AND KEEP THEIR LICENSE TO PRACTICE BAD MEDICINE WITH IMPUNITY.
           THE TRUTH IS THIS WHOLE DEBATE COMES DOWN TO ONE CRITICALLY
           
           IMPORTANT QUESTION: WHO SHOULD MAKE MEDICAL DECISIONS, DOCTORS
           OR INSURANCE COMPANY ACCOUNTANTS?
           WE'VE ALL HEARD THE HORROR STORIES. IN GEORGIA, A SIX-MONTH-OLD
           BOY WAS BURNING UP WITH 105 DEGREE FEVER. HIS MOTHER CALLED HER
           H.M.O. TWICE AND BEGGED TO BE ALLOWED TO TAKE HER SON TO AN
           EMERGENCY ROOM. BOTH TIMES THE H.M.O. REFUSED. SHE FINALLY

           DECIDEED TO TAKE HIM TO THE HOSPITAL ANYWAY. BY THE TIME THEY
           ARRIVED, THE INFECTION THAT WAS CAUSING THE FEVER HAD DESTROYED
           THE CIRCULATION IN THE BABY'S EXTREMITIES. BOTH HIS HANDS AND
           FEET HAD TO BE AMPUTATED. 234 WASHINGTON, D.C., A 12-YEAR-OLD
           BOY WAS DIAGNOSED WITH A CANCEROUS TUMOR IN HIS LEG. HIS
           ONCOLOGIST RECOMMEND ADD TREATMENT THAT COULD SAVE THE LEG. BUT
           WHEN THE DOCTOR'S OFFICE CALLED THE BOY'S H.M.O., THEY WERE
           TOLD THE ONLY TREATMENT THE H.M.O. WOULD PAY FOR WAS

           AMPUTATION. FOUR MONTHS AND SEVERAL APPEALS LATER, THE H.M.O.
           FINALLY AGREED TO PAY FOR THE TREATMENT THE DOCTOR ORDERED, BUT
           BY THEN THE CANCER HAD SPREAD. THE LEG HAD TO BE AMPUTATED. IN
           KENTUCKY A MAN WITH PROSTATE CANCER NEEDED ONE CHEMOTHERAPY
           INJECTION A MONTH. THE INJECTIONS COST $500 EACH. HIS INSURANCE
           COMPANY POLICY SAID THEY WERE FULLY COVERED. BUT WHEN THE
           H.M.O. CHANGED ADMINISTRATORS, THE MAN WAS TOLD THAT HE'D HAVE
           TO PAY $180 A MONTH OUT OF HIS OWN POCKET. HE DIDN'T HAVE $180

           A MONTH, SO HE HAD TO GO WITH THE ONLY OTHER TREATMENT HIS
           DOCTOR SAID WOULD CONTROL HIS CANCER. HE WAS CASTRATED. THE DAY
           HE RETURNED FROM THE HOSPITAL, HE GOT A LETTER FROM HIS H.M.O.
           SAYING THEY'D MADE A MISTAKE. THE H.M.O. WOULD NOW PAY THE $500
           AFTER ALL. THREE DIFFERENT PEOPLE, THREE DIFFERENT PART OF THE
           COUNTRY, BUT THEY ALL HAVE ONE THING IN COMMON. THEY WERE ALL
           POWERLESS AGAINST THE INSURANCE COMPANIES. UNFORTUNATELY I

           COULD GO ON AND ON. TWO YEARS AGO 130 MILLION AMERICANS SAID
           THEY OR SOMEONE THEY KNEW HAD A PROBLEM WITH A HEALTH INSURANCE
           COMPANY. LAST YEAR THAT NUMBER HAD GROWN TO 154 MILLION
           AMERICANS. WHEN WE FIRST INTRODUCED OUR BILL NEARLY TWO YEARS
           AGO, A LOT OF OUR REPUBLICAN FRIENDS SAID THEY DIDN'T NEED A
           PATIENTS' BILL OF RIGHTS. TODAY THEY HAVE A BILL OF THEIR OWN.
           WE CONSIDER THAT PROGRESS. BUT WE STILL HAVE BIG DIFFERENCES OF
           OPINION ABOUT WHAT A PATIENTS' BILL OF RIGHTS SHOULD DO. OUR

