[Congressional Record Volume 140, Number 11 (Tuesday, February 8, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: February 8, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
         TOP 10 IRRELEVANT ARGUMENTS IN THE HEALTH CARE DEBATE

  Mr. KERREY. Mr. President, I would like to respond to some statements 
made earlier by the distinguished Republican leader and the 
distinguished senior Senator from New Mexico. They commended the 
courage of Robert Reischauer, the head of the Congressional Budget 
Office.
  As the health care debate heats up during the next several months, we 
need to be honest with the American people. I have heard several 
arguments lately that I believe are misleading and do not contribute to 
an honest debate on health care. The arguments are irrelevant and do 
not begin to solve the health care problems facing our country. I have 
collected these into a top 10 list of irrelevant health care arguments.


                   1. is there a health care crisis?

  Whether or not there is a health care crisis is irrelevant. We do not 
wait until the majority of Americans suffer a crisis to act. If a 
constituent notifies me of a problem, I act on their behalf. For 
example, the mayor of hastings informed me of a problem with an overly 
strict interpretation of an environmental regulation. I did not respond 
that I could not help him until a majority of cities face the same 
problem. For the city of Hastings, there is a crisis now. I have heard 
from many Nebraskans about health care problems. For them, there is a 
crisis. It does not matter to them whether there is a nationwide 
crisis. They need help now.


          2. I am for/against mandates to pay for health care

  This argument is also irrelevant. We already have mandates in place 
to pay for health care today. The idea that the American people are 
reading op-ed pieces either for or against mandates when I have an 
imposed 3 percent mandate on wages now is an indication of how 
politicians have been misleading the public. This mandate is called the 
part A FICA Medicare tax. Individuals and employers each pay 1.45 
percent of payroll to finance health care.


               3. i am against national health insurance

  We currently have national health insurance. And there is a payroll 
tax used to fund it as discussed in No. 2 above. We call it Medicare, 
but it is national health insurance. You have to be 65 years of age to 
qualify. Understand, I am not advocating extending Medicare for 
everyone, but for politicians to stand up and say they are against 
national health insurance, while supporting Medicare, is a very 
misleading argument. It makes it difficult for us to reach the correct 
solution to the health care problem.


        4. i am against using broad-based taxes for health care

  Although the authors of virtually all the health reform plans, 
including President Clinton, have proclaimed their opposition to using 
broad-based taxes to pay for health care. The fact is we are already 
using broad-based taxes to pay for health care. We need to tell 
Americans, fully 30 percent of your income taxes are being used to 
finance Federal health care spending. Not only are individual income 
taxes being used, but corporate income tax, payroll taxes, and property 
taxes finance health care today. By stating that we don't want to use 
broad-based taxes to pay for health care, we are avoiding a very 
important question, How are we going to pay the bills?


                 5. i do not pay for health care today

  Many individuals and companies believe that they do not pay for 
health care today simply because they do not purchase insurance. In 
reality, as I already discussed, because a great amount of tax dollars 
are used to pay for health care, everyone is paying for health care 
today. We need to have an honest discussion on how we should be paying 
for health care so that everyone understands how much and in what 
manner they are paying.


          6. i am against a government takeover of health care

  As is made clear by argument No. 4, there is already substantial 
Government involvement in health care. The Government pays $450 billion 
out of the $700 billion of non-out-of-pocket health care expenditures 
in the United States in 1993. The question we should be debating is, 
What is the proper role for the Government? That is the question we 
need to address.


       7. UNINSURED AMERICANS ARE CAUSING THE HEALTH CARE PROBLEM

  We should not be focusing on the problem of the uninsured--the 
problem is that health care costs have risen to a point where you have 
to be insured for routine health services. The best example for me is 
that in 1974 and in 1976 when my children were born, I paid for the 
costs out-of-pocket. I did not have to be insured to have a baby. It 
now costs $6,500 for a 2-day normal delivery of a baby in Nebraska. The 
median family income in Nebraska is $18,000 per year--therefore it is a 
financial catastrophe to have a baby in Nebraska without health 
insurance. The problem is that the cost of health care has grown to a 
point where people of average means live in constant terror that they 
will have to encounter the health system. It is not just preexisting 
conditions, it is not just the lack of portability, it is the overall 
costs of health care have become extreme.


        8. REFORMING THE HEALTH CARE SYSTEM WILL CAUSE RATIONING

  There is already rationing in today's health care system. The hardest 
thing we have to deal with in health care is that at some point we 
ration care. There are very few Americans that can afford the $175,000 
that it costs, on average, to receive a bone marrow transplant for 
breast cancer. I heard earlier this week from clinical researchers and 
oncologists that rationing already exists when it comes to patients 
receiving the newest treatments. Both patients and insurers have to 
face the reality that certain procedures and treatments are very 
expensive and cannot be given to everyone. What we need to debate is 
how to set up a system where the resources are allocated in the 
fairest, most humane way.


           9. I SUPPORT A PURE COMPETITIVE HEALTH CARE MARKET

  Many today argue that the country's health care problems can be 
solved solely through the market. However, there have been so many 
interventions that there is no longer a competitive health care market. 
For example, there are licensing restrictions that limit the number and 
types of providers. Patent laws protect new drugs. The tax system 
subsidizes the purchase of health insurance and many health care 
industries are tax exempt. Although using the market can help us solve 
the current health care problems, we need to look more deeply at 
current practices that hinder competition.


