[Congressional Record Volume 140, Number 10 (Monday, February 7, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: February 7, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                           HEALTH CARE REFORM

  Mr. DURENBERGER. Mr. President, as the current Presiding Officer and 
a colleague who is seated here from Pennsylvania and some others who 
have been very active in health care reform know, I have been at it for 
quite some time and do not necessarily hold myself out as the best 
judge of the politics of health care reform. But I have been sort of 
smiling all weekend about the events of the last 2 weeks.
  I must say it was sort of slow in the health care reform business 
during December and January because there were not many politicians 
around this place, but once we all got back together again the media 
started focusing on what we said about health care reform or what we 
said about each other. It became sort of an interesting 2 weeks.
  But I must say I think the assessment from the so-called media pros 
about who is ahead or who is winning and that sort of thing sort of 
misses the mark. If I can guess at what I have been sensing here about 
the weekend, they said the first week of this new term belonged to the 
President because in a strong State of the Union Message, he touched 
the people of the country on the issue of health care reform and got 
the whole thing back on track.
  But then in the second week, with sort of the politics of 
vilification and one specific plan other than the President's plan, 
they said, well, now he is weak. Somehow, last week President Clinton 
got strong; this week President Clinton got weak because these groups 
came out and did not endorse his bill.
  Let me say, Mr. President, why this makes me smile a little bit. I 
think it is, first, because there is such an issue of personality in 
all of the politics of reform. All of a sudden, Jim Cooper cannot go 
anywhere without having something stuck in his face and asked his 
opinion, and yet, as the current Presiding Officer knows, there are a 
lot of us who are champions of the same approach as Jim Cooper. But 
there is sort of a sense of let us personalize this one as we 
personalize the Clinton plan around the President or around the 
commitment that the First Lady has made to it.
  That is the first observation. The politics of personalizing reform 
does not always lead you to the best answer.
  The second observation I make is that one of the weaknesses, if you 
will, in the Clinton plan is in its comprehensiveness. Many people 
characterize the Clinton plan as 800 movable parts.
  When I look at it, I say here is an effort by the President to try to 
solve all of the problems that are involved in health policy in this 
country--or lack of policy in the country--all done in one big, 1,320-
some page bill.
  So I think right there is sort of a weak link, the fact that the 
President wants us to do insurance reform, changing all the insurance 
market rules, substituting something called an accountable health plan. 
The President wants to do system reform. He recognizes that until the 
delivery system in health care changes in this country, we are not 
going to get costs under control, we are not going to have higher 
quality, and we are not going to be able to afford universal coverage.
  Then the third part of it is how do we do universal coverage? Do we 
do it by mandating coverage on employers or individuals or do we do it 
by actually reforming the policies, the public policies that make 
coverage affordable for everybody in this country?
  The Cooper approach, of which John Breaux and I are the principal 
sponsors in the Senate, is often characterized as ``Clinton lite.'' The 
reason it is characterized as Clinton lite is that it does understand 
reform. It does system reform, and it begins the process of coverage 
reform on the way to universal coverage.
  So what it is, in effect, is the Clinton proposal but without the 
immediacy of universal coverage by employer, or, in the case of the 
Republican bill, individual mandate.
  We do the insurance reform, we do the system reform, and we move in 
the direction of universal coverage through coverage reform.
  So I guess what I rise to say today is that the notion that somehow 
the President has been weakened by the Business Roundtable 
endorsements, by the position of the National Governors' Association, 
the position the Chamber of Commerce did or did not take, the AMA did 
or did not take, is not true. I think, in fact, that much of the 
President's proposal has been strengthened, first by the President 
himself when he put the lie to the fact that there was no crisis in 
this country; he backed off, I think, even some Republicans from that 
notion, hopefully; but, in addition to that, strengthened those parts 
of the Clinton plan that are committed to changing the way health care 
is delivered in this country by changing the way we buy health care in 
this country, which are the two critical elements on our way to 
universal coverage.
