELIEVE,

           IF WE DO NOT HAVE STRONG EXPLICIT LANGUAGE GIVING THE RIGHT TO
           ACCESS TO PEDIATRIC SPECIALISTS. NOW THERE WAS A SURVEY DONE IN
           1992 BY "PEDIATRICS MAGAZINE," AND THIS SURVEY INDICATED THAT
           OF THE PEDIATRICIANS THAT WERE ASKED, 35% REPRESENTED THAT THEY
           FELT THEIR PATIENTS HEALTH -- PATIENT'S HEALTH OUTCOME WAS
           SEVERELY UPSET BY DENIAL OF ACCESS TO PEDIATRIC SPECIALISTS.
           THEY FOUND THIS WAS ALL TOO COMMON. CHILDREN, PARTICULARLY

           CHRONIC ILLNESSES, THEY MUST BE SPECIALISTS. IT MUST BE CLEAR.
           IT MUST NOT BE TYPE OF VERY AMBIGUOUS LANGUAGE AS WE FIND IN
           THE REPUBLICAN VERSE. LEGISLATION. NOW LET ME SUGGEST ANOTHER
           AREA WHEN IT COMES TO CHILDREN WHERE ACCESS TO SPECIALISTS IS
           ACTIVE. I HAVE A LETTER FROM PAUL L. SHNURER, PRESIDENT OF THE
           AMERICAN SOCIETY OF PLASTIC AND RECON STRUB ACTIVE SURGEONS. HE
           POINTS OUT THAT APPROXIMATELY 7% OF AMERICAN CHILDREN ARE BORN
           WITH PEDIATRIC DEFORMITIES AND CONGENITAL DEFECTS. SUCH AS

           BIRTH MARKS, CLEFT LIP, CLEFT PALETTE, ABSENT INTERNAL EAR AND
           EVEN MORE PROFOUND FACIAL DEFORMITIES AND YET EVEN IN THESE
           COMPELLING CIRCUMSTANCES, HE REPORTS THAT IT IS VERY DIFFICULT
           TO GET A REFERRAL FLORIDA A MANAGED CARE PLAN TO A SPECIALIST.
           IT IS PROBABLY EVEN MORE OWE TO FROM A MANAGED CARE PLAN TO A
           SPECIALIST AND IT IS PROBABLY MORE DIFFICULT TO GET A REFERRAL
           TO A PEDIATRIC SPECIALIST. OF THOSE HE DISCUSSED WITH THAT

           INDICATED THEY HAD TROUBLE GETING REFERRALS, 74% HAD PATIENTS
           DENIED FOR INITIAL PROCEDURE, 53% HAD COVERAGE DENIED FOR
           SUBSEQUENTLY PROCEDURES. WHAT U# SEE AS ACCESS TO SPECIALISTS
           IS DIFFICULT FOR CHILDREN, ACCESS FOR PEDIATRIC SPECIALISTS IS
           EXTRAORDINARILY DIFFICULT FOR CHILDREN, AND UNLESS WE DO
           SOMETHING ABOUT THIS, WE ARE GOING TO FIND A SITUATION WHERE
           CHILDREN WILL BEGIN AGAIN AND AGAIN BE SHORT-CHANGED BY THE
           MANAGED CARE SYSTEM. NOW, THE REPUBLICANS HAVE SAID LISTEN, WE

           HAVE GOT SOMETHING IN HERE THAT SAYS IT IS AGE-SPECIFIC, AND WE
           HAVE A GREAT DEAL OF RESPECT AND ESTEEM FROM OUR COLLEAGUE FROM
           TENNESSEE WHO IS A PHYSICIAN, AND I SUSPECT IF HE WAS MAKING
           THESE DECISIONS ABOUT REFERRALS TO SPECIALISTS, HE WOULD BE
           SENSITIVE TO AGE SPECIAL AT THIS, BUT THAT'S NOT WHO MAKE THESE
           REFERRAL
           
           DECISION: IT IS ATTORNEYS, REVIEWERS, BUREAUCRATS AND
           TECHNICIANS. FRANKLY, WHEN THEY SEE AGE-SPECIFIC, THEY ARE
           GOING TO SEE, WELL, YOU KNOW, WE DON'T HAVE A PEDIATRIC

           SPECIALIST ON OUR PANEL, BUT THAT'S OKAY, BECAUSE WE CAN FIND
           SOMEBODY WHO PERHAPS SAW A CHILD IN THE LAST YEAR OR TWO, AND
           THAT'S AGE-SPECIFIC ENOUGH FOR US. THIS WHOLE APPROACH IS AN
           INVITATION, ONCE AGAIN, TO THE H.M.O., TO MAKE UP THE RULES,
           AND THEN MAKE THOSE RULES WORK AGAINST THE INTERESTS OF THEIR
           PATIENTS, AND PARTICULARLY, I AM CONCERNED THAT THEY WILL WORK
           AGAINST THE INTERESTS OF CHILDREN. NOW, THERE HAS BEEN SOME
           VARIOUS RESEARCH DONE ABOUT MANAGED CARE PLANS THROUGHOUT THE