  10. ISSUING A HEALTH CARE CARD WILL GUARANTEE HIGH QUALITY CARE FOR 
                                EVERYONE

  I support simplified eligibility for health care, however, simply 
issuing a card will not guarantee high quality care. The ability to 
receive high quality care is tied to ability to generate wealth, both 
individually and as a country. We all know that individuals who are 
wealthy do not worry about high quality care because they have the 
personal resources to pay for it. What is true for the individual is 
true for the Nation. Our capacity as a nation to afford high quality 
care, will in the end, depend on our ability to generate additional 
wealth. We must continue to focus on education and job creation which 
improve our country's wealth as we work to reform the health care 
system.
  In conclusion, I believe it is time to tell the truth to all 
Americans. When everyone is operating in an open and honest 
environment, we will be able to reform our health care system and begin 
to create a healthier America.
  Mr. President, I essentially identify what I consider to be the top 
10 irrelevant arguments on the issue of health care. The fact of the 
matter is that the American people say there is a crisis in health 
care.
  We recently heard--my latest irrelevant argument--is there not a 
crisis? There is not a crisis for us who have our health care taken 
care of, but for an increasing number of Americans, indeed a majority 
of Americans feel like they are on this thin ice where if almost 
anything happens in their life, they will find themselves medically 
indigent.
  The most courageous individual in the health care debate right now is 
the President of the United States who has introduced a very specific 
piece of legislation and has put himself at risk as a consequence and 
has indicated to all--there is only one indivisible principle that he 
has, only one principle he says that if it is not included in the 
legislation, that he is going to veto it, and that is health care 
legislation must be 100 percent universal. That is to say every single 
American has to be covered.
  I am here to say that we have a lot of work to do to enact a piece of 
legislation. I think the CBO report is useful, in fact. It does give us 
an indication of what can be on- and off-budget. I share those who say 
Mr. Reischauer was courageous in stating his honest opinion of the 
impact of the President's legislation. But if we are going to get 
universal coverage, if we are going to enact a piece of legislation, 
then we are going to have to stop all the irrelevant arguments that I 
hear over and over and over.
  For example, one of the irrelevant arguments is, should we or should 
we not have a mandate? Mr. President, we already have a mandate in 
place. Every employer pays a tax of 1.45 percent of their payroll, 
every employee pays a tax of 1.45 percent of their wages. It is 
mandated and in place right now. It goes for part A Medicare, and guess 
what part A Medicare really is? It is national health insurance. The 
only catch is, you have to be 65 before you are eligible.
  So if you walk down on the floor here and say you are against a 
mandate, if you walk to the floor and say you are against national 
health insurance, it must inescapably follow that you are against 
Medicare. That is not what is going on.
  I hear people say, ``I'm against a big Government takeover of health 
care.'' And $450 billion this year will be collected in taxes and used 
to pay for health care--Government health care, Mr. President. If you 
are against a big Government takeover of health care, then for gosh 
sakes, identify what part of the Government you want to stop; where do 
you want to get Government out?
  I think there is an emerging consensus in this body that begins by 
saying that there is a crisis; that this system is broken and it needs 
to be fixed. I believe that there is a bipartisan consensus to do just 
that. The President of the United States has not polarized the debate 
by indicating that he is unwilling to compromise. Quite the opposite. 
He has merely said that he wants to be able to go to bed at night, as I 
do, secure in the knowledge that every single American is covered. We 
can do that, Mr. President, I believe by focusing on those things that 
are indeed broken.
  I would like to suggest four things we need to fix in a couple of 
minutes and then I will let the distinguished Senator from 
Massachusetts jump in. He is looking at his watch. I will try to give 
him enough time to talk before the vote.
  Mr. President, the four things to me are, number one, the insurance 
system is broken. Indeed, the President needs to be given a great deal 
of credit for bringing the insurance companies to the table and saying 
they are willing to fix preexisting conditions, they are willing to end 
the problem of portability, they are willing to end the skimming going 
on today in the system, a system that provides an incentive only to 
insure those who are healthy. We need to fix what is wrong with the 
insurance system.
  Second, our Medicaid system is broken, and I would identify that as 
the second most important thing we need to do.
  Third, if we really want to move from a Government-controlled system, 
which we have today, to a more market-oriented system where individuals 
are more in control of making decisions about price and quality, then 
there are a number of things that we are going to have to change in our 
tax system.
  Fourth, I believe there are a whole series of things that I identify 
as coming under the heading of accountability. Our system is 
unaccountable. We have an unaccountable system when we collect money in 
Washington; we have an unaccountable system when an individual goes 
into a hospital; we have an unaccountable system when an individual 
finds themselves not able to get payment for something troubling them; 
we have a very unaccountable and difficult system.
  I came here to say that I appreciate that the Republican leader and 
the distinguished senior Senator from New Mexico recognize the courage 
of Mr. Reischauer, but I hope they also recognize the courage of the 
President of the United States for pushing this issue to a point 
wherein if we do the work and stop the irrelevant arguments, we have 
the potential of being able to reform and enact legislation this year 
that will indeed extend coverage to every single American.
  I thank the Chair and yield the floor.
  Mr. KENNEDY. Mr. President, how much time remains?
  The PRESIDING OFFICER. Two minutes eleven seconds.

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