           BILL COVERS 161 MILLION AMERICANS. THEIR BILL COVERS 48
           MILLION. IT LEAVES OUT MORE THAN 100 MILLION AMERICANS. OUR
           BILL LETS HEALTH CARE PROFESSIONALS MAKE MEDICAL DECISIONS
           ABOUT YOUR HEALTH. THEIR BILL LETS INSURANCE COMPANY
           ACCOUNTANTS MAKE THOSE DECISIONS. OUR BILL GUARANTEES YOU THE
           RIGHT TO SEE A QUALIFIED MEDICAL SPECIALIST, INCLUDING
           PEDIATRIC SPECIALISTS FOR YOUR CHILDREN. THE REPUBLICAN BILL
           DOESN'T GUARANTEE THAT EITHER YOU OR YOUR CHILDREN WILL BE ABLE
           TO SEE A QUALIFIED MEDICAL SPECIALIST. IF YOUR H.M.O. REFUSES

           20 PAY FOR CARE YOUR DOCTOR SAYS YOU NEED, OUR BILL ALLOWS YOU
           TO APPEAL THAT DECISION TO AN INDEPENDENT REVIEW BOARD. THEIR
           BILL CONTAINS AN APPEAL PROCESS TOO, EXCEPT THEY LET THE
           H.M.O.'S DECIDE WHAT DECISIONS CAN BE APPEALED. THEY ALSO LET
           H.M.O.'S HAND-PICK AND PAY THE PEOPLE WHO HEAR THE CASES.
           FINALLY, OUR PATIENTS' BILL OF RIGHTS IS ENFORCEABLE. THEIRS
           ISN'T. C.B.O. ESTIMATES THAT THE MOST OUR PATIENTS' BILL OF

           RIGHTS WOULD DO IS INCREASE PREMIUMS 4.8% OVER FIVE YEARS. LESS
           THAN 1% A YEAR. THAT COMES OUT TO LESS THAN $2 PER BENEFICIARY.
           LESS THAN $2 A MONTH TO GUARANTEE YOU THAT YOUR HEALTH
           INSURANCE WILL BE THERE WHEN YOU NEED IT. LAST MONTH WHEN WE
           OFFERED OUR PATIENTS' BILL OF RIGHTS, OUR REPUBLICAN COLLEAGUES
           VOTED TO KILL IT WITHOUT DISCUSSING THE SPECIFIC PIECES. YET,
           THEY CLAIM SUPPORT OF NEARLY ALL THE PROTECTIONS IN OUR PLAN.

           SO THIS WEEK WE INTEND TO OFFER OUR PLAN AGAIN PIECE BY PIECE.
           LET'S DEBATE EACH OF THE PROTECTIONS IN OUR PLAN. MAYBE WHEN
           OUR COLLEAGUES REALLY LOOK AT OUR PROPOSALS, THEY'LL DECIDE
           THEY CAN SUPPORT SOME OF THE PROTECTIONS IN OUR BILL. THE
           AMERICAN PEOPLE DESERVE TO KNOW EXACTLY WHERE EACH OF US STANDS
           ON EACH OF THESE PROTECTIONS. LET ME JUST SAY A WORD, MR.
           PRESIDENT, AT THIS POINT ABOUT THE KIND OF DEBATE THAT WE
           EXPECT. BY AGREEING TO THIS DEBATE, WE ARE ASSUMING OUR
           REPUBLICAN COLLEAGUES INTEND TO ALLOW A REAL HONEST DEBATE.