           COUNTRY, BUT I RECEIVED SOME FIRSTHAND INFORMATION FROM A
           DOCTOR IN LOS ANGELES WHO IS CONDUCTING A VERY INTERESTING
           PROGRAM. IT IS DR. CRAIG JONES, ESTEY UCLA MEDICAL SCHOOL, AND
           HE DEVELOPED A BREATH MOBILE PROGRAM. THIS GOES RIGHT TO THE
           SCHOOLS IN LOS ANGELES AND THEY DEAL WITH THE NUMBER-ONE
           ILLNESS AFFECTING CHILDREN, ENVIRONMENTAL ILLNESS EFFECTING
           CHILDREN AND THAT'S CHRONIC ASTHMA. DR. JONES HAS TREATED LOTS
           OF CHILDREN AND HAS GREAT OUTCOMES. BUT THEY HAVE COLLECTED

           DATA. THE STARTLING THING ABOUT THEIR DATA IS THAT A CHILD IN
           MANAGED CARE GETS THE SAME KIND OF TREATMENT FOR SEVERE ASTHMA
           AS A CHILD WITHOUT ANY INSURANCE. IF THEY LOOK AT THE NUMBERS
           THERE IS NO DIFFERENCE. BECAUSE A CHILD IN MANAGED CARE DOESN'T
           GET THE REFERRAL TO A PULMONARY SPECIALIST OR RESPIRATORY
           SPECIALIST. THEY GET, LIKE EVERY OTHER CHILD SHOWS UP IN THE
           EMERGENCY ROOM, A LITTLE BAG WITH AN INHALER AND SOME MEDICINE
           AND ARE TOLD TO GO HOME. WE CAN DO BETTER AND WE MUST DO

           BETTER, BUT WE WON'T DO BETTER UNTIL HEALTH CARE PLANS ARE
           REQUIRED TO MAKE REFERENCES TO SPECIALISTS AND IN THE
           PARTICULAR CASE OF CHILDREN, PEDIATRIC SPECIALISTS.
           

           THE PRESIDING OFFICER: THE SENATOR'S FIVE MINUTES EXPIRED.
           

           MR. REED: I SAID THIS OVER AND OVER AGAIN BUT IT STILL REMAINS
           TRUE, THERE IS A DIFFERENCE BETWEEN AN ADULT ONCOLOGIST AND
           PEDIATRIC ONCOLOGIST. NO ONE WOULD DISPUTE THAT. ONE FINAL
           POINT IF I COULD REQUEST ADDITIONAL TIME REID REED 30 SECONDS.
           

           MR. REED: ONE POINT THAT SHOULD BE MADE IS WHEN YOU GO AROUND
           AND LOOK AT HOW SPECIALISTS ARE CATEGORIZED, YOU ARE NOT GOING
           TO FIND AN AGE-APPROPRIATE SPECIALTY. YOU ARE NOT GOING TO FIND
           SOMEONE WHO IS, OH, I AM QUALIFIED AGE APPROPRIATE. THERE ARE
           PEDIATRICIANS, GERONTOLOGISTS, THEY FLOL GIST, A HOLE WHOFETE
           OF -- WHOLE HOST OF OF HOST OF PEOPLE WITH SPECIALISTS, WE HAVE
           TO WORK WITH THOSE CATEGORIES, NOT SOME VAGUE CATEGORY THAT

           WILL BE DID I TORTED BY THE INSURANCE COMPANIES.
           

           THE PRESIDING OFFICER: THE SENATOR FROM VERMONT.
           

           MR. JEFFORDS: I YIELD TEN MINUTES TO THE SENATOR FROM ARIZONA.
           

           MR. REID: WOULD THE SENATOR FROM ARIZONA WITHHOLD FOR A
           UNANIMOUS CONSENT FROM THE SENATOR FROM NEW MEXICO.
           

           MR. BINGAMAN: SKI UNANIMOUS CONSENT MY FULL STATEMENT BE
           INCLUDED IN THE RECORD. ALSO THAT LETTERS BE INCLUDED IN THE
           RECORD FROM THE AMERICAN -- LETTERS IN SUPPORT OF THE AMENDMENT
           FROM THE AMERICAN ACADEMY OF PEDIATRICS, THE KHIRNS' DEFENSE
           FUND, AMERICAN ACADEMY OF REHABILITATION, NATIONAL BREAST
           CANCER COALITION, CON SORE SCHEDULES OF CITIZENS WITH
           DISABILITIES, THE NATIONAL ASSOCIATION OF PEOPLE WITH AIDS,

           ONCOLOGY NURSING SOCIETY AND NATIONAL MULTIPLE SCLEROSIS
           SOCIETY.
           

