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JIM LEHRER: And now to two key senators involved in this debate: Edward Kennedy, Democrat of Massachusetts is a lead sponsor of the Democratic bill; Don Nickles, Republican of Oklahoma, is the assistant majority leader, and he heads the Senate Republican Task Force on Health Care Quality. Sen. Kennedy, why is your way the best way to go?
SEN. EDWARD KENNEDY (D-MA): Well, first of all, let’s put this issue in some perspective. What we are attempting to address are the kinds of abuses which exist in our health care systems, particularly with HMO’s. In too many instances managed care means mis-managed care. And the basic core of our bill is to make sure that medical decisions that are affecting the families of America are going to be decided by doctors and not bureaucrats or accountants for the major insurance industry. That’s basically at the heart of our bill. We believe you ought to put the patient’s interest first, not the profits of the HMO first, and that is a very basic and fundamental difference between our proposal and the Republican proposal.
JIM LEHRER: Sen. Nickles, do you agree that that’s a basic fundamental difference? Sen. Nickles? I’m sorry. Do you hear me? Sen. Nickles, do you hear me? Sen. Nickles, you do not hear me.
SEN. DON NICKLES (R-OK): I know you’re asking me a question. I couldn’t hear a word. But-
JIM LEHRER: Do you agree with what Sen. Kennedy said was the basic difference? Do you hear me now?
SEN. DON NICKLES (R-OK): Yes, I hear you fine. I think there are very significant differences, and I have great respect for my colleague, Sen. Kennedy. We have a different approach. I think his approach would be very, very expensive. The cost of it would go in an insured category. I don’t want to do that. What we try to do with our approach is give patients that are unprotected protection. There’s about 48 million Americans that aren’t covered by state laws. We’ll give them protection under federal, called ERISA, so we’ll do that. But we don’t want to drive up health care costs. Under his bill you might call it the lawyer’s right to bill. It gives 59 different causes of action for expanded litigation in the health care field. Also, they can sue not only HMO’s but also employers, and if they do that, the net result is a lot of employers are just going to drop these health care plans. They’re going to say, thank you very much, but I’m not going to be liable for that kind of exposure and have health care costs, which are already projected to go up about 5 percent, add that another 4 percent if we pass the Democrats bill, that’s a 9 percent increase in health care costs. It costs about an extra $500 per year, per employee. Employers can be dropping plans if that’s the case. So we came up-instead of this big excuse for litigation-we came out and said, let’s get people get health care they need so they can appeal, they can appeal internally to a physician that hasn’t been working on the case. If they’re not satisfied then, they can go to an external appeal. A physician is not even related to the case, not connected with the company in any way, shape, or form. So they can get action on the health care that they’ve been denied, not get tied up in the courts for an unbelievable period of time.
JIM LEHRER: Do you agree with Sen. Kennedy that there is a problem with-I mean, that something has to be done? In other words, the disagreement is over how to do it, right?
SEN. DON NICKLES (R-OK): Well, a basic disagreement, and when we found that 48 million Americans are not covered by state plans, we felt like they should have some basic protections, and so we put that in, and then we said, well, wait a minute, those protections should apply to everybody, so our bill-when the Democrats said yours only applies for 48 million is not true. Our bill apples to every employer-sponsored plan. We give every one of those plans the right of appeal, both internal appeal and external appeal. We think that’s a giant step in the right direction. And we also did a lot of other things. We put in some provisions to improve quality health care. We put in provisions to help women as far as some of those particular health issues that are particular to them. We reauthorized things. We put in health care quality research, so we’re trying to improve health care quality, not just drive up expenses and help the trial lawyers.
JIM LEHRER: Sen. Kennedy, yes, sir, go ahead.
SEN. EDWARD KENNEDY (D-MA): If I could make a quick response.
JIM LEHRER: Sure.
SEN. EDWARD KENNEDY (D-MA): It’s interesting that the doctors in this country support our program and the nurses support our program. And the 170 health professional and patients organizations support our program. And it’s interesting, the doctors and the nurses are not great fans of the trial lawyers, and they supported this program because they know that a right without a remedy is no right at all, and they know the importance of having accountability in these programs.