  What it means, Mr. President, is we are much closer together today on 
health care reform than we were 2 weeks ago. We can agree on the way in 
which we change this system through insurance reform. We have already 
agreed on that in most of our bill. We can agree that we are going to 
take that system reform a step farther by developing rules, national 
rules, for health alliances or buying groups, accountable health plans, 
which is the substitute for health insurance as we know it, basic 
benefit package, that sort of thing; national rules where the things 
that make a difference in this health care marketplace, and then one 
local market at a time, in southern Illinois, in northern Minnesota, 
each market operates differently within these national rules.
  We begin to change the rewards in the system, to reward the best, 
those who give us the highest value for the lowest possible price. We 
do not tell them exactly how to do it. But we set in place these new 
rules. We have President Clinton and the First Lady to thank for that.
  So the notion that seems to be abroad--I must say is fostered by one 
or the other of our colleagues who continue to attack anyone who does 
not support the Clinton plan in its totality --the notion that somehow 
the President's plan was weakened last week, I say as someone who has 
been at this for the 16 years I have been in the Senate, is the 
opposite from the truth. Because I think the heart of the President's 
approach, changing this system whose costs are strangling us today, was 
strengthened last week.
  I want to take this just one step farther and tell you exactly why it 
was strengthened by the Governors. The Governors said, if you folks go 
out of here in 1994 and you have not given us some national rules for 
this health care system that are different from the ones we have today, 
which are the more you do, the more you get paid--we do not care about 
what; we do not care about costs--change those rules. And then in our 
local markets you are going to see a lot of change. If you do not go 
out here and do that, we will end up doing it State by State and you 
probably will not like the way it is done if we do it State by State.
  The Business Roundtable, National Association of Manufacturers, and 
all the rest of these people join in saying the leaders in health care 
reform in America have been the employers. They are not just the bill 
payers; they are the leaders in reform.
  Everywhere you go in this country you see markets changing in 
medicine, you see the practice of medicine changing, you see insurance 
in the indemnity sense leaving the marketplace, and a more accountable 
health plan joining the marketplace. It is because the large employers, 
small employers, coalition of employers, have come together to say this 
community health care system can do better for its people than it is 
doing now and we want to assist our employees in making that happen.
  The people of the Business Roundtable and, I know, the people at 
these other organizations represent all the communities in America that 
have already been trying through their employer and employee groups to 
change this marketplace.
  So my bottom line, Mr. President, is I think health care reform is 
stronger today than it was last week. I think the best parts of the 
Clinton plan are stronger today by the endorsement of people who 
actually have been out there changing these systems than it was last 
week.
  I just hope that those who would either characterize the endorsements 
of other plans yesterday or last week as defeat for the President would 
rethink it. You can find Jim Cooper in the Bill Clinton plan. You can 
find Jim Cooper in the John Chafee Republican plan. There is a broad 
consensus in the middle of this and the House of Representatives for 
what it takes to do health care reform.
  But unfortunately, some of that consensus was labeled ``Clinton,'' 
some of it was labeled ``Cooper''--personalities--and some of it got 
labeled Chafee--the personalities--so we do not recognize them for 
their similarities. We recognize them for the personalities of their 
authors, and that is too bad. I just hope my colleagues and the people 
in the White House, the administration and so forth, who worked an 
awful long time on health care reform will recognize that reform is 
better off today, getting stronger every day, than a week or two ago.
  I say to those on either edge of this debate, my colleagues who are 
single-payer advocates, my colleagues who are advocates of, you know, 
let us just make everybody pay the first $3,000 of their medical bills, 
will give the folks in the middle of this process, Bill Clinton, 
Hillary Rodham Clinton, Jim Cooper, John Chafee, Dave Durenberger, John 
Breaux, Republicans and Democrats alike, Harris Wofford--people in the 
middle of this thing who really want to do health care reform in 1994--
the Governors, give us a chance. Give us a chance.
  Look at the middle. Look at the things that we have in common. Look 
at the things in which there is very little disagreement. Make us 
settle our differences. Make the Republicans in the middle get together 
with the Democrats in the middle, get together with the President in 
the middle, and let us get on with it. It is not that hard.
