A SENATOR: MR. PRESIDENT?
           
           

           THE PRESIDING OFFICER: THE SENATOR FROM WEST VIRGINIA.
           

           MR. ROCKEFELLER: MR. PRESIDENT, I ASK IF I MIGHT SPEAK AS IF IN
           MORNING BIRS FOR --
           

           THE PRESIDING OFFICER: THE SENATOR WOULD BE REMINDED --
           

           MR. ROCKEFELLER: MR. PRESIDENT, I WOULD ASK UNANIMOUS CONSENT
           THAT THE ORDER FOR THE QUORL CALL -- THE QUORUM CALL BE
           RESCIND.
           

           THE PRESIDING OFFICER: WITHOUT OBJECTION.
           

           MR. ROCKEFELLER: I ASK TO SPEAK FOR TEN MINUTES IN MORNING
           BUSINESS.
           

           THE PRESIDING OFFICER: WITHOUT OBJECTION, SO ORDERED.
           

           MR. ROCKEFELLER: I THANK THE PRESIDING OFFICER AND APOLOGIZE
           FOR MY PARLIAMENTARY MISTAKE. I'VE COME TO THE FLOOR TO TALK
           ABOUT SOMETHING OF FUNDAMENTAL IMPORTANCE TO THE PEOPLE THAT I
           REPRESENT IN MY STATE OF WEST VIRGINIA. AND THAT HAS TO DO WITH
           EQUAL TREATMENT FOR ALL AMERICANS WITH RESPECT TO HEALTH CARE.
           AND I'M NOT JUST TALKING ABOUT CONGRESSMEN, I AM NOT JUST
           TALKING ABOUT C.E.O.'S OR CUSTODIANS. I'M TALKING ABOUT ALL

           AMERICANS AND ALL THE TIME. I WANT TO TALK ABOUT WHAT I THINK
           IS AN URGENT NEED HERE IN CONGRESS TO PASS LEGISLATION THAT HAS
           TO DO WITH THE QUALITY OF HEALTH CARE AND THAT THAT LEGISLATION
           SHOULD APPLY TO EVERY SINGLE AMERICAN AMERICAN. WHEN ENOUGH OF
           US RECOGNIZE THESE NEEDS, I'M CONVINCED THAT WOOR EA GOING TO
           ENACT LEGISLATION -- THAT WE'RE GOING TO ENACT LEGISLATION AND
           IT'S GOING TO BE CALLED "PATIENT PROTECTION." IT MAY HAVE SOME
           OTHER NAME. IT MAY BE MODIFIED. IT MAY BE EXPANDED. WHO KNOWS?

           BUT THE NEED FOR IT IS UNDENIABLE AND IT HAS TO HAPPEN. EVERY
           SINGLE DAY THAT PASSES WITHOUT THE ENACTMENT OF SOME KIND OF
           PATIENT PROTECTION LEGISLATION IS ANOTHER DAY THAT MILLIONS OF
           AMERICANS, THOUSANDS OF PEOPLE I REPRESENT IN WEST VIRGINIA,
           ARE SUBJECT TO THE DENIAL OF NEEDED TREATMENTS BY INSURANCE
           COMPANIES THAT ARE LOOKING OUT FOR THEIR BOTTOM LINE. EVERY
           SINGLE DAY THAT WE AS A CONGRESS FAIL TO ACT ON THE PATIENTS'
           BILL OF RIGHTS ACT, IF WE WANT TO CALL IT THAT, IS ANOTHER DAY