Now, secondly, the Republican program only covers 48 million Americans. It doesn’t cover the other over 100 million Americans that needs these protections. There’s a very basic and fundamental gap that the Republican program refuses to address. And beyond that, even within their program, they’re still permitting the insurance companies to call the tune, because they are not permitting the ultimate judgment decision on health care to be made by the doctors and the patients. They’re not permitting that.
They’re not encouraging that. They’re not writing that into law. And that is what is absolutely essential. You have to have that kind of protection. Furthermore, in the Republican program they are not guaranteed the kind of specialty care for a child that has cancer. They’re not permitting women that need the OB-GYN and gynecological services to have specialists as primary care physicians They are not permitting the clinical trials, which are so important.
And they are also effectively refusing to permit the states to make the judgment on calling for accountability. For example, in Mr. Nickles’ own state of Oklahoma, county and state employees can sue for accountability. And they have tax paid health insurance. And I wonder why Mr. Nickles is so opposed to permitting a farmer in Oklahoma or small businessman or woman or a worker in Oklahoma the same kind of protections in Oklahoma that they are giving to the county and state officials.
JIM LEHRER: Let’s start there and go back up, Sen. Nickles. Let’s start there and go back through Sen. Kennedy’s point.
SEN. DON NICKLES (R-OK): Well, let me just make a couple of comments. One, Sen. Kennedy talks about states rights, but he really believes that the federal government should run health care-
SEN. EDWARD KENNEDY (D-MA): We’re leaving this to the state.
SEN. DON NICKLES (R-OK): And the federal government should run insurance. The states regulate insurance, not the federal government. Frankly, the federal government is not doing a very good job even managing Medicare. We told the federal government last year to get Medicare information to the 38 million Medicare beneficiaries. They’ve done that to 5 million people. We told ’em to put in a hot line or toll free telephone line. They haven’t done that yet. So they’re doing a crummy job in many cases of doing what we told them with Medicare. The private sector is regulated by the states and Sen. Kennedy wants the federal government to do it all, and the federal government is not doing a very good job. And now concerning states, Senator Kennedy’s state has 24 mandates. Oklahoma has 24 mandates, some of which are covered by the federal-are identical to the federal proposal, not all of it. But some of us don’t really think the federal government should be micromanaging this from Washington, D.C.. We don’t think the federal government did a very good job.
JIM LEHRER: Is that the heart of the argument from your point of view, Sen. Nickles?
SEN. DON NICKLES (R-OK): I think so. That’s exactly right. And with all due respect to my colleague from Massachusetts and the president, they want the federal government to run health care. They want it to run the insurance industry. They want the federal government to be micromanaged. They didn’t win a couple of years ago when they tried to national the health care industry. They failed in Congress, so now they’re trying to do it with a great title, the Patients’ Bill of Rights, a great title, but really what you should call it is a lawyer’s right to bill, because basically that’s what it would do. It would just be turning this over to the trial lawyers. And health care costs would explode. And as a result of that, millions of people would lose their health insurance.
SEN. EDWARD KENNEDY (D-MA): Well, the fact is that the bureaucracy that is out there, Jim, is the insurance industry bureaucracy. They’re the bureaucracy that’s out there. They’re the ones, the HMO’s that are making the decisions denying care. It isn’t the federal government today. It is in the insurance industry, number one. Secondly, we believe that the states ought to be able to make the judgments and decisions about the enforcement on a liability. Mr. Nickles still has not answered the question of why county and state employees in the state of Oklahoma can sue, and workers or farmers cannot.
JIM LEHRER: But what about-
SEN. EDWARD KENNEDY (D-MA): Let me just mention this point.
JIM LEHRER: All right.
SEN. EDWARD KENNEDY (D-MA): There are 23 million Americans that have the protections, the liability protections, the accountability protections that I would permit the states to make their judgments on. We leave this up to the states. There are 23 million Americans that have that protection now. It’s working. There premiums aren’t any higher. The CBO has made the judgment now-
JIM LEHRER: That’s the Congressional Budget Office.
SEN. EDWARD KENNEDY (D-MA): The Congressional Budget Office says that it’ll amount to about $7 a month, of which $2 a month would be paid by the worker. It seems to me that those workers would like to have that kind of insurance to make sure that they’re going to get the best of the health care instead of additional kinds of profits to make up for the HMO’s.