  I think one of the difficult issues will be how do we get the 
universal coverage. As someone who served on the Finance Committee all 
of the years that I have been here, I think we know why that is. We are 
currently spending $400 billion in public subsidies for employed 
persons, the elderly, and low income in this country. We are spending 
it with rules made in 1954, the tax rules, and 1965, the Medicare-
Medicaid rules. They are all outdated. They are not buying good health 
care. They are not doing good coverage of the elderly, disabled, low-
income or poor people. They are either buying too much health insurance 
or not enough health insurance. They are either buying the wrong kind 
of services or too expensive services or unneeded services. They are 
antiquated. They are broken. We ought to throw them out and start over.
  We do not do that naturally, literally, because we have in our 
communities examples of how we can get the universal coverage by making 
it possible to change the public subsidies so that those subsidies 
finance the premiums on account of a health plan. If the elderly and 
disabled in America are able to buy an accountable health plan instead 
of buying part A, part B, supplemental, cancer, heart insurance, and 
then getting reimbursed reasonable and customary, and deluged in 
paperwork, wow, we fix that.
  If the low income could go to work in America with a substantial part 
of their premiums for accountable health plans paid, it would be so 
much less expensive for employers to have to subsidize those plans as 
well.
  The key is the accountable health plan. The key is putting the 
subsidies in some order that makes some sense according to age and sex, 
if you are elderly or disabled, according to income if you are not so 
well off. It is not that hard.
  But we need to get about that. I think that is the critical part. 
That is the part that will take us to universal coverage.
  So, in summary, Mr. President, what do you say the message of this 
week is? It is simply let us get on with it. There is change taking 
place in health care in all of America. What it needs is a sense of 
direction. And that is what you and I and the rest of this place are 
about. Give it a sense of direction. Do not tell it how to get there, 
but give it a sense of direction and you will get the markets to 
respond.

  This is the week that CBO is going to come out with its estimate, and 
there will be another brouhaha over whether or not the Clinton plan is 
fully funded. I suspect CBO will say it is not fully funded. Then 
people will say, well, there is another defeat for the President. Not 
at all. Remember, the President is trying to do everything in one bill 
in 5 years, and it probably cannot be done.
  The opportunity that is presented by the CBO estimating process is to 
get inside the $400 billion we are now spending in public, taxpayer 
money to subsidize this system and change the way we do it, so we can 
make health care access affordable for every single American through 
some kind of a public subsidy, tax subsidy, social insurance subsidy, 
employer subsidy, or insurance reform.
  I am convinced by the many years of experience I have had in 
Minnesota that it can be done. It cannot be done if the chairman of the 
Business Roundtable is to be vilified. He was not responsible for the 
position they took. Business people all over America are responsible 
for it, who have been changing their own communities and health care 
and are the ones who said the strongest part of Clinton is the Cooper, 
or the Cooper part of Clinton. It was not the president of Prudential, 
who happened to be the chairman of the Business Roundtable at a time 
when all of the other members of the Roundtable are saying there is a 
better way to do it. It is contained inside the Clinton plan.
  So, Mr. President, I am very excited by the opportunity that we all 
have been presented with by President Clinton and Mrs. Clinton taking 
on the challenge of health care reform. I am excited that so many of 
our colleagues accepted that challenge, or created their own 
approaches, or endorsed approaches of others. I am most excited that we 
are now going to get it done in 1994. We are not going to put it off 
because it is too difficult, or because there is no crisis, or because 
the Republicans do not agree on all of the details, or because the 
Democrats do not agree on all of the details. The consensus, as in most 
things, lives in the bill, and I hope that as soon as possible the 
folks that are in the middle can get their act together so that the 
folks on either side who may be waiting for them to fail can join them 
and join the President in guaranteeing that every American will never 
have to, in the future, go without the security of access to needed 
health care and medical services and long-term care service in this 
country.
  Mr. President, I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. CHAFEE. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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