           THAT AMERICANS ARE LEFT VULNERABLE TO HEALTH CARE DECISIONS
           MADE BY PEOPLE WHO ARE NOT DOCTORS IN FACT. DOCTORS COMPLAIN
           ABOUT THIS ALL THE TIME. BUT WHO ARE IN FACT BUSINESS
           PROFESSIONALS. EVERY DAY THAT WE DO NOT ACT, AMERICANS ARE HE
           REFUSED THE SPECIALTY TREATMENT THAT THEY NEED AND DESERVE. AND
           I'M GOING TO GIVE TWO EXAMPLES OF THIS WHICH I THINK ARE SCARY
           AND WHICH ARE VERY REAL. AND MAKE NO MISTAKE, MR. PRESIDENT, IF
           WE DON'T RESPOND, IF WE DON'T RESPOND FORCEFULLY, MORE
           AMERICANS ARE GOING TO LOSE CONFIDENCE IN OUR HEALTH CARE

           SYSTEM. IT'S VERY INTERESTING TO ME, HAVING OBSERVED HEALTH
           CARE NOW FOR QUITE A NUMBER OF YEARS YEARS, THAT IT USED TO BE
           THAT IT WAS ONLY PATIENTS OR ONLY CONSUMERS OF HEALTH CARE WHO
           WERE WORRIED ABOUT THE COST OF HEALTH CARE, THE QUALITY OF
           HEALTH CARE, THE PROBLEMS OF HEALTH CARE, THE PAPERWORK OF
           HEALTH CARE. NOW THE PEOPLE WHO REALLY ARE COMING ONBOARD IN
           THIS ANGST ARE PHYSICIANS THEMSELVES. AND NURSES AND PEOPLE WHO
           WORK IN HOSPITALS WHO HAVE TO DEAL WITH THE REALITIES OF WHAT
           THE HEALTH CARE SYSTEM HAS BECOME IN THIS COUNTRY. WEST

           VIRGINIA IS NO EXCEPTION. WEST VIRGINIA MAY HAVE SOME MORE
           PROBLEMS THAN SOME OTHER STATES, BUT WE'RE NO EXCEPTION WITH
           REGARD TO THE NEED FOR PATIENT PROTECTION. I CONSTANTLY RUN
           INTO WEST VIRGINIANS WHEN I'M AT HOME WHO COMPLAIN TO ME -- NOT
           AT MY INVITATION BUT AT THEIRS -- ABOUT BEING DENIED TREATMENT
           THAT THEY FELT THAT THEY WERE PROMISED OR THAT THEY KNEW THEY
           WERE PROMISED FROM PLANS, HEALTH CARE PLANS WHERE THEY THOUGHT
           THEIR PREMIUMS ENTITLED THEM TO SOMETHING CALLED "QUALITY

           HEALTH CARE" AND "FAIR TREATMENT." ONE COMPLAINT THAT I HEAR
           ALL TOO OFTEN IS BEING DENIED SPECIALTY CARE. THAT'S A VERY BIG
           DEAL. GENERAL PRACTITIONERS CAN TAKE CARE OF A LOT OF PROBLEMS
           BUT SOMETIMES YOU COME TO A POINT WHERE YOU TO HAVE MORE. UNDER
           MOST MANAGED CARE PLANS, A PATIENT'S PRIMARY CARE PHYSICIAN MAY
           IN FACT REFER AS THE GATEKEEPER OR WHATEVER, A PATIENT TO A
           SPECIALIST IF THEY DETERMINE THAT SPECIALTY CARE IS NECESSARY.
           THAT MAKES A LOT OF SENSE TO ME. PRIMARY CARE PHYSICIAN IS IN A

           VERY GOOD POSITION TO DO THAT. THAT'S A PROFESSIONAL DECISION
           INVOLVING GOING TO ANOTHER PROFESSIONAL. HOWEVER, THINGS MAY
           CHANGE IF THE SPECIALIST IS NOT ON THE LIST OFTEN CALLED "THE
           PLAN'S NETWORK." LET ME EXPLAIN. SUDDENLY SOMEBODY THEN COMES
           FROM THE ADMINISTRATIVE OFFICE OR FROM SOME OTHER DIVISION AND
           THEY MAY TAKE OVER AND SUDDENLY THE PATIENT WHO, ALONG WITH THE
           PRIMARY CARE PHYSICIAN, IS ANXIOUS FOR THE PATIENT TO SEE A

