Let me also apologize to you, Senator Nickles, and to the other Senate conferees, because a number of my House colleagues could not be with us today. Many of them took the opportunity to return home when the House abruptly concluded its business yesterday. The House keeps a very odd schedule these days. That may be one of many items worth addressing after the November elections.

Five months have now elapsed since the House passed the bill that is in conference today. Some of us -- Dr. Norwood and myself among them -- have been working on this issue for years. We share the belief that if you pay good money for health insurance, you should get good health care when you need it. The only thing worse than having no insurance is paying for insurance and getting nothing in return.

Although there are wide differences between the House and Senate bills, I remain hopeful that this conference will be a productive one and allow us to send meaningful patient rights legislation to the President to be signed into law.

That will require us to resolve three critical issues.

First, how many people are going to be covered by this legislation? Is every American going to have the same rights in dealing with his or her insurance company? Or do we propose to create one or two or three different classes of citizens?

Second, who will decide what treatment you get and why? Will the decision rest with you and your medical professional, or will it be in the hands of an HMO bureaucrat? When your doctor and your HMO disagree, will you be able to appeal a decision to an independent external review? And will that review have the final say based on medical knowledge or will it be resolved by a narrower definition of medical necessity put forward by the HMO?

Third, as one of my Jesuit teachers once told me, a right without a remedy is no right at all. What happens when an HMO refuses to follow the recommendation of the external review body, and it causes harm or death to the patient? If an HMO is making medical decisions by denying treatment, shouldn’t it be held accountable in the same way we make doctors responsible for their actions?

The staff has already begun work on a small number of the other issues raised in this conference. It is my view that this conference could be concluded rather quickly if we used the bipartisan House bill -- the only bipartisan bill before us -- as the basis for our discussions.