           THE PRESIDING OFFICER: WITHOUT OBJECTION, SO ORDERED. THE
           SENATOR FROM ARIZONA.
           

           MR. KYL: THANK YOU, MR. PRESIDENT. LET ME BEGIN BY
           COMPLIMENTING SENATOR JEFFORDS, CHAIRMAN OF THE COMMIT EERK,
           FOR THE WORK THEY HAVE DONE AND ALL MEMBERS OF THE COMMITTEE IN
           BRINGING THIS LEGISLATION FORTH. TO MAKE A POINT TO THOSE
           WATCHING THIS DEBATE THAT FRANKLY IT IS NOT QUITE AS CUT AND
           DRIED, AS BLACK AND WHITE AS PEEL ON BOTH SIDES OF THE AISLE
           ARE ATTEMPT WILLING TO TO MAKE IT. THIS IS A COMPLICATED ISSUE.
           I WANT TO COMPLIMENT SOME OF MY FRIENDS AND THE DEMOCRATIC SIDE
           FOR INSISTING THE ISSUE BE BROUGHT BEFORE THE SENATE FOR

           DEBATE. BECAUSE THERE ARE INDEED SITUATIONS AROUND THIS COUNTRY
           IN WHICH SOME H.M.O.'S HAVE ABUSED THEIR POSITION. AND IN ORDER
           TO CUT COSTS, WHICH WE ALL WOULD LIKE TO SEE DONE, HAVE DENIED
           THE HIEST QUALITY CARE TO PEOPLE UNDER THEIR CARE. THAT'S
           SOMETHING THAT WE ALL SHOULD BE CONCERNED ABOUT. BUT JUST AS
           MUCH WE NEED TO BE CONCERNED ABOUT HOW MUCH IT IS GOING TO COST
           TO FIX THE PROBLEM BECAUSE IF IT COSTS TOO MUCH, THE COST OF
           INSURANCE IS GOING TO ESCALATE TOO HIGH AND TOO MANY PEOPLE

           WILL NO LONGER BE ABLE TO BUY THE INSURANCE THAT'S OFFERED. AND
           SO WE HAVE GOT TO BE VERY, VERY CAREFUL THAT IN WORKING OUT A
           SOLUTION TO WHAT IS IN FACT A REAL PROBLEM, WE DON'T GO TOO
           FAR. AND THAT'S WHERE THE DIFFERENCES OF OPINION ARE HERE. THEY
           SHOULD BE CONSIDERED REASONABLE DIFFERENCES BETWEEN REASONABLE
           PEOPLE. BUT I FEAR THAT TOO MUCH OF THE DEBATE HAS BEEN
           CHARACTERIZED BY FINGER POINTING, AND BY BOTH SIDES
           CHARACTERIZING THE OTHER SIDES IDEAS AS ABSOLUTELY OFF THE
           WALL, NO ONE COULD POSSIBLY EVER THINK SUCH A THING COULD SOLVE

           THE PROBLEM, WHEN IN REALITY, THERE ARE SOME COMMON ANSWERS
           HERE, AND THERE ARE SOME GOOD IDEAS HERE ON BOTH SIDES. NOW,
           ONE OF THE PROBLEMS THAT SENATOR EDWARDS WAS REFERRING TO A
           MOMENT AGO WAS A PROBLEM DURING THE EXTERNAL REVIEW PROCESS AS
           TO WHAT WOULD BE INCLUDED IN THAT EXTERNAL REVIEW PROCESS, AND
           THERE IS GOING TO BE A CHANGE MADE AT THE INSTANCE OF SENATOR
           ASHCROFT AND MYSELF THAT I AM SURE WILL BE FULLY ACCEPTABLE TO
           THE SENATOR FROM NORTH CAROLINA, BECAUSE IT ACCEPTS PART OF THE
           DEFINITION THAT HE AND OTHERS HAVE OFFERED WITH RESPECT TO WHAT

           OUGHT TO BE CONSIDERED, SPECIFICALLY AMONG THE FACTORS TO BE
           CONSIDERED ARE NOT JUST WHAT THE H.M.O. WRITES AS ITS PRACTICE
           GUIDELINES OR DEFINITIONS BUT ALSO RECOGNIZE BEST PRACTICE, AND
           GENERALLY ACCEPTED MEDICAL PRACTICE. AND I KNEW THAT THE
           SENATOR WOULD BE PLEASED WITH THAT. THE FACT OF THE MATTER IS,
           IF WE CONTINUE TO TALK ABOUT THIS, WE ARE GOING TO BE ABLE TO
           COME TO SOME COMMON AGREEMENT ON WHAT WILL MAKE THIS WORK, BUT
           WE HAVE GOT TO BE CAREFUL THAT IT DOESN'T END UP COSTING SO
           MUCH THAT IT DRIVES PEOPLE OFF OF INSURANCE PLANS. I WOULD LIKE
           TO TALK ABOUT THAT FOR JUST A MOMENT HERE. DAVID BRODER, 5