           SPECIALIST BECAUSE OF SOME HEALTH PROBLEM, FINDS OUT THAT THE
           EXECUTIVES -- NOT THE PHYSICIANS, BUT THE EXECUTIVES -- IN
           CHARGE OF THE MANAGED CARE PLAN, PEOPLE WHO ARE NOT DOCTORS,
           WHO ARE NOT MEDICAL PROVIDERS, RESERVE THE RIGHT TO REFUSE
           PAYMENT FOR THE SPECIALIST RECOMMENDED BY HIS OR HER ORIGINAL
           DOCTOR. IN FACT, THIS IS A FREQUENT OCCURRENCE. THIS IS A
           FREQUENT OCCURRENCE FOR PEOPLE WHO HAVE INSURANCE COMPANIES
           THAT PUSH THEIR EMPLOYEES TO STEER PATIENTS TO ONLY THE
           PHYSICIANS LISTED WITHIN THEIR PLAN. THAT'S NOT THE WAY IT'S

           MEANT TO WORK. INSURANCE COMPANIES DON'T ALWAYS MAKE THE BEST
           MEDICAL CHOICES, MR. PRESIDENT, BECAUSE THEY'RE NOT TRAINED IN
           THAT BUSINESS. THEY'RE TRAINED IN A DIFFERENT BUSINESS. TOO
           OFTEN MOTIVATED BY THEIR BOTTOM LINE, WHICH IS UNDERSTANDABLE,
           AND NOT OFTEN ENOUGH MOTIVATED BY PATIENTS' HEALTH CARE NEEDS,
           MANY SPECIALTY REFERRALS ARE REFUSED. AND THE NOW I GO TO MY
           EXAMPLES, AND I WOULD HOPE THAT MY COLLEAGUES WOULD LISTEN. I
           THINK OF A LITTLE 6-YEAR-OLD BOY FROM WEST VGINIA WHO BECAME

           SERIOUSLY ILL. CONCERNED, HIS MOTHER RUSHED HIM TO THE DOCTOR'S
           OFFICE, HIS DOCTOR'S OFFICE IN FACT. WHERE HE WAS QUICKLY
           DIAGNOSED WITH DIABETES. HIS PRIMARY CARE PHYSICIAN REFERRED
           HIM TO AN OUT-OF-PLAN PEDIATRIC END CHRISTIAN MILLION TOOGIST.
           A SPECIALIST IN CHILDHOOD DISEASES, THAT IS. THAT WAS THE
           TREEFERL A SPECIALIST IN CHILDHOOD DISEASES. NOW, THE
           SPECIALIST PLACED IN YOUNG CHILD ON INSULIN TO CONTROL HIS
           CONDITION. BUT WHEN THE CHILD'S PRIMARY CARE DOCTOR REFERRED

           HIM BACK TO THE SPECIALIST FOR A FOLLOW-UP VISIT, WHICH MAKES A
           LOT OF SENSE, THE REFRAL WAS DENIED STATING, QUOTE, "SERVICE
           AVAILABLE WITH IN-PLAN ENDOCRINOLOGIST." NOW, THAT ISN'T SOUND
           SO BAD, DOES IT?
           JUST GO TO THE IN-HOUSE, IN-PLAN ENDOCRIN OL JIFMT WHILE IT
           SOUNDS LIKE THE CHILD CAN GET THE CARE THAT WAS NEEDED FROM THE
           IN-PLAN SFIRX THE REALITY WAS THAT HE COULD NOT GET THAT HEALTH
           CARE FOR A VERY SUBTLE BUT BASIC REASON -- THE IN-PLAN