           THAT MEANS DEBATING AND VOTING ON EACH OF THE MAJOR PROTECTIONS
           IN OUR PATIENTS' BILL OF RIGHTS. IF WE HAVE THAT SORT OF
           DEBATE, THEN WHETHER WE WIN OR LOSE, WE WILL CERTAINLY AGREE
           NOT TO BRING THE PATIENTS' BILL OF RIGHTS UP AGAIN THIS YEAR.
           UP OR DOWN, WIN OR LOSE, IF THE DEBATE THIS WEEK IS FAIR AND
           HONEST, WE WILL NOT OFFER OUR PATIENTS' BILL OF RIGHTS AGAIN
           THIS YEAR. IF WE ARE NOT ABLE TO DO THAT, IF WE DON'T HAVE A
           REAL DEBATE, IF WE ARE NOT PERMITTED TO OFFER OUR PROTECTIONS
           AS AMENDMENTS SO THE SENATE CAN DISCUSS AND VOTE ON EACH OF
           THEM, IF THERE ARE THOSE WHO TRY TO PREVENT AN HONEST DEBATE BY

           USING PARLIAMENTARY TACTICS, WE ARE PUTTING THEM ON NOTICE NOW,
           THIS DEBATE WILL CERTAINLY NOT END ON THURSDAY. WE WILL
           CONTINUE TO OFFER THE PROTECTIONS IN OUR PLAN AS AMENDMENTS FOR
           AS LONG AS WE HAVE TO, UNTIL WE FINALLY DO HAVE THAT HONEST
           DEBATE. WE KNOW FROM EXPERIENCE THAT WE CAN PASS BILLS THAT
           PROTECT THE HEALTH OF AMERICA'S FAMILIES WHEN WE WANT TO.
           TOGETHER REPUBLICANS AND DEMOCRATS PASSED A BILL ALLOWING
           PEOPLE TO TAKE THEIR HEALTH CARE WITH THEM WHEN THEY CHANGED
           JOBS. TOGETHER WE PASSED A BILL TO HELP WORKING PARENTS
           PURCHASE PRIVATE AFFORDABLE HEALTH INSURANCE FOR THEIR KIDS.

           TOGETHER WE CAN PASS A REAL MEANINGFUL PATIENTS' BILL OF RIGHTS
           THIS WEEK. MR. PRESIDENT, I SEND AN AMENDMENT TO THE DESK AND
           ASK FOR ITS CONSIDERATION.
           

           THE PRESIDING OFFICER: THE CLERK WILL REPORT.
           

           THE CLERK: THE SENATOR FROM SOUTH DAKOTA, MR. DASCHLE, PROPOSES
           AN AMENDMENT NUMBERED 1232.
           

           MR. DASCHLE: MR. PRESIDENT, I ASK UNANIMOUS CONSENT THE
           AMENDMENT BE CONSIDERED AS READ.
           

           THE PRESIDING OFFICER: WITHOUT OBJECTION, SO ORDERED.
           

           MR. DASCHLE: MR. PRESIDENT, LET ME EXPLAIN THIS PARTICULAR
           AMENDMENT. THIS AMENDMENT IS THE REPUBLICAN BILL. IT IS OFFERED
           AS A SUBSTITUTE TO THE DEMOCRATIC BILL FOR ONE REASON. SENATOR
           LOTT HAS BEEN VERY CANDID AND VERY PUBLICLY OPEN ABOUT HIS
           INTENTIONS. HIS INTENTION, OF COURSE, IS TO OFFER A NONDEBATED,
           UNAMENDED REPUBLICAN VEHICLE AT THE END OF THE DEBATE NOT
           HAVING BEEN SCRUTINIZED, NOT HAVING BEEN SUBJECT TO AMENDMENT,
           NOT HAVING HAD ANY OPPORTUNITY TO THOUGH ROAM ANALYZE THE