JIM LEHRER: Just make sure that we-and I don’t want to over-simplify this, but what you’re saying, Sen. Kennedy, is that all of these protections will not be there unless there is a federal law enacted, is that correct?
SEN. EDWARD KENNEDY (D-MA): I believe that we ought to protect the child, whether the child lives in Florida, Mississippi, or Massachusetts. And I think they ought to have those kinds of protections. The states are not providing the protection. We ought to establish a floor. The states want additional kind of protections. They ought to be there. But we have some responsibility to make sure that these decisions are going to be made for the interests and the health of those children and not for the profits of the industry. That’s at the heart of the issue.
JIM LEHRER: And, Sen. Nickles, you believe that these protections can be there without the federal government passing a law and mandating them down the list.
SEN. DON NICKLES (R-OK): Jim, what we try to do is we try and protect the unprotected. Most are protected by state plans. And what Sen. Kennedy’s trying to do is say no we want the federal government to do it all, and the federal government is doing a crummy job right now with Medicare.
JIM LEHRER: How would the federal government do it all under Sen. Kennedy’s bill?
SEN. DON NICKLES (R-OK): Under Sen. Kennedy’s bill-has a whole list of mandates and states you have to do it-you do it as we see fit. This is a bill-not a bill of rights-it’s Kennedy’s bill of mandates. There’s 359 federal mandates in Sen. Kennedy’s bill that will greatly increase health care costs, and it’s basically telling the states you can’t do it, we know best, government knows best, Washington, D.C. knows best, we’re going to tell you how to do it, as if there’s no response. You know, states you can’t do it. Now Sen. Kennedy’s state has not even applied with a bill that we passed last year, the so-called Kassebaum-Kennedy bill. It’s one of five states that still hasn’t complied, and I don’t know why they haven’t but my point being we shouldn’t try and micromanage from the government trying to say that we can do better. What we try to do in our bill is protect those people who are not under state law, and then we offer every plan, not just 48 million Americans, for every plan in America we say everybody has a right to an appeal, internal and external appeal, so they can get their health care decisions made when they need it so they can help their kids and their family get those health care decisions, not go to court and have to wait two, three, four years to get a decision by a trial lawyer.
SEN. EDWARD KENNEDY (D-MA): Now Sen. Nickles mis-states our legislation and then differs with it. That’s a tried and tested mechanism here in the United States Senate. If you look at the various kinds of protections we’re talking about is not to permitting an HMO to let someone drive by an emergency room when there’s an emergency room there and emergency necessary, to permit gynecological and obstetric services as primary care–very important to women, obviously-to encourage clinical trials-that is very important-to eliminate the gag rule-what specifically are you complaining about on the ones I’ve mentioned so far? Those are five of the protections. Which of those do you object to?
SEN. DON NICKLES (R-OK): Well, I just mentioned that everyone Sen. Kennedy mentioned-for example, in the gag rule 44 states have done it, the other states are considering it, but the gag rule is not really necessary. Thirty some states are doing in the emergency room-what we do is we put in and make sure those protections are available for plans that aren’t-
SEN. EDWARD KENNEDY (D-MA): Let me mention just on the gag rule-this is just for one minute-they say they eliminate the gag rule, but you know something else, in every one of the HMO agreements the head of the HMO can fire any doctor-do you hear that-can fire any doctor-so the one hand-under your bill we can say we eliminate the gag rule, but unless you prohibit the-
JIM LEHRER: We have to go.
SEN. EDWARD KENNEDY (D-MA): –to fire that doctor, it’s an empty-it’s an empty right.
JIM LEHRER: Sen. Nickles, what’s going to happen to this issue in the United States Senate?
SEN. DON NICKLES (R-OK): We’ve offered to bring it up this week. We still haven’t got an agreement from our Democrats to have the amount of time, the fair amount of time to consider both proposals, but my guess is before we leave for the office break that we will pass not the Kennedy bill, but I think we’ll pass a bill that Republicans have worked on for the last seven months. I think it’s a good bill, and we’ll go to conference without it.
SEN. EDWARD KENNEDY (D-MA): I’m hopeful that we can find a bill because it’s important to the American people that we find one together.
JIM LEHRER: Gentlemen, thank you very much.