           SPECIALIST WAS AN ADULT ENDOCRINOLOGIST, NOT A CHILD
           ENDOCRINOLOGIST. SPECIALIZING IN ADULT DIABETES BUT DIABETES IS
           NOT THE SAME IN CHILDREN AND ADULTS. AND THERE ARE DIFFERENT
           SPECIALTIES FOR ADULTS AND FOR CHILDREN IN THAT FIELD.
           TREATMENTS DIFFERENT, AND THERE IS SERIOUS RISK OF DEVELOPING
           FUTURE HEALTH PROBLEMS WHEN A CHILDHOOD DIABETES IS NOT DEALT
           WITH PROPERLY BY A PROPER PHYSICIAN. THE INSURANCE COMPANY IN
           THIS CASE WAS GAMBLING, IN EFFECT RISKING THIS CHILD'S FUTURE

           HEALTH, FOR THE FEW DOLLARS THAT THEY SAVE BY SAYING, OH, YOU
           HAVE TO GO TO AN IN-PLAN DOCTOR. NOW, AS BAD AS THAT CASE IS --
           AND I WISH IT WERE THE ONLY ONE -- BUT IT IS NOT, MR.
           PRESIDENT. I WAS RECENTLY TOLD THE STORY OF A 14-DAY-OLD BABY
           GIRL. 14 DAYS OLD, THIS PRECIOUS LITTLE CHILD'S HEALTH WAGS
           ALREADY JEOPARDIZED BY HER HEALTH PLAN. AND WHAT DO I MEAN BY
           THAT?
           THIS POOR CHILD WAS BROUGHT TO HER DOCTOR 14 DAYS AFTER BIRTH

           BECAUSE OF A URINEARY TRACT INFECTION. TREATMENT OF THE URINARY
           TRACT INFECTION AT THAT AGE REQUIRES AN EVALUATION FOR URINARY
           TRACT ABNORMALITIES, BUT THE REFERRAL FROM THE PEDIATRICIAN TO
           AN OUT-OF-PLAN SPECIALIST WAS DENIED -- AGAIN SAYING, SERVICES
           ARE AVAILABLE IN-IN, AN IN-PLAN UROLOGIST. WELL, OKAY, IF SHE
           COULD GET THE RIGHT TREATMENT IN-PLAN, THAT'S WHAT H.M.O.'S ARE
           FOR, RIGHT?
           BUT SHE COULDN'T. SHE COULDN'T GET THE HELP, BECAUSE THE

           UROLOGIST THAT THE PLAN WOULD HAVE HAD HER SEE WAS, ONCE AGAIN,
           AN ADULT UROLOGIST. AM I PICKING HERE, AM I JUST BEING PETTY?
           NO. THE PROBLEM LIES IN DISCOVERING AND TREATING URINARY TRACT
           ABNORMALITIES IS VITAL TO PREVENTING SERIOUS AND PERMANENT
           KIDNEY DAMAGE, AND THE APPROPRIATE SPECIALIST FOR SUCH A
           SITUATION IS A PEDIATRIC UROLOGIST. I HAVE WORKING IN MY

           OFFICE, THANKS TO THE ROBERT BYRD FOUNDATION, A PEDIATRIC CARD
           OL JIFMT A PEDIATRIC CARDIOLOGIST IS DIFFERENT FROM AN ADULT
           CARDIOLOGIST. IN OTHER WORDS, IT IS ADULT AND A CHILD ARE
           DIFFERENT AND THEY REQUIRE DIFFERENT SPECIALISTS WITH DIFFERENT
           SKILLS AND IT IS A BASIC AND IMPORTANT FACT. SO SIMPLY TO SAY
           THAT YOU HAVE AN UROLOGIST IN-HOUSE IS NOT TO SAY THAT IF THAT
           UROLOGIST DEALS WITH ADULTURE OL GEE PROBLEMS THAT IT IS
           EFFICIENT -- UROLOGY PROBLEMS THAT IT IS SUFFICIENT FOR A
           14-DAY-OLD BABY GIRL. SO THIS DECISION WAS BASED ON AN H.M.O.