           DIFFERENCES BETWEEN THE REPUBLICAN BILL AND THE DEMOCRATIC
           BILL. BY OFFERING OUR FIRST AMENDMENT AS THE REPUBLICAN
           SUBSTITUTE, WE NOW LAY DOWN A DUAL TRACK FOR THE WEEK. THEIR
           BILL AND OUR BILL. BOTH ARE SUBJECT TO AMENDMENTS, BOTH ARE
           SUBJECT TO CONSIDERATION, BOTH ARE SUBJECT TO THE DEBATE THAT
           WE HAD ANTICIPATED WHEN WE REACHED THIS AGREEMENT. WE WILL BE
           OFFERING AMENDMENTS TO THE REPUBLICAN BILL. WE WOULD LOVE
           NOTHING MORE THAN FOR OUR BILL TO PASS WITHOUT AMENDMENT. BUT
           CERTAINLY IF THAT IS NOT TO BE, THEN OFFERING THE REPUBLICAN

           BILL SO THAT IT CAN BE SUBJECT TO AMENDMENT WHEN IT IS FINALLY
           OFFERED IN THE END, WE WILL HAVE HAD THE KIND OF DEBATE AND THE
           KIND OF OPPORTUNITY TO MAKE THE REPUBLICAN BILL WHAT IT SHOULD
           HAVE BEEN IN THE FIRST PLACE. A GOOD BILL, OFFERING REAL
           PROTECTIONS, DEALING WITH EACH OF THESE ISSUES ONE BY ONE. MR.
           PRESIDENT, I RETAIN THE BALANCE OF OUR TIME BOTH UNDER THE

           AMENDMENT AS WELL AS THE GENERAL DEBATE. MR. GRAMM: MR.
           PRESIDENT?
           
           

           THE PRESIDING OFFICER: THE SENATOR FROM TEXAS.
           

           MR. GRAMM: MR. PRESIDENT, LET ME BEGIN BY EXPLAINING HOW WE
           CAME TO BE HERE. THEN I WANT TO TAKE A LITTLE WALK DOWN MEMORY
           LANE, AS RONALD REAGAN USED TO SAY, AND TALK ABOUT THE REAL
           DEMOCRAT HEALTH CARE BILL, THE BILL OFFERED IN 1993. I THEN
           WANT TO TALK ABOUT THE DIFFERENCE BETWEEN THE TWO BILLS, THE
           DEMOCRAT KENNEDY BILL, OUR BILL, AND WHY THAT DIFFERENCE IS
           RELEVANT TO EVERY WORKING AMERICAN FAMILY. AND THEN I'D LIKE TO

           CONCLUDE BY EXPLAINING WHY OUR BILL IS A GOOD BILL AND WHY I AM
           CONFIDENT THAT IF SENATOR KENNEDY AND I COULD GO INTO EVERY
           HOUSE IN AMERICA AND SIT DOWN WITH PEOPLE AT THEIR KITCHEN
           TABLE, AND IF HE COULD EXPLAIN HIS BILL AND WHAT HE'S TRYING TO
           DO AND IF I COULD EXPLAIN OUR BILL AND WHAT WE'RE TRYING TO DO,
           I AM K69 THAT 90% OF THE PEOPLE IN AMERICA -- I AM CONFIDENT
           THAT 90% OF THE PEOPLE IN AMERICA WOULD CHOOSE OUR BILL. WE'RE
           GOING TO HAVE FOUR DAYS OF DEBATE, BUT THE OUTCOME OF THE
           DEBATE, I THINK, IS CLEAR. WE'RE GOING TO WIN WHEN THE VOTES

           ARE CAST AND WE'RE GOING TO WIN THIS DEBATE, BECAUSE WE HAVE A
           BETTER PROGRAM. OUR PROGRAM BENEFITS THE PEOPLE WHO DO THE WORK
           AND PAY THE TAXES AND PULL THE WAGON IN AMERICA. AND I THINK
           WHEN THE WEEK IS OVER THAT WE WILL HAVE DISCREDITED THE
           APPROACH OF 24 BILL AS WE DISCREDITED THE BILL IN 1993. BUT OF
           GREATER IMPORTANCE, WE WILL HAVE PASSED A REAL BILL THAT GIVES
           AMERICANS REAL FREEDOMS. NOW, OUR COLLEAGUES HAVE LAMENTED THAT