           RESPECTED COLUMNIST WROTE ON APRIL 7 IN "THE WASHINGTON POST,"
           THAT THE COLD TRUTH ABOUT HEALTH CARE, HE SAYS, "RAISES THIS
           CRITICAL POLICY ISSUE," WHICH IS THE IRREFUTABLE LINK BETWEEN
           HEALTH CARE PREMIUM INCREASES AND THE NUMBER OF AMERICANS
           WITHOUT INSURANCE. HE SAYS AS WE DEBATE THE VARIOUS PROPOSAL
           HERE WE HAVE TO KEEP THIS LINKAGE IN MIND. MY COLLEAGUES ON THE
           OTHER SIDE OF THE AISLE ARE QUICK TO POINT OUT THEIR BILL COULD
           IMPROVE HEALTH CARE BUT NOT SO QUICK TO ADMIT IT IS GOING TO
           RAISE COSTS. THAT'S THE PROBLEM. BECAUSE IF IT RAISES COSTS TOO

           MUCH, SOME EMPLOYERS WILL STOP OFFERING HEALTH INSURANCE AS A
           BENEFIT, THAT WILL MAKE INSURANCE MORE UNAFFORDABLE FOR A LOT
           OF AMERICANS AND OBVIOUSLY THAT MEANS PEOPLE ARE WORSE OFF NOT
           BETTER OFF. HERE ARE STATISTICS, MR. PRESIDENT, THAT I THINK WE
           SHOULD KEEP IN MIND. THE LEWYN GROUP A RESPECTED CONSULTANT
           GROUP SAID FOR 1% OF PREMIUM INCREASE AN ADDITIONAL 300,000
           CITIZENS WILL LOSE INSURANCE. 300,000 LOSE THEIR INSURANCE FOR
           1% INCREASE. THE BERENS GROUP, ANOTHER RESEARCH GROUP, A 5%

           INCREASE WOULD COST 1.6 MILLION AMERICANS TO BECOME UNINSURED.
           IT FURTHER POINTS OUT THAT THIS INCREASE WOULD FORCE EMPLOYEES
           WHO HAVE ALREADY HAD -- WHO HAVE INSURANCE TO PAY AN ADDIONAL
           AVERAGE OF $95 PER HOUSEHOLD IN OUT-OF-POCKET EXPENSES. MR.
           PRESIDENT, MOST FAMILIES ARE NOT GOING TO BE ABLE TO AFFORD
           THAT. THE CONGRESSIONAL BUDGET OFFICE HAS CONCLUDED THAT THE
           BILL OFFERED BY OUR COLLEAGUES ON THE OTHER SIDE OF THE AISLE,
           THE DASCHLE-KENNEDY DEMOCRATIC PROPOSAL, WOULD INCREASE
           PREMIUMS BY 6.1%. NOW THAT'S THE CONGRESSIONAL BUDGET OFFICE.

           THAT'S NOT A BIASED INSURANCE COMPANY STUDY OR ANYTHING ELSE OF
           THAT SORT. BY THESE PROJECTIONS OF THESE SPECIALTY GROUPS, THIS
           WOULD RESULT IN ALMOST TWO MILLION MORE UNINSURED NATIONALLY.
           IN MY OWN STATE OF ARIZONA, OVER 34,000 PEOPLE WHO ARE
           CURRENTLY INSURED WOULD BE UNINSURED AS A RESULT OF THE
           INCREASED PREMIUM COSTS IF THE DEMOCRATIC PROPOSAL WERE TO
           PASS. SO THAT'S WHY SOME OF THE PEOPLE ON THIS SIDE OF THE
           AISLE ARE SO CONCERNED ABOUT WHAT'S BEING DONE HERE. YES, THERE
           IS A PROBLEM. BUT THE PHYSICIANS FIRST RULE OF THUMB OF COURSE

           IS TO DO NO HARM. AND WE ARE CONCERNED ON THIS SIDE THAT THE
           PROPOSAL OF THE DEMOCRATS IS SO COSTLY THAT IT WOULD IN EFFECT
           REMOVE THREE MILLION PEOPLE FROM THE
{END: 1999/07/14 TIME: 18-45 , Wed.  106TH SENATE, FIRST SESSION}