           ON AN ADULT UROLOGIST WITHOUT SPECIALTY TRAINING IN PEDIATRIC
           DISORDERS AND NOT CAPABLE OF CARING SUFFICIENTLY FOR AN INFANT. AND WHY?
           BECAUSE KEEPING HER WITHIN THE PLAN'S NETWORK OF DOCTORS COSTS
           LESS. NOW, I UNDERSTAND BUSINESS, AND BUSINESS IS IMPORTANT.
           BUT THIS BUSINESS OF QUALITY OF HEALTH CARE TREATMENT IS VERY
           SERIOUS AND VERY SCARY, AND THAT'S WHAT WE HAVE TO FOCUS ON,
           WHAT WE'RE THINKING ABOUT WHAT WE'RE GOING TO DO. NOW, THESE

           ARE OUR CHILDREN, THE MOST HELPLESS AND VULNERABLE OF ALL OF
           AMERICAN CITIZENS. THEY HAVE NO WAY OF DEFENDING THEMSELVES.
           THEY DEPEND ON THEIR PARENTS. THEY DEPEND ON THAT YOU ARE
           COMMUNITIES TO TAKE CARE OF THEM. AND THESE PEOPLE IN TURN
           DEPEND ON US HERE IN CONGRESS TO ENSURE THAT THEY ARE NOT TAKEN
           ADVANTAGE OF, THAT GAMES ARE NOT PLAYED WITH THEIR HEALTH, AND
           THE HEALTH OF THEIR CHILDREN. SO THE TIME HAS COME FOR US TO
           PASS A BILL WHICH GUARANTEES CERTAIN COMMON-SENSE PROTECTIONS

           FOR EVERY SINGLE PATIENT IN AMERICA, YOUNG OR OLD, RICH OR
           POOR. THIS LEGISLATION WHICH WE HAVE THE OPPORTUNITY TO PASS --
           AND OBLIGATION I THINK TO ENACT THIS YEAR -- THE PATIENTS' BILL
           OF RIGHTS ACT OF 198 WILL DO EXACTLY THAT. I'M INTERESTED IN
           GOOD HEALTH CARE FOR OUR PEOPLE, MR. PRESIDENT. AND I DON'T
           THINK IT'S A GAME. AND I DON'T THINK IT HAS ANYTHING TO DO WITH
           POLITICS. I THINK IT'S A VERY, VERY SERIOUS CONSIDERATION. I

           THANK THE PRESIDING OFFICER, YIELD THE FLOOR. MR. FORD: MR.
           PRESIDENT?
           
           

           THE PRESIDING OFFICER: THE SENATOR FROM KENTUCKY.
           

           MR. FORD: I ASK UNANIMOUS CONSENT THAT THE SENATOR FROM
           MONTANA, MR. BAUCUS, BE ADDED AS A COSPONSOR OF THE FORD
           AMENDMENT PENDING BEFORE THE SENATE.
           

           THE PRESIDING OFFICER: WITHOUT OBJECTION, SO ORDERED.
           

           MR. FORD: I THANK THE CHAIR.
           

           A SENATOR: MR. PRESIDENT?
           
           

           THE PRESIDING OFFICER: THE SENATOR FROM INDIANA.
           

           MR. LUGAR: MR. PRESIDENT, IN BEHALF OF THE LEADER, I ASK
           UNANIMOUS CONSENT THAT THE SENATE NOW RESUME CONSIDERATION OF
           THE TOBACCO LEGISLATION, S. 1415, FOR DEBATE ONLY UNTIL THE
           HOUR OF
           
           3:00 P.M. TODAY.
           

           THE PRESIDING OFFICER: WITHOUT OBJECTION, SO ORDERED.
           

           MR. LUGAR: I THANK THE CHAIR. MR. PRESIDENT, I SUGGEST THE
           ABSENCE OF A QUORUM.
           

           THE PRESIDING OFFICER: THE CLERK WILL CALL THE ROLL.
           
{END: 1998/06/17 TIME: 14-15 , Wed.  105TH SENATE, SECOND SESSION}