           WE HAVE WAITED THIS LONG TO DEAL WITH THIS ISSUE. I WANT TO
           REMIND EVERYONE THAT LAST YEAR THROUGHOUT THE YEAR THE MAJORITY
           LEADER OFFERED TO BRING THIS BILL UP, AND HE OFFERED TO BRING
           IT UP IN TWO DIFFERENT FORMS. THE MOST REASONABLE OFFER, I
           THOUGHT, WAS LET THE DEMOCRATS WRITE THE BEST BILL THEY CAN
           WRITE, THAT DOES THE MOST THAT THEY CAN PROVIDE TO HELP PEOPLE
           WITH HEALTH INSURANCE AND TO IMPOSE WHATEVER RESTRICTIONS THEY
           WANT TO WRITE. THEN LET REPUBLICANS PUT TOGETHER THE BEST BILL

           THEY CAN PUT TOGETHER, BRING THE TWO BILLS TO THE FLOOR OF THE
           SENATE AND LET THE SENATE CHOOSE BETWEEN ONE -- CHOOSE ONE OR
           THE OTHER. THAT WAS REJECTED BY THE MINORITY. WE THEN OFFERED
           THEM THE ABILITY TO BRING THE TWO BILLS UP, AND EACH SIDE HAVE
           FIVE AMENDMENTS. THAT WAS REJECTED BY THE MINORITY. SO I WOULD
           SUBMIT, NOT TO WASTE A LOT OF TIME TO GET INTO A DEBATE WITH
           THE MINORITY LEADER OR WITH OTHER DEMOCRATS, BUT I WOULD SIMPLY
           SUBMIT THAT WE'VE BEEN TWO YEARS GET TO GO THIS POINT BECAUSE

           THE DEMOCRATS HAVE WANTED TO BE TWO YEARS GETTING TO THIS
           POINT. WE COULD HAVE BROUGHT UP BILLS AND VOTED UNDER AN
           ORDERLY PROCESS TWO YEARS AGO, BUT IN REALITY THE DEMOCRATS
           THOUGHT THEY HAD A POLITICAL ISSUE. THAT'S WHY WE'RE ONLY
           GETTING TO THIS BILL NOW. I THINK WE'RE GOING TO PROVE THIS
           WEEK THEY DON'T HAVE MUCH OF A POLITICAL ISSUE. AND I THINK
           WHEN THE DEBATE IS OVER, THEY'RE GOING TO BE GLAD IT'S OVER.
           AND I THINK THE AMERICAN PEOPLE ARE GOING TO BE GLAD IT'S OVER.
           NOW LET ME REMIND MY COLLEAGUES AND ANYBODY THAT'S WATCHING

           THIS DEBATE IN AMERICA THAT THIS IS NOT THE FIRST TIME THAT
           BILL CLINTON AND TED KENNEDY VPTED TO REWRITE THE HEALTH CARE
           -- HAVE WANTED TO REWRITE HEALTH CARE SYSTEM OF THIS COUNTRY. I
           HAVE HERE ON THIS DESK THE CLINTON HEALTH CARE BILL AND THE
           VERSION OF IT THAT WAS SPONSORED BY SENATOR KENNEDY. NOW LET ME
           REMIND THOSE WHO FOLLOWED THAT DEBATE IN 1993, THEIR MEMORIES
           MIGHT HAVE GOTTEN A LITTLE CROWDED -- CLOUDED. LET ME REMIND

