[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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