           THEM WHAT THIS BILL DID. THIS BILL SAID THAT THE PROBLEM IN
           AMERICA WAS THAT WE HAD 43 MILLION AMERICANS WHO DIDN'T HAVE
           HEALTH INSURANCE. AND THAT IN TRYING TO DEAL WITH HEALTH
           INSURANCE AND MAKE IT AVAILABLE, WE NEEDED TO GET RID OF THE
           CURRENT HEALTH CARE SYSTEM AND WE NEEDED TO SET UP ON A
           REGIONAL BASIS IN AMERICA HEALTH CARE COLLECTIVES THAT PEOPLE
           WOULD BE FORCED TO JOIN, AND THESE COLLECTIVES WOULD BE RUN BY
           THE GOVERNMENT. THE WHOLE IDEA BEHIND THE KENNEDY BILL IN 1993

           WAS GIVE UP FREEDOM TO CONTROL COST. AND LET ME JUST REMIND YOU
           WITHOUT HAVING TO GO -- OBVIOUSLY I WOULDN'T HAVE ENOUGH TIME
           IN THE DAY OR THE WEEK TO GO THROUGH ALL THESE PROVISIONS. BUT
           LET ME JUST REMIND YOU OF A COUPLE OF THEM. IN 1993 SENATOR
           KENNEDY, SENATOR DASCHLE AND PRESIDENT CLINTON SAID THAT WE'RE
           GOING TO HAVE THE GOVERNMENT TAKE OVER THE HEALTH CARE SYSTEM
           IN YOUR HOMETOWN IN PHOENIX, ARIZONA. THERE WOULD BE ONE HEALTH
           CARE COLLECTIVE RUN BY THE GOVERNMENT. AND IF YOU REFUSED TO

           JOIN THAT COLLECTIVE, YOU WOULD BE FINED $5,000. THAT'S WHAT
           THEY WANTED IN 1993. THAT WAS THEIR CONCEPT OF FREEDOM WHEN
           THEY LAST ASKED US TO LET THEM RUN THE HEALTH CARE SYSTEM IN
           AMERICA. NOW -- THEN THEY SAID IF THIS PLAN DID NOT PROVIDE THE
           KIND OF HEALTH CARE YOU NEEDED AND YOU SOUGHT TO GET THAT
           HEALTH CARE THROUGH YOUR PHYSICIAN, AND THE HEALTH CARE WAS NOT

           ALLOWED UNDER THIS PLAN, THE PHYSICIAN COULD BE FINED $50,000.
           SO YOU NEEDED HEALTH CARE FOR YOUR CHILD. THEIR CONCEPT OF
           FREEDOM IN 1993, IN THE CLINTON-KENNEDY HEALTH CARE BILL, WAS
           WE KNOW WHAT KIND OF HEALTH CARE YOU NEED, THEY SAID. WE'RE
           GOING TO PROVIDE IT IN THIS BILL. AND IF YOU WANT HEALTH CARE
           OUTSIDE THIS BILL AND A PHYSICIAN PROVIDES IT FOR YOU, WE'RE
           GOING TO FINE THEM $50 240U THOUSAND. THAT WAS THEIR CONCEPT 6

           FREEDOM IN 1993. IN 1993 THEY SAID, WELL, WHAT ABOUT THE
           CIRCUMSTANCE WHERE YOUR BABY'S REALLY SICK?
           AND SOUG TO A DOCTOR AND SAY I NEED HEALTH CARE. AND THEY SAY,
           WELL, UNDER THE CLINTON-KENNEDY PLAN, WE'RE NOT ALLOWED TO
           PROVIDE THIS KIND OF TREATMENT. AND YOU SAID, WELL, FORGET
           ABOUT THE PLAN. I'LL PAY FOR IT OUT OF MY OWN POCKET. IN 1993
           SENATOR KENNEDY AND SENATOR DASCHLE AND PRESIDENT CLINTON
           THOUGHT SO MUCH OF FREEDOM THAT THEY SAID IF YOU PAY THE DOCTOR

           OUT OF YOUR
{END: 1999/07/12 TIME: 14-00 , Mon.  106TH SENATE, FIRST SESSION}